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Hyperventilation with hypoproteinemia.

T H Rossing1, D Boixeda, N Maffeo

  • 1Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.

The Journal of Laboratory and Clinical Medicine
|November 1, 1988
PubMed
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Hypoproteinemia causes metabolic alkalosis and unexplained hypocapnia (lowered carbon dioxide levels) in patients, regardless of liver cirrhosis. This respiratory compensation appears excessive and its mechanism remains unclear.

Area of Science:

  • Pulmonary Physiology
  • Acid-Base Balance
  • Clinical Medicine

Background:

  • Hypoproteinemia is known to cause metabolic alkalosis.
  • Respiratory compensation in hypoproteinemia, particularly in liver cirrhosis patients who hyperventilate, is not well understood.
  • The relationship between low serum protein levels and respiratory changes requires further investigation.

Purpose of the Study:

  • To investigate the respiratory compensation in clinically stable hypoproteinemic patients.
  • To determine if hypocapnia occurs in hypoproteinemia and its correlation with protein levels.
  • To explore potential mechanisms and associated findings like high anion gap in these patients.

Main Methods:

  • Studied 23 clinically stable patients with hypoproteinemia (low albumin-to-globulin ratio).

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  • Included patients with liver cirrhosis (n=12) and other medical conditions (n=11).
  • Measured arterial blood gases (PaCO2, pH) and assessed serum protein concentrations.

    • Main Results:

    • All patients exhibited marked hypocapnia and alkalemia, irrespective of liver cirrhosis.
    • Reduced PaCO2 levels were proportional to decreased serum albumin and total protein.
    • Many patients presented with an inappropriately high anion gap, suggesting unidentified anions.

    Conclusions:

    • Hypoproteinemia induces excessive hypocapnia and alkalemia, independent of hypoxemia or liver cirrhosis.
    • The observed hyperventilation is linked to reduced serum protein concentrations.
    • The underlying mechanisms for hyperventilation and unidentified anions in hypoproteinemia require further research.