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Metabolic Alkalosis Contributes to Acute Hypercapnic Respiratory Failure in Adult Cystic Fibrosis^*

^* From the Departments of Physiotherapy (Ms. Holland), and Respiratory Medicine (Drs. Wilson, Kotsimbos, and Naughton), The Alfred Hospital, Melbourne, VIC, Australia.

Correspondence to: Anne Holland, BAppSc, Department of Physiotherapy, Alfred Hospital, Commercial Rd, Melbourne, 3004, VIC, Australia; e-mail: a.holland1{at}pgrad.unimelb.edu.au

Background and study objectives: Patients with end-stage cystic fibrosis (CF) develop respiratory failure and hypercapnia. In contrast to COPD patients, altered electrolyte transport and malnutrition in CF patients may predispose them to metabolic alkalosis and, therefore, may contribute to hypercapnia. The aim of this study was to determine the prevalence of metabolic alkalosis in adults with hypercapnic respiratory failure in the setting of acute exacerbations of CF compared with COPD.

Design: Levels of arterial blood gases, plasma electrolytes, and serum albumin from 14 consecutive hypercapnic CF patients who had been admitted to the hospital with a respiratory exacerbation were compared with 49 consecutive hypercapnic patients with exacerbations of COPD. Hypercapnia was defined as a PaCO₂ of 45 mm Hg.

Results: Despite similar PaCO₂ values, patients in the CF group were significantly more alkalotic than were those in the COPD group (mean [± SD] pH, 7.43 ± 0.03 vs 7.37 ± 0.05, respectively; p < 0.01). A mixed respiratory acidosis and metabolic alkalosis was evident in 71% of CF patients and 22% of COPD patients (p < 0.01). The mean concentrations of plasma chloride (95.1 ± 4.9 vs 99.8 ± 5.2 mmol/L, respectively; p < 0.01) and sodium (136.5 ± 2.8 vs 140.4 ± 4.5 mmol/L, respectively; p < 0.01) were significantly lower in the CF group, and the levels of serum albumin were significantly reduced (27.4 ± 5.8 vs 33.7 ± 4.8 mmol/L, respectively; p < 0.01).

Conclusion: Metabolic alkalosis contributes to hypercapnic respiratory failure in adults with acute exacerbations of CF. This acid-base disturbance occurs in conjunction with reduced total body salt levels and hypoalbuminemia.

Key Words: acid-base imbalance • COPD • cystic fibrosis • nutrition disorders • water-electrolyte imbalance

This article has been cited by other articles:

				L. E. M. Omron, A. Holland, J. Wilson, T. Kotsimbos, and M. Naughton Metabolic Alkalosis and Cystic Fibrosis Chest, March 1, 2004; 125(3): 1169 - 1170. [Full Text] [PDF]

				S J Kelly Salt depletion and hypoalbuminaemia in cystic fibrosis may add to hypercapnia in acute respiratory failure Thorax, November 1, 2003; 58(11): 973 - 973. [Full Text]