Purpose: Acid–base disturbances were investigated in patients with cirrhosis in relation to hemodynamic derangement to analyze the hyperventilatory effects and the metabolic compensation. Methods: A total of 66 patients with cirrhosis and 44 controls were investigated during a hemodynamic study. Results: Hyperventilatory hypocapnia was present in all patients with cirrhosis and progressed from Child class A to C (P<0.01). Arterial pH increased significantly from class A to C (P<0.001) and was correlated inversely to the mean arterial blood pressure (r=–0.30, P<0.02), systemic vascular resistance (r=–0.25, P<0.05), indocyanine green clearance (r=–0.37, P<0.005), and serum sodium (r=–0.38, P<0.002). Metabolic compensation was shown by a reduced standard base excess in all patients (P<0.001). Standard base excess contained elements related to changes in serum albumin, water dilution, and effects of unidentified ions (all P<0.001). A significant hepatic component in the acid–base disturbances could not be identified. Conclusion: Hypocapnic alkalosis is related to disease severity and hyperdynamic systemic circulation in patients with cirrhosis. The metabolic compensation includes alterations in serum albumin and water retention that may result in a delicate acid–base balance in these patients.