What Is Respiratory Compensation?

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  • Written By: Mary McMahon
  • Edited By: Nancy Fann-Im
  • Last Modified Date: 05 November 2019
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Respiratory compensation is an adjustment to breathing rate to address abnormal blood pH. This provides an immediate way for the body to address dangerously alkaline or acid blood levels while waiting for the kidneys and other organs to kick in and stabilize the blood pH even further. This is most commonly seen in hospitalized patients who have severe health problems leading to metabolic acidosis or alkalosis. In the case of patients on ventilators, care providers need to remain alert to blood pH levels so they can adjust the ventilation to keep the patient within a safe range.

Patients who breathe slowly have difficulty clearing carbon dioxide, leading to a fall in blood pH. Comas, blood overdoses, and some forms of shock can cause a decrease in respiratory rate and contribute to metabolic acidosis. Other patients may hyperventilate, making the blood more alkaline by quickly expressing carbon dioxide. The change in blood pH will trigger the body to attempt to adjust the respiratory rate to compensate, and the kidneys will also start working on stabilizing the pH levels.


In cases of high pH, respiratory compensation involves breathing more slowly to raise the acidity of the blood by retaining carbon dioxide. Patients in a state of metabolic acidosis breathe more quickly to express carbon dioxide. Both forms of respiratory compensation can be observed by care providers who may notice changes in a patient's respiration rate that coincide with blood pH levels. Patients who cannot breathe independently may need adjustments to their ventilator settings to provide respiratory compensation.

Acid-base disturbances in the blood can become a serious medical issue and occur in conjunction with a variety of health problems. Care providers can use quick finger-stick tests to check on the acid-base level in the blood and determine if a patient needs interventions. They may also assume that the blood pH is abnormal on the basis of the patient's condition, behavior, and symptoms. A patient being treated for an opiate overdose who is breathing slowly, for example, probably has acidic blood and needs treatment to address it.

Care providers must be attentive during anesthesia and mechanical ventilation, as the patient's blood pH can be disturbed if the equipment is not set correctly. Patients who cannot breathe on their own may already have health problems, putting them at risk of dangerous pH levels, and doctors must determine what level of respiratory compensation would be appropriate for a patient's needs. General ventilation guidelines provide specific directions on how to adjust the equipment to address concerns about acidic or alkaline blood.


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