w w w . st u d e nt n u rs e p l a n n e r .

co m
 w w w . st u d e nt n u rs e p l a n n e r . co m

Proof that the more Basic you are, the worse it is for everyone.
This is Arty.
Arty’s normal pH balance anything anything
less normal greater
is between 7.35-7.45
than 7.35 pH 7.45 than

if arty gets critically Sick ACIDOSIS ALKALOSIS

his body may leave “normal”
ph range ->
if Arty enters Acidosis or Alkalosis, his body is going to correct this by ONE of these ways:

(think breathing!!) OR (think kidneys!!!)

to find out if the body’s to find out if the body’s

imbalance is through the lungs imbalance is metabolic.
we measure the rate and depth of we measure kidney excretion or
breathing, through carbon dioxide retention through Bicarbonate

carbon dioxide = PaCo2 Bicarbonate = HCO3

less normal normal

greater less greater
than 35 PaCo2 45 than than 22 HCO3 26 than
ALKALOSIS ACIDOSIS ACIDOSIS ALKALOSIS

NOTICE THE pH is FLIPPED. Why? NOTICE THE pH is FLIPPED. Why?

The more Carbon Dioxide The more Bicarbonate,

the MORE ACiDiC!!!!!
if Arty’s Paco2 is above 45 then we know
there is too much carbon dioxide being
retained in the lungs and his
working to fix this by breathing fast.
Arty has become
if Arty’s Paco2 is below 35 then
Arty has become
1. Lungs. 2. Acidic. 3. Basic/Alkalotic
the MORE Basic!!!!!
if Arty’s HCo3 is above 26 then we know
there is too much bicarb in the body and
are our are not excreting urine and are
retaining bicarb. Arty has become
if Arty’s HCo3 is below 22 then we know
there is A low amount of bicarb in the body
being lost through urine or stool.
Arty Has Become
1. Kidneys 2.. Basic/Alkalotic 3. Acidic.
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the doctor will order an Arterial Blood Gas (ABG) the respiratory therapist receives
from a patients artery in their wrist. ABG’s Result determines: pH, PaCo2, HCo3.
Using the reference chart below and a standard “tic tac toe” board, plug in the abg results.
Once you get ‘3-in-a-Row’ you can determine if Arty is acidic or alkalotic,
and which one of arty’s systems is the reason for the pH shift.

“Normal”

>-
pH 7.35-7.45

Paco2 is Acidic
PaCo2 45-35
HCo3 22-26

always start with a labeled tic tac toe board:

Quick Version:
acid normal base A N B

this will count as a mark in the game

next plug in the data one result at a time

If the If the
pH - 7.26 acid norm base acid norm base pH - 7.48
pH pH

Arty is in acidosis. Arty is in alkalosis.

The paco2 and hco3 will tell us if he is in If the paco2 and hco3 will tell us if he is in
metabolic acidosis, or respiratory acidosis. metabolic alkalosis, or respiratory alkalosis.

pH - 7.26 acid norm base acid norm base pH - 7.48

PaCo2 - 60 pH pH PaCo2 - 30
PaCo2 PaCo2

Three in a row shows that Arty is in Three in a row shows that Arty is in
respiratory acidosis, regardless of the HCo3. respiratory alkalosis regardless of the HCo3.

pH - 7.26 acid norm base acid norm base pH - 7.48

PaCo2 - 60 pH PaCo2 pH PaCo2 - 30
HCo3 - 15 PaCo2 HCo3 - 15
HCo3
HCo3
Three in a row, = metabolic acidosis. Three in a row, = metabolic alkalosis.
regardless of the HCo3. regardless of the PaCo2.
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“Normal”

>- PaCo2
pH 7.35-7.45
45-35
Paco2 is Acidic
HCo3 22-26
1 2 3
pH
7.51 A N B pH
7.29 A N B pH
7.35 A N B

