Stewart analysis unmasks acidifying and alkalizing effects of ionic shifts during acute severe respiratory alkalosis

Purpose: Although both the Henderson-Hasselbalch method and the Stewart approach can be used to analyze acid-base disturbances and metabolic and respiratory compensation mechanisms, the latter may be superior in detecting subtle metabolic changes. Materials and methods: We analyzed acid-base disturbances using both approaches in six healthy male volunteers practicing extreme voluntary hyperventilation. Arterial blood gas parameters were obtained during a breathing exercise consisting of approximately 30 cycles of powerful hyperventilation followed by breath retention for approximately 2 min. Results: Hyperventilation increased pH from 7.39 +/- 0.01 at baseline to 7.74 +/- 0.06, PaCO2 decreased from 34.1 +/- 1.1 to 12.6 +/- 0.7 mmHg, PaO2 increased from 116 +/- 4.6 to 156 +/- 4.3 mmHg. Baseline apparent strong ion difference was 42.3 +/- 0.5 mEq/L, which decreased to 37.1 +/- 0.7 mEq/L following hyperventilation. The strong ion gap significantly decreased following hyperventilation, with baseline levels of 10.0 +/- 0.9 dropping to 6.4 +/- 1.1 mEq/L. Conclusions: Henderson-Hasselbalch analysis indicated a profound and purely respiratory alkalosis with no metabolic compensation following extreme hyperventilation. The Stewart approach revealed metabolic compensa-tion occurring within minutes. These results challenge the long-held axiom that metabolic compensation of acute respiratory acid-base changes is a slow process. (C) 2021 Published by Elsevier Inc.