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Describe How The Kidneys Respond To Respiratory Acidosis

Merck And The Merck Manuals

Merck And The Merck Manuals

Acidosis is caused by an overproduction of acid in the blood or an excessive loss of bicarbonate from the blood (metabolic acidosis) or by a buildup of carbon dioxide in the blood that results from poor lung function or depressed breathing (respiratory acidosis). If an increase in acid overwhelms the body's acid-base control systems, the blood will become acidic. As blood pH drops (becomes more acidic), the parts of the brain that regulate breathing are stimulated to produce faster and deeper breathing (respiratory compensation). Breathing faster and deeper increases the amount of carbon dioxide exhaled. The kidneys also try to compensate by excreting more acid in the urine. However, both mechanisms can be overwhelmed if the body continues to produce too much acid, leading to severe acidosis and eventually heart problems and coma. The acidity or alkalinity of any solution, including blood, is indicated on the pH scale. Metabolic acidosis develops when the amount of acid in the body is increased through ingestion of a substance that is, or can be broken down (metabolized) to, an acid—such as wood alcohol (methanol), antifreeze (ethylene glycol), or large doses of aspirin (acetylsalicylic acid). Metabolic acidosis can also occur as a result of abnormal metabolism. The body produces excess acid in the advanced stages of shock and in poorly controlled type 1 diabetes mellitus (diabetic ketoacidosis). Even the production of normal amounts of acid may lead to acidosis when the kidneys are not functioning normally and are therefore not able to excrete sufficient amounts of acid in the urine. Major Causes of Metabolic Acidosis Diabetic ketoacidosis (buildup of ketoacids) Drugs and substances such as acetazolamide, alcohols, and aspirin Lactic acidosis (buildup of lactic acid Continue reading >>

Respiratory Acidosis

Respiratory Acidosis

Practice Essentials Respiratory acidosis is an acid-base balance disturbance due to alveolar hypoventilation. Production of carbon dioxide occurs rapidly and failure of ventilation promptly increases the partial pressure of arterial carbon dioxide (PaCO2). [1] The normal reference range for PaCO2 is 35-45 mm Hg. Alveolar hypoventilation leads to an increased PaCO2 (ie, hypercapnia). The increase in PaCO2, in turn, decreases the bicarbonate (HCO3–)/PaCO2 ratio, thereby decreasing the pH. Hypercapnia and respiratory acidosis ensue when impairment in ventilation occurs and the removal of carbon dioxide by the respiratory system is less than the production of carbon dioxide in the tissues. Lung diseases that cause abnormalities in alveolar gas exchange do not typically result in alveolar hypoventilation. Often these diseases stimulate ventilation and hypocapnia due to reflex receptors and hypoxia. Hypercapnia typically occurs late in the disease process with severe pulmonary disease or when respiratory muscles fatigue. (See also Pediatric Respiratory Acidosis, Metabolic Acidosis, and Pediatric Metabolic Acidosis.) Acute vs chronic respiratory acidosis Respiratory acidosis can be acute or chronic. In acute respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range (ie, >45 mm Hg) with an accompanying acidemia (ie, pH < 7.35). In chronic respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range, with a normal or near-normal pH secondary to renal compensation and an elevated serum bicarbonate levels (ie, >30 mEq/L). Acute respiratory acidosis is present when an abrupt failure of ventilation occurs. This failure in ventilation may result from depression of the central respiratory center by one or another of the foll Continue reading >>

Handling Ph: How Your Body Regulates Acidity

Handling Ph: How Your Body Regulates Acidity

When it comes to pH, your body likes to keep a tight control of the balance between acidity and alkalinity. The normal range for pH in your body is between 7.35-7.45 so, very slightly alkaline. At times, this balance can be disrupted. I will be talking about what occurs. Now, we must think about the ways you can control acidity. One is to remove/add acid, the other is to remove/add base. So how can we do this? There are two places where we can do this — the lungs and the kidneys. The lungs may seem like a strange place for controlling pH however, if we consider how CO2 is transported from the tissues (read more here), we see that CO2 dissociates into carbonic acid. Hence, the higher the CO2 levels in the tissues, the lower the pH gets (more acidic). So, if we are experiencing an Acidosis (low pH), if we decrease our CO2, we can increase the pH. We do this by hyperventilating and blowing off our CO2 however, this is limited by the amount of CO2 we have in our bodies; once we have blown off all our CO2, there is no more that the lungs can do to help us compensate. Conversely, if we experience an Alkylosis (high pH) our lungs can try to compensate by slowing down our breathing to increase our CO2 however, this can be dangerous because it can cause hypoxia (lack of oxygen). The benefit of respiratory compensation is that it happens very quickly (a few minutes) however, it has a very limited range of effectiveness. The kidneys deal in acids and bases, they can excrete/retain H+ if needed and they also control the excretion/retention of bicarbonate (HCO3-). If you are acidotic, your kidneys will try to excrete H+ and retain HCO3-, if you are alkylotic, your kidneys will try to retain H+ and excrete HCO3-. The drawback of this is that it takes a few days to be effective but, Continue reading >>

Renal Physiology Acid-base Balance

Renal Physiology Acid-base Balance

Sort Your patient's blood pH is too low (acidosis), caused by metabolic acidosis. After examining the patient, you find that the urine bicarbonate levels are too low (H+ is being reabsorbed) and blood carbon dioxide levels are too high (too much blood acid); What does this mean? Based on the patient's pCO2 levels are they compensating or not? This means that the original problem of a low bicarbonate level needs to be compensated for by the lungs, which need to hyperventilate, expelling more CO2 (an acid). Since this patient's pCO2 levels are also high (not expelling enough acid), they are NOT compensating. Patient's blood pH is too high (alkalosis). This can be caused by either respiratory or metabolic alkalosis. Let's say it is metabolic alkalosis. What do you need to check to see if patient is compensating? If bicarbonate levels are high (too much base) and blood CO2 levels are high (too much acid), what do the lungs need to do to compensate? What does the patient's elevated Pco2 levels tell you? Patients partial pressure of Carbon dioxide and bicarbonate Take shallower breaths to prevent loss of acid Patient is compensating Patient's blood pH is too high (alkalosis). This can be caused by either respiratory or metabolic alkalosis. Let's say it is metabolic alkalosis. What do you need to check to see if patient is compensating? If bicarbonate levels are high (too much base) and blood CO2 levels are low (too little acid), what do the lungs need to do to compensate? Since the patient's pCO2 level is low, this tells you what? Patients pCO2 and bicarbonate Take shallower breaths to prevent loss of acid Not compensating Continue reading >>

Acid-base Homeostasis

Acid-base Homeostasis

Abstract Acid-base homeostasis and pH regulation are critical for both normal physiology and cell metabolism and function. The importance of this regulation is evidenced by a variety of physiologic derangements that occur when plasma pH is either high or low. The kidneys have the predominant role in regulating the systemic bicarbonate concentration and hence, the metabolic component of acid-base balance. This function of the kidneys has two components: reabsorption of virtually all of the filtered HCO3− and production of new bicarbonate to replace that consumed by normal or pathologic acids. This production or generation of new HCO3− is done by net acid excretion. Under normal conditions, approximately one-third to one-half of net acid excretion by the kidneys is in the form of titratable acid. The other one-half to two-thirds is the excretion of ammonium. The capacity to excrete ammonium under conditions of acid loads is quantitatively much greater than the capacity to increase titratable acid. Multiple, often redundant pathways and processes exist to regulate these renal functions. Derangements in acid-base homeostasis, however, are common in clinical medicine and can often be related to the systems involved in acid-base transport in the kidneys. Basic Concepts Intracellular and extracellular buffers are the most immediate mechanism of defense against changes in systemic pH. Bone and proteins constitute a substantial proportion of these buffers. However, the most important buffer system is the HCO3−/CO2 buffer system. The Henderson–Hasselbach equation (Equation 1) describes the relationship of pH, bicarbonate (HCO3−), and PCO2:where HCO3− is in milliequivalents per liter and PCO2 is in millimeters of mercury. Equation 2 represents the reaction (water [H2O] Continue reading >>