PaCo2 61 PaCo2
PaCo2
36 PaCo2 pH PaCo2
53 pH HCo3 pH HCo3

HCo3 27 HCo3 HCo3 23 PaCo2 HCo3 27

Metabolic Alkalosis Respiratory Acidosis Respiratory Acidosis

4 5 6
pH
7.38 A N B pH
7.26 A N B pH
7.31 A N B

PaCo2 41 PaCo2 42 PaCo2 38

HCo3 23 HCo3 18 HCo3 18

7 8 9
pH
7.25 A N B pH
7.05 A N B pH
7.15 A N B

PaCo2
47 PaCo2
141 PaCo2
52
HCo3 20 HCo3 27 HCo3 17

10 11 12
pH
7.49 A N B pH
7.53 A N B pH
7.34 A N B

PaCo2
29 PaCo2
28 PaCo2
36
HCo3 22 HCo3 24 HCo3 20

13 14 15
pH
7.45 A N
B
pH
7.38 A N B pH
7.51 A N B

PaCo2
28 PaCo2
38 PaCo2
40
HCo3 20 HCo3 26 HCo3 28

16 17 18
pH
7.20 A N B pH
7.33 A N B pH
7.35 A N B

PaCo2 44
PaCo2
80 PaCo2
45
HCo3 26 HCo3 21 HCo3 23
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Also Known As:

pH
7.35 A N B

PaCo2 61 PaCo2 pH HCo3

When the pH is NORMAL, you have compensation.
HCo3 27
The acid/base balance is at a “normal” range because the
kidneys and lungs are functioning together to maintain the Respiratory Acidosis
normal pH balance range.
with compensation
This means you will not get a full tic tac toe, and the
respiratory and metabolic system is functioning well together.

When the opposite system is working the other direction to

pH
7.16 A N B

assist the pH into normal range. PaCo2 33 pH PaCo2

In this example: HCo3 12 HCo3
We can see the body is in Metabolic Acidosis given our tic tac
toe, but our BiCarb is starting to become Alkalotic to help the Metabolic Acidosis
acidosis, with creates partial compensation. partial compensated

pH
7.17 A N B

When the opposite system is NOT working the other PaCo2 43 pH PaCo2
19 HCo3
direction to assist the pH into normal range, or has not
HCo3
started to work in the direction of balancing out the pH.

In this example: Metabolic Acidosis

un-compensated
We can see in the first example the Co2 is normal so it has
not entered in an alkalotic state to help the acidosis of the
metabolic system making no type of effort or
pH
7.17 A N B
compensation. PaCo2 46 pH
In the second example the body is an acidotic state and HCo3 19 PaCo2
HCo3
likely due to mixed disorders. Because the pH, HCo3, and
PaCo2 are acidotic, this is uncompensation.
Combined Acidosis
un-compensated
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“Normal”

>-
pH 7.35-7.45

Paco2 is Acidic
PaCo2 45-35
HCo3 22-26
19 20 21
pH
7.39 A N B pH
7.73 A N B pH
7.17 A N B

PaCo2 49 PaCo2 25 PaCo2 43

HCo3 29 HCo3 19 HCo3 19

22 23 24
pH
7.36 A N B pH
7.39 A N B pH
7.18 A N B

PaCo2 55 PaCo2 53 PaCo2 45

HCo3 36 HCo3 34 HCo3 23

25 26 27
pH
7.59 A N B pH
7.16 A N B pH
7.74 A N B

PaCo2 44 PaCo2 33 PaCo2 39

HCo3 38 HCo3 12 HCo3 35

28 29 30
pH
7.61 A N B pH 7.37 A N B pH
7.52 A N B

PaCo2
36 PaCo2 30 PaCo2
31
HCo3 33 HCo3 18 HCo3 21

31 32 33
pH
7.31 A N B pH
7.30 A N B pH
7.16 A N B

PaCo2 49 PaCo2 59 PaCo2 44

HCo3 25 HCo3 22 HCo3 20

34 35 36
pH
7.37 A N B pH
7.10 A N B pH
7.40 A N B

PaCo2 39 PaCo2 30 PaCo2 32

HCo3 25 HCo3 14 HCo3 16
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“Normal”

