Interpretation: Compensated and Uncompensated Blood Gas Analysis

James Barnett, RN, MSN Clinical Educator Neuroscience PCC Vanderbilt University Medical Center May 2007

Compensatory Mechanisms


Compensation is the bodys way of restoring a normal blood pH Remember: Acid + Base Neutrality

Compensation DOES NOT treat the root of the problem the reason for the acid-base acidimbalance is STILL THERE!!!

Compensatory Mechanisms


The body has three means to try to compensate for an acid-base imbalance acid

Chemical Respiratory Renal

Chemical Compensation


 

Chemicals within the blood act within seconds to correct respiratory or metabolic imbalances Used up quickly not effective long-term longChemical buffers in the blood include
Bicarbonate  Phosphate  Proteins


Respiratory Compensation


Used to compensate for metabolic imbalances only Chemoreceptors respond to changes in H+ concentrations alters respiratory rate and depth Remember CO2 is an acid

Respiratory Compensation


Respiratory Rate will



Increase when blood H+ is increased (acidic pH)

CO2 is blown off  Amount of acid in blood is decreased


Decrease when H+ is decreased (alkaline pH)

CO2 is retained  Amount of acid in blood is increased


Respiratory Compensation


This means


Metabolic acidosis causes an increase in rate and depth of ventilation as the body attempts to get rid of acid (CO2) Metabolic alkalosis causes a decrease in rate and depth of ventilation as the body attempts to retain acid (CO2)

Renal Compensation
  

Used to compensate for respiratory imbalances Remember: HCO3- is a base Kidneys respond to changes in blood pH
Excrete H+ and retain HCO3- when acidemia is present (1:1 ratio)  Retain H+ and excrete HCO3- when alkalemia is present (1:1 ratio)


Renal Compensation


This means


A respiratory acidosis will make the kidneys excrete acid (H+) and retain base (HCO3-) A respiratory alkalosis will make the kidneys excrete base (HCO3-) and retain acid (H+)

Renal Compensation


This is the slowest compensation May take hours to days Most powerful method of compensation Ineffective in patients with renal failure

Note on Compensation

The body is very smart and will not overcompensate for an imbalance

Degrees of Compensation


An acid-base imbalance will be compensated for acidin one of three ways



Uncompensated Partially compensated Fully compensated

Degrees of Compensation


Uncompensated


Body has made no attempt to correct the acid-base acidimbalance

Partially compensated
Body is attempting to correct the imbalance  Blood pH remains abnormal in spite of the attempt


Degrees of Compensation


Fully compensated


The body is correcting the imbalance Blood pH is normal Other blood gas values remain abnormal until the root cause is treated and corrected

Uncompensated AcidAcid-Base Imbalance

Uncompensated Imbalance
  

pH abnormal Either PaCO2 OR HCO3- abnormal All other values normal If PaCO2 is abnormal


Problem is respiratory Problem is metabolic

If HCO3- is abnormal


Uncompensated Imbalance


Uncompensated respiratory acidosis pH PaCO2 HCO3< 7.35 > 45 WNL

Uncompensated respiratory alkalosis pH PaCO2 HCO3> 7.45 < 35 WNL

  

  

Remember that CO2 is an acid and that the more of it there is the worse is the acidemia. Notice that with uncompensated respiratory, the HCO3 is normal this is because the body has not began to compensate for the alterations in CO2

Uncompensated Imbalance


Uncompensated metabolic acidosis pH PaCO2 HCO3< 7.35 WNL < 22

Uncompensated metabolic alkalosis pH PaCO2 HCO3> 7.45 WNL > 26

  

  

Remember that HCO3 is a base and that the more of it there is the more alkalotic you will be. Notice that in the case of uncompensated metabolic the PaCO2 is normal indicating that the body has not began to compensate.

Partially Compensated Imbalances



Occur when compensation mechanisms are activated, but have not had sufficient time to normalize the blood pH NOTE: Some people say that there is no such thing as partially compensated it is kind of like being a little pregnant but it is indicative of a part of the process called compensation

Partially Compensated Imbalances

 

pH is abnormal Both PaCO2 and HCO3- are abnormal in the same direction (increased or decreased from normal)
If PaCO2 is high ( acid), HCO3- will also be high ( alkaline) to neutralize the environment  If PaCO2 is low ( acid), HCO3- will also be low ( alkaline) to neutralize the environment


Partially Compensated Imbalances



Partially Compensated Respiratory Acidosis pH PaCO2 HCO3< 7.35 > 45 > 26

Partially Compensated Respiratory Alkalosis pH PaCO2 HCO3> 7.45 < 35 < 22

  

  

In the case of Partially Compensated Resp Acidosis, the pH is low, indicating an acid environmentwhen you look at the PaCO2, it too is acidic, which is how you know that you have a respiratory acidosis. With the HCO3 being high, you can deduce that the body is raising its base to counteract the acid represented by the pH; therefore, partially compensated respiratory acidosis.

Partially Compensated Imbalances



Partially Compensated Metabolic Acidosis pH PaCO2 HCO3< 7.35 < 35 < 22

Partially Compensated Metabolic Alkalosis pH PaCO2 HCO3> 7.45 > 45 > 26

  

  

With partially compensated metabolic acidosis, you notice first that the pH is low (acidosis). Ask yourself, which number is representative of an acid condition. In this case it is the low base (HCO3), so you know you have a metabolic acidosis. You know it is partially compensated because the PaCO2 is low indicating that CO2 (an acid) is being lost from the body to correct for the low pH.

Compensated Imbalances

Occur when compensatory mechanisms have been able to fully normalize blood pH

Compensatory Mechanisms


Both PaCO2 and HCO3- are abnormal, but in the same direction


If PaCO2 is high ( acid), HCO3- will also be high ( alkaline) If PaCO2 is low ( acid), HCO3- will also be low ( alkaline)

Compensated Imbalances


Compensated Respiratory Acidosis pH WNL but closer to 7.35 > 45 > 26

Compensated Respiratory Alkalosis pH WNL but closer to 7.45 < 35 < 22

 

PaCO2 HCO3-

 

PaCO2 HCO3-

In compensated respiratory acidosis, the pH tends to range between 7.35 and 7.39 still acidic, But in the normal pH range. When you look at the PaCO2, you notice that it is high (acidic), but The HCO3 is also high, indicating that the body has compensated and normalized the low pH.

Compensated Imbalances


Compensated Metabolic Acidosis pH WNL but closer to 7.35 < 35 < 22

Compensated Metabolic Alkalosis pH WNL but closer to 7.45 > 45 > 26

 

PaCO2 HCO3-

 

PaCO2 HCO3-

Mixed Imbalances


Occur when patient has both metabolic and respiratory disorders that cause an acid-base acidimbalance Examples:
Diabetic KetoAcidosis (metabolic acidosis) with decreased respiratory drive (respiratory acidosis)  Severe vomiting (metabolic alkalosis) with high fever (respiratory alkalosis)


Mixed Imbalances


pH will be normal PaCO2 and HCO3- will be abnormal PaCO2 will be high with low HCO3- (both tend toward acid side) PaCO2 will be low with high HCO3- (both tend toward base side)

Mixed Imbalances


Mixed acidosis pH PaCO2 HCO3< 7.35 > 45 < 22

Mixed alkalosis pH PaCO2 HCO3> 7.45 < 35 > 26

  

  

Notice with the mixed acidosis that you have an acidic pH (less than 7.35, with other Parameters indicating an acid environment. High PaCO2 (too much acid). Low HCO3 (too little base an acidic environment). This is classic mixed acidosis.

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Effects of Acid Base on Oxygenation