Renal Response To Acid-base Imbalance

Renal Response To Acid-base Imbalance

The kidneys respond to acid-base disturbances by modulating both renal acid excretion and renal bicarbonate excretion. These processes are coordinated to return the extracellular fluid pH, and thus blood pH, to normal following a derangement. Below we discuss the coordinated renal response to such acid-base disturbances. Acidosis refers to an excess extracellular fluid H+ concentration and thus abnormally low pH. The overall renal response to acidosis involves the net urinary excretion of hydrogen, resorption of nearly all filtered bicarbonate, and the generation of novel bicarbonate which is added to the extracellular fluid. Processes of renal acid excretion result in both direct secretion of free hydrogen ions, thus acidifying the urine, as well as secretion of hydrogen in the form of ammonium. These mechanisms are molecularly coupled to the generation of fresh bicarbonate, which is added to the extracellular fluid. Additionally, as discussed in renal bicarbonate excretion, nearly all filtered bicarbonate is resorbed and thus its urinary loss is minimized. Together, these processes slowly reduce ECF hydrogen ions and increase ECF bicarbonate concentrations, thus gradually raising blood pH to its normal value. Alkalosis refers to a insufficient extracellular fluid H+ concentration and thus abnormally high pH. The overall response to alkalosis involves reduced urinary secretion of hydrogen and the urinary excretion of filtered bicarbonate. Renal acid excretion is minimized in the context of alkalosis, thus preventing further increases in the ECF pH. Instead, renal bicarbonate excretion is increased, resulting in loss of bicarbonate from the extracellular fluid, and an alkalinization of the urine. Together these processes reduce ECF bicarbonate concentrations and in doin Continue reading >>

3. Control Of The Hydrogen Ion

3. Control Of The Hydrogen Ion

ACTIVITY (pH) IN THE BODY 3.1. NORMAL pH There is a normal pH value in each body compartment (i.e. extracellular fluid, plasma, intracellular fluid etc). Intracellular pH is difficult to measure and may vary in different types of cells and in different parts of cells. pH of the plasma (i.e. pH of the plasma of whole blood = conventional "blood" pH) is controlled at 7.4 (7.35 - 7.45). This section discusses the processes which restore the blood pH to normal if it is displaced. Changes in plasma pH reflect pH changes in other compartments. When the source of pH change is intracellular the plasma pH change will be in the same direction as the intracellular pH change but of lesser magnitude. When the primary change is in the extracellular fluid the magnitude of any intracellular change will be less than the extracellular change (Van Slyke 1966). Theoretically, opposite pH changes could occur from shifts of acid or base from one point of the body to another. Proving that such a change has occurred is generally impossible. K+ shifts are said to do this but the evidence is nebulous and the conclusions conflicting. (See Section 8). There are three mechanisms which diminish pH changes in body fluid: buffers; respiratory; renal. 3.2. THE BUFFER SYSTEMS OF THE BODY (a) Proteins are the most important buffers in the body. They are mainly intracellular and include haemoglobin. The plasma proteins are buffers but the absolute amount is small compared to intracellular protein. Protein molecules possess basic and acidic groups which act as H+ acceptors or donors respectively if H+ is added or removed. (b) Phosphate buffer (H2PO4- : HP042-) is mainly intracellular. The pK of this sytem is 6.8 so that it is moderately efficient at physiological pH's. The concentration of phosphate is low Continue reading >>

Egan's Ch. 13

Egan's Ch. 13

what is the state called in which arterial blood is more acidic than normal? aka increased concentration of hydrogen ions. Flashcards Matching Hangman Crossword Type In Quiz Test StudyStack Study Table Bug Match Hungry Bug Unscramble Chopped Targets Acid-Base Balance Question Answer what is the state called in which arterial blood is more acidic than normal? aka increased concentration of hydrogen ions. acidemia what is the difference called between the normal buffer base and the actual buffer base in a whole blood sample? base excess (BE) what is alkalemia? decreased hydrogen ion concentration in the blood; blood pH greater than 7.45 how is BE expressed? mEq/L what is the normal BE? +2 mEq/L what is the buffer base? the total blood buffer capable of binding hydrogen ions what is the normal blood buffer base (NBB) range? 48-52 mEq/L what is a titrable, nonvolitile acid called? fixed acid what does a fixed acid represent? the by-product of protein catabolism what kind of acids are phosphoric acid and sulfuric acid? fixed what is the Henderson-Hasselbalch (H-H) equation? the specific equation for calculating the pH of the bicarbonate buffer system of the blood what does pH = 6.1 + log HCO3-/(PaCO2 x 0.03) represent? H-H equation what is the importance of the H-H equation? it equals the pH of blood plasma, and since all buffer systems in the blood are in equilibrium, the pH of one system equals the pH of the entire plasma solution. what is hypercapnia? excess amounts of CO2 in the blood (PaCO2) what is the presence of lower than normal amounts of CO2 in the blood (PaCO2)? hypocapnia define metabolic acidosis? non-respiratory processes resulting in acidemia what is called when non-respiratory processes, such as losing fixed acid or gaining HCO3-, result in alkalemia? metabo Continue reading >>