>-
pH 7.35-7.45

Paco2 is Acidic
PaCo2 45-35
HCo3 22-26

37 38 39
pH
7.15 A N B pH
7.41 A N B pH
7.44 A N B

PaCo2 42 PaCo2 50 PaCo2 48

HCo3 15 HCo3 30 HCo3 29
40 41 42
pH
7.16 A N B pH
7.58 A N B pH
7.17 A N B

PaCo2 44 PaCo2 43 PaCo2 33

HCo3 18 HCo3 35 HCo3 17

43 pH 44 45
7.38 A N B pH
7.62 A N B pH
7.40 A N B

PaCo2
43 PaCo2 29 PaCo2
51
HCo3 25 HCo3 21 HCo3 32
46 pH 47 48
7.13 A N B pH
7.15 A N B pH
7.43 A N B

PaCo2
31 PaCo2
43 PaCo2
42
HCo3 20 HCo3 18 HCo3 24
49 50 pH 51
pH
7.60 A N B 7.42 A N B pH
7.35 A N B

PaCo2
43 PaCo2 38 PaCo2
55
HCo3 39 HCo3 24 HCo3 35
52 53 54 pH
pH
7.39 A N B pH
7.38 A N B 7.12 A N B

PaCo2
31 PaCo2 52 PaCo2 33
HCo3 15 HCo3 33 HCo3 13
Answers
1. Metabolic Alkalosis; remember the paco2 is within range of 35-45.
2. Respiratory Acidosis; body is in acidic state with a normal bicarb.
3. Respiratory Acidosis; because the paco2 is so high and the hco3 is almost normal.
4. nomral balance
5. Metabolic Acidosis
6. Metabolic Acidosis
7. combined acidosis
8. respiratory acidosis
9. combined acidosis
10. respiratory Alkalosis
11. respiratory Alkalosis
12. Metabolic acidosis
13. resipratory Alkalosis / combined.
14. normal balance
15. Metabolic Alkalosis
16. respiratory acidosis
17. Metabolic acidosis
18. normal balance
19. fully compensated Respiratory acidosis or fully compensated metabolic alkalosis
20. Partially Compensated Respiratory Alkalosis / uncompensated because pH isn’t within range)
21. Uncompensated Metabolic Acidosis
22. Fully compensated respiratory acidosis or fully compensated metabolic alkalosis
23. Fully compensated respiratory acidosis or fully compensated metabolic alkalosis
24. unCompensated Respiratory Acidosis since paco2 & hco3 are within range.
25. Uncompensated Metabolic Alkalosis
26. Partially Compensated metabolic acidosis
27. uncompensated metabolic acidosis
28. uncompensated metabolic acidosis
29. Fully Compensated Respiratory alkalosis or fully compensated metabolic acidosis
30. Partially Compensated Respiratory Alkalosis / uncompensated because pH isn’t within range)
31. Uncompensated respiratory acidosis
32. Uncompensated respiratory acidosis
33. Uncompensated Metabolic Acidosis
Answers
34. normal balance
35. Partially Compensated metabolic acidosis
36. Fully Compensated Respiratory alkalosis or fully compensated metabolic acidosis
37. Uncompensated Metabolic Acidosis
38. fully compensated Respiratory acidosis or fully compensated metabolic alkalosis
39. fully compensated Respiratory acidosis or fully compensated metabolic alkalosis
40. Uncompensated Metabolic Acidosis
41. Uncompensated Metabolic Alkalosis
42. Partially Compensated metabolic acidosis
43. normal balance
44. Partially Compensated Respiratory Alkalosis / uncompensated because pH isn’t within range)
45. fully compensated Respiratory acidosis or fully compensated metabolic alkalosis
46. Partially Compensated metabolic acidosis
47. Uncompensated Metabolic Acidosis
48. normal balance
49. Uncompensated Metabolic Alkalosis
50. normal balance
51. Fully compensate respiratory acidosis or fully compensated metabolic alkalosis
52. Fully Compensated Respiratory alkalosis or fully compensated metabolic acidosis
53. Fully compensate respiratory acidosis or fully compensated metabolic alkalosis
54. Partially Compensated metabolic acidosis
Notes: