Secondary Responses to Altered Acid-Base Status: The Rules of Engagement
Abstract
Each of the four canonical acid-base disorders expresses as a primary change in carbon dioxide tension or plasma bicarbonate concentration followed by a secondary response in the countervailing variable. Quantified empirically, these secondary responses are directional and proportional to the primary changes, run a variable time course, and tend to minimize the impact on body acidity engendered by the primary changes. Absence of an appropriate secondary response denotes the coexistence of an additional acid-base disorder. Here we address the expected magnitude of the secondary response to each cardinal acid-base disorder in humans and offer caveats for judging the appropriateness of each secondary response.
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ABG interpretation can be challenging and subject to human error, especially in time-pressured critical care scenarios.
“However, ABG interpretation can be challenging and subject to human error, especially in time-pressured critical care scenarios2.”
From Structural error asymmetry and harm-weighted analysis of ChatGPT versus ICU Physicians in acid–base interpretation: a prospective observational study (2026) · cites this paper as [2]
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Physiological Approach to Assessment of Acid–Base Disturbances
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“This structural decomposition analysis goes beyond previous reports attributing errors solely to arithmetic miscalculation 2 .”
- Authors
- Adrogué, H. J., & Madias, N. E.
- Affiliations
- Houston Methodist (US)
- Tufts University (US)
- Corresponding author
- Adrogué, Horacio J.
- Venue
- Journal of the American Society of Nephrology
- Published
- 2010-06
- Volume
- 21
- Issue
- 6
- Pages
- 920-923
- ISSN
- 1046-6673 (ISSN-L)
- OpenAlex
- W2137120995
- Cited by
- 91
- References
- 32
- Citations by year
- 2026: 7 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 3 · 2020: 6 · 2019: 7 · 2018: 7 · 2017: 7 · 2016: 4 · 2015: 10 · 2014: 2 · 2013: 9 · 2012: 9
- FWCI
- 5.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Society of Nephrology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Renal function and acid-base balance
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Physical Sciences › Earth and Planetary Sciences › Oceanography › Ocean Acidification Effects and Responses
- Keywords
- acid-base balance, acid-base disorders, carbon dioxide tension, plasma bicarbonate, respiratory compensation, renal compensation
- MeSH terms
- Acid-Base Equilibrium, Acid-Base Imbalance, Acidosis, Acidosis, Respiratory, Bicarbonates, Carbon Dioxide, Humans, Time Factors, Hypocapnia
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