Fluid/electrolyte Balance

Fluid/electrolyte Balance

Content Body Fluids Compartments Composition of Body Fluids Electrolyte Composition of Body Fluids Extracellular and Intracellular Fluids Fluid Movement Among Compartments Fluid Shifts Regulation of Fluids And Electrolytes Water Balance and ECF Osmolality Water Output Regulation of Water Intake Regulation of Water Output Primary Regulatory Hormones Disorders of Water Balance Electrolyte Balance Sodium in Fluid and Electrolyte Balance Sodium balance Regulation of Sodium Balance: Aldosterone Atrial Natriuretic Hormone (ANH) Potassium Balance Regulation of Potassium Balance Regulation of Calcium Regulation of Anions Acid-Base Balance Sources of Hydrogen Ions Hydrogen Ion Regulation Chemical Buffer Systems -- 1. Bicarbonate Buffer System - -2. Phosphate Buffer System -- 3. Protein Buffer System Physiological Buffer Systems Renal Mechanisms of Acid-Base Balance Reabsorption of Bicarbonate Generating New Bicarbonate Ions Hydrogen Ion Excretion Ammonium Ion Excretion Bicarbonate Ion Secretion Respiratory Acidosis and Alkalosis Respiratory Acid-Base Regulation Metabolic pH Imbalance Respiratory/Renal Compensation/Metabolic Acidosis Metabolic Alkalosis Fluid Balance- The amount of water gained each day equals the amount lost Electrolyte Balance - The ions gained each day equals the ions lost Acid-Base Balance - Hydrogen ion (H+) gain is offset by their loss Body Fluids Compartments Intracellular Fluid (ICF) - fluid found in the cells (cytoplasm, nucleoplasm) comprises 60% of all body fluids. Extracellular Fluid (ECF) - all fluids found outside the cells, comprises 40% of all body fluids Interstitial Fluid - 80% of ECF is found in localized areas: lymph, cerebrospinal fluid, synovial fluid, aqueous humor and vitreous body of eyes, between serous and visceral membranes, glomerular Continue reading >>

Exercise 47: Acid-base Balance: Computer Simulation

Exercise 47: Acid-base Balance: Computer Simulation

4. ACTIVITY 2: HYPERVENTILATION WHAT ACID-BASE IMBALANCE OCCURRED WITH HYPERVENTILATION? THE pH VALUE BEGAN TO EXCEED THE NORMAL RANGE BETWEEN 10 AND 20 SECONDS - AS SOON AS IT ROSE ABOVE 7.45, THIS INDICATED THE CONDITION OF ALKALOSIS. 8. ACTIVITY 3: REBREATHING DID REBREATHING RESULT IN ACIDOSIS OT ALKALOSIS? WHY? HINT: SPECIFICALLY RELATE THIS TO THE LEVEL OF CO2. REBREATHING RESULTED IN ACIDOSIS BECAUSE THE pH VALUE BEGAN TO DIP BELOW THE NORMAL RANGE BETWEEN 20 AND 30 SECONDS - SOON AS IT WENT BELOW 7.35. ACIDOSIS IS THE RESULT OF IMPAIRED RESPIRATION (HYPOVENTILATION) THAT LEADS TO THE ACCUMULATION OF TOO MUCH CARBON DIOXIDE IN THE BLOOD. Continue reading >>

Regulation Of Blood Ph

Regulation Of Blood Ph

Although many people are unaware of the fact, maintaining the acid/base balance of your blood is actually vital to your survival. If the pH of your blood drops below 7.2 or rises above 7.6, then very soon your brain will no longer be able to function normally and you will be in dire straits1. As luck would have it, although you cannot consciously detect your blood pH, the human body does in fact have an elegant but effective means of coping with every change in pH, large or small. This relies on three interlinking objects: buffers, the lungs and the kidneys. Buffers pH is a measurement of the concentration of hydrogen H+ ions and buffers are molecules which take in or release ions in order to maintain the H+ ion concentration at a certain level. Buffers in the blood include haemoglobin (Hb), certain proteins (Prot) and phosphates, and are the first line of defence whenever sudden changes in pH occur. When the pH is too low and the blood becomes too acidic, it is due to the presence of too many H+ ions in the blood. The buffers will attempt to mop up the excess. Conversely, a lack of H+ ions leads to the blood becoming too basic, and so the buffers release H+ ions. Buffers therefore help to maintain the pH of the blood by either sacrificing or accepting H+ ions as necessary to maintain the number of free H+ ions floating around in the blood. ← Buffer taking up excess H+ Buffer releasing H+ → H-Hb ↔ Hb- + H+ Prot-H ↔ Prot- + H+ H2PO4- ↔ HPO42- + H+ The Lungs Through these buffer reactions, the pH can be quickly corrected before any damage is done, but this does not provide a long-term solution to the problem. The buffers can only mop up or release so many H+ ions before they reach their capacity and are no longer of any use, and then the situation will once agai Continue reading >>

4.5 Respiratory Acidosis - Compensation

4.5 Respiratory Acidosis - Compensation

Acid-Base Physiology 4.5.1 The compensatory response is a rise in the bicarbonate level This rise has an immediate component (due to a resetting of the physicochemical equilibrium point) which raises the bicarbonate slightly. Next is a slower component where a further rise in plasma bicarbonate due to enhanced renal retention of bicarbonate. The additional effect on plasma bicarbonate of the renal retention is what converts an "acute" respiratory acidsosis into a "chronic" respiratory acidosis. As can be seen by inspection of the Henderson-Hasselbalch equation (below), an increased [HCO3-] will counteract the effect (on the pH) of an increased pCO2 because it returns the value of the [HCO3]/0.03 pCO2 ratio towards normal. pH = pKa + log([HCO3]/0.03 pCO2) 4.5.2 Buffering in Acute Respiratory Acidosis The compensatory response to an acute respiratory acidosis is limited to buffering. By the law of mass action, the increased arterial pCO2 causes a shift to the right in the following reaction: CO2 + H2O <-> H2CO3 <-> H+ + HCO3- In the blood, this reaction occurs rapidly inside red blood cells because of the presence of carbonic anhydrase. The hydrogen ion produced is buffered by intracellular proteins and by phosphates. Consequently, in the red cell, the buffering is mostly by haemoglobin. This buffering by removal of hydrogen ion, pulls the reaction to the right resulting in an increased bicarbonate production. The bicarbonate exchanges for chloride ion across the erythrocyte membrane and the plasma bicarbonate level rises. In an acute acidosis, there is insufficient time for the kidneys to respond to the increased arterial pCO2 so this is the only cause of the increased plasma bicarbonate in this early phase. The increase in bicarbonate only partially returns the extracel Continue reading >>

Key Concepts:

Key Concepts:

Blood, Sweat, and Buffers: pH Regulation During Exercise Acid-Base Equilibria Experiment Authors: Rachel Casiday and Regina Frey Revised by: A. Manglik, C. Markham, K. Castillo, K. Mao, and R. Frey Department of Chemistry, Washington University St. Louis, MO 63130 For a printable version of this tutorial, please click here Exercise and how it affects the body Acid-base equilibria and equilibrium constants How buffering works Equilibrium Constants Henderson-Hasselbalch Equation Direction of Equilibrium Shifts Application to Blood pH Related Tutorials: Hemoglobin and the Heme Group: Metal Complexes in the Blood for Oxygen Transport Iron Use and Storage in the Body: Ferritin and Molecular Representations How Does Exercise Affect the Body? Many people today are interested in exercise as a way of improving their health and physical abilities. When we exercise, our heart rate, systolic blood pressure, and cardiac output (the amount of blood pumped per heart beat) all increase. Blood flow to the heart, the muscles, and the skin increase. The body's metabolism becomes more active, producing CO2 and H+ in the muscles. We breathe faster and deeper to supply the oxygen required by this increased metabolism. With strenuous exercise, our body's metabolism exceeds the oxygen supply and begins to use alternate biochemical processes that do not require oxygen. These processes generate lactic acid, which enters the blood stream. As we develop a long-term habit of exercise, our cardiac output and lung capacity increase, even when we are at rest, so that we can exercise longer and harder than before. Over time, the amount of muscle in the body increases, and fat is burned as its energy is needed to help fuel the body's increased metabolism. Figure 1 This figure highlights some of the majo Continue reading >>

Blood Gas Analysis--insight Into The Acid-base Status Of The Patient

Blood Gas Analysis--insight Into The Acid-base Status Of The Patient

Acid-Base Physiology Buffers H+ A- HCO3- CO2 Buffers H+ A- CO2 Cells Blood Kidney Lungs Fluids, Electrolytes, and Acid-Base Status in Critical Illness Blood Gas Analysis--Insight into the Acid-Base status of the Patient The blood gas consists of pH-negative log of the Hydrogen ion concentration: -log[H+]. (also, pH=pK+log [HCO3]/ 0.03 x pCO2). The pH is always a product of two components, respiratory and metabolic, and the metabolic component is judged, calculated, or computed by allowing for the effect of the pCO2, ie, any change in the pH unexplained by the pCO2 indicates a metabolic abnormality. CO +H 0ºº H CO ººHCO + H2 2 2 3 3 - + CO2 and water form carbonic acid or H2CO3, which is in equilibrium with bicarbonate (HCO3-)and hydrogen ions (H+). A change in the concentration of the reactants on either side of the equation affects the subsequent direction of the reaction. For example, an increase in CO2 will result in increased carbonic acid formation (H2CO3) which leads to an increase in both HCO3- and H+ (\pH). Normally, at pH 7.4, a ratio of one part carbonic acid to twenty parts bicarbonate is present in the extracellular fluid [HCO3-/H2CO3]=20. A change in the ratio will affect the pH of the fluid. If both components change (ie, with chronic compensation), the pH may be normal, but the other components will not. pCO -partial pressure of carbon dioxide. Hypoventilation or hyperventilation (ie, minute2 ventilation--tidal volume x respitatory rate--imperfectly matched to physiologic demands) will lead to elevation or depression, respectively, in the pCO2. V/Q (ventilation/perfusion) mismatch does not usually lead to abnormalities in PCO2 because of the linear nature of the CO2 elimination curve (ie, good lung units can make up for bad lung units). Diffus Continue reading >>

Respiratory Acidosis

Respiratory Acidosis

Respiratory acidosis is a medical emergency in which decreased ventilation (hypoventilation) increases the concentration of carbon dioxide in the blood and decreases the blood's pH (a condition generally called acidosis). Carbon dioxide is produced continuously as the body's cells respire, and this CO2 will accumulate rapidly if the lungs do not adequately expel it through alveolar ventilation. Alveolar hypoventilation thus leads to an increased PaCO2 (a condition called hypercapnia). The increase in PaCO2 in turn decreases the HCO3−/PaCO2 ratio and decreases pH. Terminology[edit] Acidosis refers to disorders that lower cell/tissue pH to < 7.35. Acidemia refers to an arterial pH < 7.36.[1] Types of respiratory acidosis[edit] Respiratory acidosis can be acute or chronic. In acute respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range (over 6.3 kPa or 45 mm Hg) with an accompanying acidemia (pH <7.36). In chronic respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range, with a normal blood pH (7.35 to 7.45) or near-normal pH secondary to renal compensation and an elevated serum bicarbonate (HCO3− >30 mm Hg). Causes[edit] Acute[edit] Acute respiratory acidosis occurs when an abrupt failure of ventilation occurs. This failure in ventilation may be caused by depression of the central respiratory center by cerebral disease or drugs, inability to ventilate adequately due to neuromuscular disease (e.g., myasthenia gravis, amyotrophic lateral sclerosis, Guillain–Barré syndrome, muscular dystrophy), or airway obstruction related to asthma or chronic obstructive pulmonary disease (COPD) exacerbation. Chronic[edit] Chronic respiratory acidosis may be secondary to many disorders, including COPD. Hypoventilation Continue reading >>

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