Interpretation of Acid Base Status

1. Using a pH of 7.40 as absolute normal, classify the pH as being either Acidic (acidosis
or Basic (al!alosis
". Using a #a$%" of 40 mm Hg as absolute normal, classify the #a$%" as being either
Acidic (#a$%" & 40 mm Hg or Basic (#a$%" ' 40 mm Hg
(. Using a H$%(
)
of "4 m*+,- as absolute normal, classify the H$%(
)
as being either Acidic
(H$%(
)
' "4 m*+,- or Basic (H$%(
)
& "4 m*+,-
.ormal /anges 0bsolute .ormal 0cidic 1asic
pH 7.(2 3 7.42 7.40 ' 7.40 & 7.40
#a$%" mm Hg (2 ) 42 40 & 40 ' 40
H$%(
)
m*+,- "" 3 "4 "4 ' "4 & "4
4. Identify the parameter (#a$%" or H$%(
)
5hich correlates 5ith the pH.
a. If the pH and #a$%" correlate, this indicates a respiratory impairment
or
b. If the pH and H$%(
)
correlate, this indicates a metabolic impairment
2. Identify if there is respiratory or renal compensation present
a. If the non)correlating parameter is 5ithin normal limits, this 5ould be
classified as an uncompensated or acute impairment
or
b. If the non)correlating parameter is outside of normal range, this 5ould be
classified as either a compensated or partially compensated impairment
i. If the pH is in normal range, the 016 is interpreted as compensated
ii. If the pH is not in normal range, the 016 is interpreted as partially
compensated
c. /espiratory compensation is usually complete in 1" 3 "4 hours.
d. /enal compensation ta!es ( 3 2 days to complete. 7he !idneys 5ill retain or
e8crete H$%(
)
to pro9ide compensation.
Case Examples for Arterial Blood Gas Interpretation
Respiratory Alkalosis
Example 1 Acid or Base Comments
pH 7.47 1 %utside normal range
#a$%" mm Hg (0 1 $orrelates 5ith pH (respiratory problem
H$%(
)
m*+,- "( 0 :ithin normal range (uncompensated
Interpretation; Uncompensated /espiratory 0l!alosis (0cute 0l9eolar Hyper9entilation
Example 2 0cid or 1ase Comments
pH 7.44 1 %utside normal range (partially compensated
#a$%" mm Hg (0 1 $orrelates 5ith pH (respiratory problem
H$%(
)
m*+,- "1 0 %utside normal range (compensated
Interpretation; #artially $ompensated /espiratory 0l!alosis
Example 3 0cid or 1ase Comments
pH 7.44 1 In normal range (compensated
#a$%" mm Hg (0 1 $orrelates 5ith pH (respiratory problem
H$%(
)
m*+,- 1< 0 %utside normal range (compensated
Interpretation; $ompensated /espiratory 0l!alosis ($hronic 0l9eolar Hyper9entilation
Respiratory Acidosis
Example 4 0cid or 1ase Comments
pH 7.(0 0 %utside normal range
#a$%" mm Hg 42 0 $orrelates 5ith pH (respiratory problem
H$%(
)
m*+,- "2 1 :ithin normal range (uncompensated
Interpretation; Uncompensated /espiratory 0cidosis (0cute =entilatory >ailure
Example 5 0cid or 1ase Comments
pH 7.(( 0 %utside normal range (partially compensated
#a$%" mm Hg 42 0 $orrelates 5ith pH (respiratory problem
H$%(
)
m*+,- "7 1 %utside normal range (compensated
Interpretation; #artially $ompensated /espiratory 0cidosis
Example 0cid or 1ase Comments
pH 7.(4 0 In normal range (compensated
#a$%" mm Hg 42 0 $orrelates 5ith pH (respiratory problem
H$%(
)
m*+,- (0 1 %utside normal range (compensated
Interpretation; $ompensated /espiratory 0cidosis ($hronic =entilatory >ailure
!eta"olic Alkalosis
Example # Acid or Base Comments
pH 7.4< 1 %utside normal range
#a$%" mm Hg 4" 0 :ithin normal range (uncompensated
H$%(
)
