[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"menu":3,"$fpEeBHilAP0XnplHT1zaiLcRSheCRa_glqi9HWtexW6w":210},{"main":4,"mainTranslated":17,"footer":45,"footerTranslated":109},[5,8,11,14],{"title":6,"url":7},"Course library","https:\u002F\u002Fwww.medmastery.com\u002Fcourse-library",{"title":9,"url":10},"Pricing","https:\u002F\u002Fwww.medmastery.com\u002Fpricing",{"title":12,"url":13},"Earn credits","https:\u002F\u002Fwww.medmastery.com\u002Fcme-credits",{"title":15,"url":16},"Institutions","https:\u002F\u002Fwww.medmastery.com\u002Finstitutions",{"de":18,"es":27,"fr":36},[19,21,23,25],{"title":20,"url":7},"Kurse",{"title":22,"url":10},"Preise",{"title":24,"url":13},"CME-Punkte",{"title":26,"url":16},"Organisationen",[28,30,32,34],{"title":29,"url":7},"Biblioteca de cursos",{"title":31,"url":10},"Precios",{"title":33,"url":13},"Gana créditos",{"title":35,"url":16},"Instituciones",[37,39,41,43],{"title":38,"url":7},"Cours",{"title":40,"url":10},"Tarifs",{"title":42,"url":13},"Obtenir des crédits",{"title":44,"url":16},"Établissements",[46,59,79,97],{"title":47,"group":48,"menu":49},"Company",true,[50,53,56],{"title":51,"url":52},"Our teachers","https:\u002F\u002Fwww.medmastery.com\u002Fteachers",{"title":54,"url":55},"About us","https:\u002F\u002Fwww.medmastery.com\u002Fabout-us",{"title":57,"url":58},"Work with us","https:\u002F\u002Fwww.medmastery.com\u002Fwork-with-us",{"title":60,"group":48,"menu":61},"Product",[62,64,67,70,73,76,78],{"title":63,"url":7},"Courses",{"title":65,"url":66},"Magazine","https:\u002F\u002Fwww.medmastery.com\u002Fmagazine",{"title":68,"url":69},"Podcast","https:\u002F\u002Fwww.medmastery.com\u002Fpodcasts",{"title":71,"url":72},"Webinars","https:\u002F\u002Fwww.medmastery.com\u002Fwebinars",{"title":74,"url":75},"Guides","https:\u002F\u002Fwww.medmastery.com\u002Fguides",{"title":15,"url":77},"https:\u002F\u002Fwww.medmastery.com\u002Finstitutions\u002F",{"title":9,"url":10},{"title":80,"group":48,"menu":81},"Legal",[82,85,88,91,94],{"title":83,"url":84},"Imprint","https:\u002F\u002Fwww.medmastery.com\u002Fimprint",{"title":86,"url":87},"Newsletter policy","https:\u002F\u002Fwww.medmastery.com\u002Fnewsletter-privacy-policy",{"title":89,"url":90},"Privacy policy","https:\u002F\u002Fwww.medmastery.com\u002Fprivacy-policy",{"title":92,"url":93},"Cookie Policy","https:\u002F\u002Fwww.medmastery.com\u002Fcookie-policy",{"title":95,"url":96},"Terms","https:\u002F\u002Fwww.medmastery.com\u002Fterms",{"title":98,"group":48,"menu":99},"Customer support",[100,103,106],{"title":101,"url":102},"FAQs","https:\u002F\u002Fwww.medmastery.com\u002Ffaqs",{"title":104,"url":105},"Contact","https:\u002F\u002Fwww.medmastery.com\u002Fcontact",{"title":107,"url":108},"support@medmastery.com","mailto:support@medmastery.com",{"de":110,"es":143,"fr":177},[111,118,128,137],{"title":112,"group":48,"menu":113},"Unternehmen",[114,116,117],{"title":115,"url":52},"Unsere Dozentinnen und Dozenten",{"title":54,"url":55},{"title":57,"url":58},{"title":119,"group":48,"menu":120},"Produkt",[121,122,123,124,125,126,127],{"title":20,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":26,"url":77},{"title":22,"url":10},{"title":129,"group":48,"menu":130},"Rechtliches",[131,133,134,135,136],{"title":132,"url":84},"Impressum",{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":138,"group":48,"menu":139},"Kundenservice",[140,141,142],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},[144,151,162,171],{"title":145,"group":48,"menu":146},"Empresa",[147,149,150],{"title":148,"url":52},"Nuestros profesores",{"title":54,"url":55},{"title":57,"url":58},{"title":152,"group":48,"menu":153},"Producto",[154,156,157,158,159,160,161],{"title":155,"url":7},"Cursos",{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":35,"url":77},{"title":31,"url":10},{"title":163,"group":48,"menu":164},"Información legal",[165,167,168,169,170],{"title":166,"url":84},"Aviso legal",{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":172,"group":48,"menu":173},"Atención al cliente",[174,175,176],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},[178,185,196,204],{"title":179,"group":48,"menu":180},"Entreprise",[181,183,184],{"title":182,"url":52},"Nos enseignants",{"title":54,"url":55},{"title":57,"url":58},{"title":186,"group":48,"menu":187},"Produit",[188,189,190,191,192,193,194],{"title":38,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":15,"url":77},{"title":195,"url":10},"Tarification",{"title":197,"group":48,"menu":198},"Mentions légales",[199,200,201,202,203],{"title":197,"url":84},{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":205,"group":48,"menu":206},"Service client",[207,208,209],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},{"content":211,"related":287,"meta":353,"internal":363},{"title":212,"leadIn":213,"category":214,"elements":217,"becomeAnExpert":251,"author":273,"readDuration":285,"readDurationFormatted":286},"Easy rules for assessing compensation","These super simple rules will help you decide whether metabolic \u002F respiratory compensation is adequate.",{"id":215,"name":216},1,"Course previews",[218,229,234,239,246],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},449,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Easy rules for assessing metabolic compensation.","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=M_HcaaNVuKo",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},8,"\u003Cp>Learn some super simple rules that will help you decide whether compensation is adequate or not. You'll learn exactly how the lungs compensate a metabolic problem and how the kidneys compensate a respiratory problem.\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},11.200000000000001,"Join our Acid-Base Essentials course today!","\u003Cp>Learn how to resolve acid-base problems with a simple, four-step approach in our \u003Cstrong>\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Facid-base-essentials\">Acid-Base Essentials\u003C\u002Fa>\u003C\u002Fstrong> course. Dr. Franz Wiesbauer and Dr Rainer Oberbauer join forces to cover important topics like anion gap, mixed acid-base problems, and compensation. \u003C\u002Fp>",{"type":240,"data":241},"cta",{"readDurationInSeconds":242,"text":243,"buttonText":244,"buttonUrl":245},3.466666666666667,"Become a great clinician with our video courses and workshops","Start learning for free","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister",{"type":230,"data":247},{"readDurationInSeconds":248,"title":249,"text":250},217.06666666666666,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:00] \u003C\u002Fstrong>Welcome back. So, in some of the previous videos, we've learned how to tell if multiple metabolic problems were present at the same time. Remember, that was what the delta anion gap and the corrected bicarb were all about. In this lesson, you will learn how to tell if an additional respiratory problem is present on top of metabolic problems or if an additional metabolic problem is present on top of a respiratory problem. In this video, we're going to learn about \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:30] \u003C\u002Fstrong>compensation. Compensation refers to the fact that the lungs will try to compensate for a metabolic problem by hyper and hypoventilating and the kidneys will try to compensate for a respiratory problem by excreting or retaining bicarb. So, this is the kidney representing the metabolic system, and these are the lungs representing the respiratory system. When there's metabolic acidosis, the lungs will hyperventilate and when there's metabolic alkalosis, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:00] \u003C\u002Fstrong>the lungs will hypoventilate. And when there's respiratory acidosis, the kidneys will cause bicarb retention. And when there's respiratory alkalosis, the kidneys will cause bicarb excretion. That's what the whole concept of compensation is all about. So, let's have a look at what the kidneys do in the case of a respiratory acidosis first. So, we said that in respiratory acidosis, the pCO2 goes up, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:30] \u003C\u002Fstrong>which causes the pH to go down in response to that. And the kidneys will try to compensate by increasing bicarb as well. So, when there's no additional metabolic problem then the kidneys will increase bicarb by a predicted amount. Since renal compensation takes hours to days, bicarb will increase just a little bit in acute respiratory acidosis and more in chronic respiratory acidosis because the kidneys have more time. Let's see what happens \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:00]\u003C\u002Fstrong> in the acute phase. So, in this setting, for each 10-unit increase in pCO2, the bicarb will increase by 1 unit. What about the chronic phase? There, we said that the kidneys have more time to adapt, so here, for every 10-unit increase in the pCO2, bicarb will increase by 3 units. And what about respiratory alkalosis? Here, the pCO2 goes down in response to hyperventilation. As a consequence, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:30]\u003C\u002Fstrong> the pH goes up and since the kidneys try to compensate for that, they will cause bicarbonate excretion so the bicarb will go down. What happens in acute respiratory alkalosis? Here, for every 10-unit decrease in pCO2, bicarb will decrease by 2 units. And what happens in the chronic setting? Here, for every 10-unit decrease in pCO2, the bicarb will decrease by 4 units. What \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:00]\u003C\u002Fstrong> if the bicarb doesn't change by these amounts? Well, that probably means that there's an additional metabolic problem. If the bicarb is lower than predicted by these rules, there's also metabolic acidosis, and if it's higher than predicted, then there's probably also metabolic alkalosis. And what about metabolic acidosis? We know that here, as the bicarb goes down, the pH goes down and as a compensatory mechanism, the pCO2 \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:30]\u003C\u002Fstrong> also goes down, due to hyperventilation. Now, respiratory compensation takes place immediately. So, here, we don't discriminate between acute and chronic settings. So, let's see by how much the lungs adapt in metabolic acidosis. For each unit decrease in bicarb, the pCO2 goes down by 1 unit. And what about metabolic alkalosis? Here, we also don't discriminate between acute and chronic problems since the lungs adapt \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:04:00]\u003C\u002Fstrong> to this immediately as well. So, in metabolic alkalosis, the bicarb goes up and the pH will go up too. As a consequence, the patient will start to hypoventilate, in order to correct the pH. As you can imagine, there's a certain limit as to how much the patient can hypoventilate. So, this type of compensation is somewhat limited. Let's see by how much the pCO2 changes in this setting. So, for every 2-unit increase in bicarb. The pCO2 \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:04:30] \u003C\u002Fstrong>will increase by 1 unit. What's the problem if the pCO2 doesn't change by the predicted amount? What if the pCO2 is lower than predicted? Well, then that means that respiratory alkalosis is also present and if it's higher than predicted, then respiratory acidosis is also present. So, here's a little memory aid that should help you to remember what we've just learned. So, on the left side, we write down acidosis. On the right side, we write down \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:05:00]\u003C\u002Fstrong> alkalosis. Then we have acute respiratory problems, chronic respiratory problems, and metabolic problems. And here are the compensatory changes that take place in each setting. We said in acute respiratory acidosis, for every 10-unit increase in pCO2, bicarb goes up by 1 unit. In acute respiratory alkalosis, we said for every 10-unit decrease in pCO2, bicarb goes down by 2 units. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:05:30] \u003C\u002Fstrong>In chronic respiratory acidosis, we said for every 10-units increase in pCO2, bicarb goes up by 3 units. And in chronic respiratory alkalosis, we said for every 10- unit decrease in pCO2, bicarb goes down by 4 units. What about metabolic acidosis? Here, for every 1-unit decrease in bicarb, pCO2 goes also down by 1 unit. And what about metabolic alkalosis? Here, for every 2-unit increase \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:06:00]\u003C\u002Fstrong> in bicarb, pCO2 will also go up by 1 unit. So, do you recognize the pattern here? Well, to tell you the truth, you really only have to remember the numbers in the left column and add 1 to the numerator in order to arrive at the numbers of the right column. So, it's 1 \u002F 10 for acute respiratory acidosis and 2 \u002F 10 for acute respiratory alkalosis. It's 3 \u002F 10 for chronic respiratory acidosis and \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:06:30] \u003C\u002Fstrong>4 \u002F 10 for chronic respiratory alkalosis. It's 1 \u002F 1 for metabolic acidosis and 2 \u002F 1 for metabolic alkalosis. We can now complete our algorithm for diagnosing any acid-based problem. Let's write down the updated algorithm. So, we said, number one, we calculate the anion gap. Number two, if there is an elevated anion gap, we calculate the delta anion gap and the corrected bicarb. Number three, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:07:00] \u003C\u002Fstrong>we check the pH and the pCO2 in order to identify the primary problem—is it metabolic or respiratory? And now, there's an add-on. Number four, check if compensation is adequate, and if it's not, an additional acid-based problem is present. You now have all the tools it takes in order to assess over 90% of acid-based problems. Now, go through the practice cases and make sure that what you've learned sticks.\u003C\u002Fp>",{"courses":252,"showAwardsBelow":48},[253],{"id":254,"isFreeCmeCourse":255,"title":256,"type":257,"specialization":258,"teachers":260,"cmeCredits":215,"teacherIllustration":263,"backgroundImage":264,"relativeUrl":265,"lastChanged":266,"created":267,"description":268,"relativeURL":265,"meta":269},1614,false,"Acid-Base Essentials","course",[259],"Nephrology",[261,262],"Franz Wiesbauer, MD MPH","Rainer Oberbauer, MD MSc","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55e92-d69a-41d5-8055-a653ef928363","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55e93-91b7-42cd-9fef-aa002465a7f6","\u002Fcourses\u002Facid-base-essentials","1773309358","1580071905","In this course you learn a simple, four-step approach that will help you solve any acid-base problem, without memorization or complicated math. Important topics like anion gap, mixed acid-base problems, and compensation will be crystal clear after completing the lessons and quizzes in this course.",{"duration":270,"quizzes":271,"lessons":272},3971,3,23,{"id":274,"name":261,"image":275,"profession":276,"relativeUrl":279,"specializations":280},1563,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401",{"name":277,"description":278},"Internist","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.","\u002Fteachers\u002Ffranz-wiesbauer-md-mph",[259,281,282,283,284],"Professional development","Cardiology","Ultrasound","Emergency medicine and critical care",245,"5m",[288,310,328],{"id":289,"title":290,"text":291,"image":292,"author":300,"path":303,"readDuration":304,"readDurationFormatted":305,"internal":306},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":293,"title":294,"size":295,"location":297},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":296,"height":296},1200,{"bucket":298,"key":299},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":274,"title":261,"relativeURL":279,"image":275,"professionLong":278,"profession":301,"weight":302},{"name":277},4,"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":307,"updated":308,"published":309},1778115738,1778118425,1778118255,{"id":311,"title":312,"text":313,"image":314,"author":320,"path":322,"readDuration":323,"readDurationFormatted":286,"internal":324},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":315,"title":294,"size":316,"location":318},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":317,"height":317},600,{"bucket":298,"key":319},"\u002F2026-04\u002FC121_magazine image.png",{"id":274,"title":261,"relativeURL":279,"image":275,"professionLong":278,"profession":321,"weight":302},{"name":277},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,{"created":325,"updated":326,"published":327},1777403036,1777572381,1777412421,{"id":329,"title":330,"text":331,"image":332,"author":337,"path":346,"readDuration":347,"readDurationFormatted":348,"internal":349},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":333,"title":294,"size":334,"location":335},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":317,"height":317},{"bucket":298,"key":336},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":338,"title":339,"relativeURL":340,"image":341,"professionLong":342,"profession":343,"weight":345},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":344},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,"4m",{"created":350,"updated":351,"published":352},1776705362,1776710540,1776710541,{"seo":354,"og":356},{"title":355,"description":213},"Easy rules for assessing compensation | Medmastery",{"title":355,"description":213,"image":357},{"alt":294,"title":294,"size":358,"location":361},{"width":359,"height":360},947,494,{"bucket":298,"key":362},"\u002Fmigrated-images\u002FScreen Shot 2018-03-21 at 2.17.30 pm.png",{"id":227,"created":364,"updated":365,"published":364},1521638863,1655189586]