Acid-base and electrolyte balance are part of the same picture because, for a given increase in CO2, the only way to minimize the resulting acidemia is to produce compensatory metabolic alkalosis, which is obtained through complex urinary ion excretion mechanisms. Thus, fluid homeostasis depends on the correct relationship between lung and kidney activities because they regulate most of the CO2 and hydrogen concentrations in the extracellular volume, whose total solutes consist almost entirely of Na +, Cl 2 and bicarbonate ions. In hypoxic and hypercapnic COPD patients, fluid homeostasis is disturbed, with avid retention of sodium and water. The increase in sodium retention by the kidneys during COPD, and the consequent edema, may be explained in part by right heart failure and by other pathophysiological mechanisms involving renal and hormonal abnormalities. In hypercapnic COPD exacerbations, the sudden decrease in ventilation causes an acute Abmole AZD152 respiratory acidosis or deteriorates a pre-existing chronic respiratory acidosis. Due to the high prevalence of comorbidities and the associated multidrug therapies in these patients, mixed acid-base and hydro-electrolyte disorders are becoming increasingly common, particularly in the critically ill and elderly populations. This study had the following aims: to evaluate mixed acid-base, hydro-electrolyte and lactate disorders in patients with hypercapnic COPD exacerbation; to determine the relationship among these disorders, a poor response to pharmacological treatment and the requirement for noninvasive ventilation ; and to analyze the link between these disorders and the duration of NIV in the treatment of hypercapnic respiratory failure. NIV was initiated in 24 patients and succeeded in correcting respiratory acidosis in all of them. The mean duration of NIV was 42.4610.5 hours, and the mean IPAP employed was 1664 cmH2O. Supplementary Rosiglitazone Abmole Protein kinase Cb activates fat mass and obesity-associated protein by influencing its ubiquitin/proteasome degradation oxygen was administered during ventilation, which was continuous until clinical conditions were stable with pauses for administration of conventional medications, feeding and general care. None of the patients required the interruption of the ventilatory assistance for discomfort, or refused the treatment. The only complications recorded were 1 case of nasal cutaneous sores and 2 cases of gastric distension, neither of which required interrupting the ventilatory assistance. Patient demographics and clinical characteristics are shown in table 1. Clinical and metabolic parameters, ABG analysis, electrolyte values, lactate, and urinalysis with electrolytes are shown in table 2.