m*+,- "< 1 $orrelates 5ith pH (metabolic problem
Interpretation; Uncompensated ?etabolic 0l!alosis
Example $ 0cid or 1ase Comments
pH 7.47 1 %utside normal range (partially compensated
#a$%" mm Hg 47 0 %utside normal range (compensated
H$%(
)
m*+,- "< 1 $orrelates 5ith pH (metabolic problem
Interpretation; #artially $ompensated ?etabolic 0l!alosis
Example % 0cid or 1ase Comments
pH 7.42 1 In normal range (compensated
#a$%" mm Hg 4< 0 %utside normal range (compensated
H$%(
)
m*+,- "< 1 $orrelates 5ith pH (metabolic problem
Interpretation; $ompensated ?etabolic 0l!alosis
!eta"olic Acidosis
Example 1& Acid or Base Comments
pH 7.(1 0 %utside normal range
#a$%" mm Hg (@ 1 :ithin normal range (uncompensated
H$%(
)
m*+,- "0 0 $orrelates 5ith pH (metabolic problem
Interpretation; Uncompensated ?etabolic 0cidosis
Example 11 0cid or 1ase Comments
pH 7.(( 0 %utside normal range (partially compensated
#a$%" mm Hg (( 1 %utside normal range (compensated
H$%(
)
m*+,- "0 0 $orrelates 5ith pH (metabolic problem
Interpretation; #artially $ompensated ?etabolic 0cidosis
Example 12 0cid or 1ase Comments
pH 7.(2 0 In normal range (compensated
#a$%" mm Hg (1 1 %utside normal range (compensated
H$%(
)
m*+,- "0 0 $orrelates 5ith pH (metabolic problem
Interpretation; $ompensated ?etabolic 0cidosis
!ixed Alkalosis
Example 13 0cid or 1ase Comments
pH 7.2@ 1 %utside normal range
#a$%" mm Hg (0 1 %utside normal range
H$%(
)
m*+,- "@ 1 %utside normal range
Interpretation; ?i8ed /espiratory and ?etabolic 0l!alosis
!ixed Acidosis
Example 14 0cid or 1ase Comments
pH 7."< 0 %utside normal range
#a$%" mm Hg 22 0 %utside normal range
H$%(
)
m*+,- "0 0 %utside normal range
Interpretation; ?i8ed /espiratory and ?etabolic 0cidosis
Exceptions to t'e R(le
Example 15 0cid or 1ase Comments
pH 7.22 1 %utside normal range (partially compensated
#a$%" mm Hg 2( 0 %utside normal range (compensated
H$%(
)
m*+,- (" 1 $orrelates 5ith pH (metabolic problem
Interpretation; 0cute 0l9eolar Hyper9entilation Superimposed on $hronic =entilatory
>ailure
$omments; -oo!s li!e partially compensated metabolic al!alosis. 7his 5ould be seen in
a patient 5ith a history of $%#A 5ho presents 5ith hypo8ia, increased 5or! of
breathing, dyspnea, tachycardia and tachypnea due to an acute episode. 7he patient
appears to ha9e a metabolic al!alosis because their #a$%" is normally higher and renal
compensation has occurred. 7he hypo8emia causes an increased respiratory rate 5hich
decreases the #a$%" from baseline. 7his patient 5ill de9elop 0cute on $hronic
=entilatory >ailure (see e8ample 14 and may re+uire 9entilatory support if treatment is
not effecti9e.
Example 1 0cid or 1ase Comments
pH 7."< 0 %utside normal range (partially compensated
#a$%" mm Hg 72 0 $orrelates 5ith pH (respiratory problem
H$%(
)
m*+,- (0 1 %utside normal range (compensated
Interpretation; 0cute on $hronic =entilatory >ailure
$omments; -oo!s li!e partially compensated respiratory acidosis. 7his 5ould be seen in
a patient 5ith a history of $%#A 5ho de9elops respiratory failure as the result of an
acute episode such as pneumonia in addition to their $%#A. 7he patientBs #a$%" is
higher than baseline causing the pH to fall belo5 normal range. 7his patient 5ill re+uire
aggressi9e treatment and may re+uire 9entilatory support.