Normal values:

pH = 7.35-7.45
PCO2 = 35-45
HCO2 = 22-26
Anion gap < 16

Acid Base Primary Compensatory

PaCO2 pH Etiology
Disorder Change Change
Hypoventilation
Respiratory Increased
Increased Decreased Increased HCO3 Airway
Acidosis CO2
obstruction
Respiratory Decreased Anxiety
DecreasedIncreased Decreased HCO3
Alkalosis CO2 PE
Lactic acidosis
Metabolic Decreased
DecreasedDecreased Decreased CO3 DKA
Acidosis HCO3
Poisons
Vomiting (pyloric
Metabolic Increased
Increased Increased Increased CO2 stenosis)
Alkalosis HCO3
Diuretic therapy

Primary Disorder Expected Changes

Metabolic Acidosis PCO2 = 1.5 x HCO3 + (8 +/- 2)
Metabolic Alkalosis PCO2 = 0.7 x HCO3 + (21 +/- 2)
Acute Respiratory Acidosis Change in pH = 0.008 x (PCO2 - 40)
Chronic Respiratory Acidosis Change in pH = 0.003 x (PCO2 - 40)
Change in pH = 0.008 X (40 -
Acute Respiratory Alkalosis
PCO2)
Chronic Respiratory AlkalosisChange in pH = 0.017 x (40 - PCO2)

Caveats
Metabolic acid base problem exists if

 pH is abnormal and pH and PCO2 change in same direction (both up or

down)
 Respiratory compensation is intact if PCO2 resembles last 2 digits of pH

Respiratory acid base problem exisits if:

 PCO2 is abnormal
 pH and PCO2 change in opposite directions

Mixed acid base problem exists if:

 PCO2 is abnormal and pH has not changed as expected or normal
 pH is abnormal and PCO2 has not changed as expected or is normal

pH 7.46, CO2 32mmHg, HCO3- 23mEq/L

Respiratory alkalosis, Uncompensated

Feedback:
if HCO3- caused the acidosis or the alkalosis, it is METABOLIC
if CO2 caused the acidosis or alkalosis, it is RESPIRATORY
if CO2 and HCO3- caused the imbalanced, it is COMBINED

To determine compensation:

Uncompensated= abnormal pH and change in one blood parameter

Partially compensated= all 3 values of pH, HCO3-, CO2 are abnormal

Fully compensated= pH is normal, both HCO3- and CO2 are abnormal

Corrected= all parameters are normal

Normal ranges:

pH is 7.35-7.45
HCO3- is 22-26
CO2 is 35-45

pH 7.30, CO2 46 mmHg, HCO3 16 mEq/L

Combined, Partially compensated

If the CO2 caused the acidosis or alkalosis, it is what?

Respiratory
What is the normal range of bicarbonate ion (HCO3-) in arterial blood?
22-26

Ben has anxiety attack. His ABGs results show he is in respiratory alkalosis. He has
just had a car accident. What is your next nursing intervention?
Have him breathe into paper bag

What is the normal range of carbon dioxide (CO2) in arterial blood?

35-45

pH 7.31, CO2 50mmHg, HCO3- 22mEq/L

Respiratory acidosis, Uncompensated

If HCO3- caused the acidosis or the alkalosis, it is what?

Metabolic

What is the normal range of pH in the body?

7.35-7.45

If the CO2 and the HCO3- caused the imbalance, it is what?

Combined

pH 7.47, CO2 48 mmHg, HCO3 30 mEq/L

Metabolic alkalosis, partially compensated

When all 3 values--- pH, HCO3-, CO2 are abnormal. It is

Partially compensated

pH 7.30, CO2 46 mmHg, HCO3 16 mEq/L

Combined, partially compensated

pH 7.31, CO2 44 mmHg, HCO3 20 mEq/L

Metabolic acidosis, Uncompensated
When there is an abnormal pH and change in one blood parameter. It is
Uncompensated

When pH is normal, both HCO3 and CO2 are abnormal. It is

Fully compensated

When all parameters of pH, HCO3-, and CO2 are normal. It is

Corrected
ORGAN REGULATES DISTURBANC CAUSES COMPENSATION
E

LUNGS pCO2 ↑ acidosis HYPOVENTALATION ↑ HCO3

(Respiratory) (acid) (↑ CO2 in blood) (metabolic
alkalosis)

↓ alkalosis HYPERVENTALATION ↓ HCO3

(increased breathing) (metabolic
acidosis)

KIDNEYS HCO3 ↑ alkalosis BICARBONATE ↑ pCO2

(Metabolic) (alkaline) REABSORPTION (respiratory
(back to blood) acidosis)

↓ acidosis BICARBONATE ↓ pCO2

EXCRETION (respiratory
(urine) alkalosis)
(excrete alkaline ex
diarrhea remaining is
acid)

pH pCO2 HCO3

Compensated NORMAL Abnormal Abnormal

Partially compensated Abnormal Abnormal Abnormal

Uncompensated Abnormal Either pCO2 or HCO3 is Abnormal

One is normal & other is Abnormal