Acidosis and Alkalosis

Video

This is a great SIMPLE and quick explanation of Acidosis and Alkalosis for nurses. It does not give you a great deal of details. It is to teach you the basic knowledge of the concepts. This is the way I learned how to do ABG questions after being thoroughly confused in the beginning.

See Below for more Explanation on this (found on All Nurses website):

NORMAL VALUES
pH
7.35-7.45
CO2 (carbon dioxide-acidic) 35-45
HCO3 (bicarbonate-alkaline) 22-26

Always look at your pH first. If its high, then it’s alkaline. If it’s low, it’s acidic.
Then look for another odd value.

If you see an increased pH, increased CO2, and increased HCO3 we at least know the pH is alkaline. But is it respiratory or metabolic? Using the ROME method we knowRespiratory is Opposite (look at pH & CO2) & Metabolic is Equal (look at pH & HCO3). Ok, so pH is high & CO2 is high. It can’t be respiratory because the values should be opposite. If it were respiratory then CO2 would be lower. Our pH is high & our HCO3 is high, so it must be metabolic because values are both higher than normal. Why is the CO2 high as well? Because it’s compensating! The body is more alkaline, so the lungs will retain CO2 to lower the pH.

Rules for compensation:
2 odd values = uncompensated
3 odd values (NO normals) = partially compensated
when pH returns to normal value (1 normal) = fully compensated

Respiratory acidosis examples:

pH <7.35 PCO2 >45 HCO3 22-26 (uncompensated)
pH <7.35 PCO2 >45 HCO3 >26 (partially compensated)
pH 7.35-7.45 PCO2 >45 HCO3 >26 (fully compensated)

PH was low & CO2 was high, so HCO3 increases to compensate. The pH will rise in response to bicarb release from the kidneys. When the bicarb is enough to bring the pH within normal levels the HCO3 is said to be fully compensating the pH. The pH level is within normal limits, but CO2 and HCO3 are not until things eventually normalize.


Respiratory alkalosis examples:

pH >7.45 PCO2 <35 HCO3 22-26 (uncompensated)
pH >7.45 PCO2 <35 HCO3 <22 (partially compensated)
pH 7.35-7.45 PCO2 >45 HCO3 <22 (fully compensated)


Metabolic acidosis examples:

pH <7.35 PCO2 35-45 HCO3 <22 (uncompensated)
pH <7.35 PCO2 <35 HCO3 <22 (partially compensated)
pH 7.35-7.45 PCO2 <35 HCO3 <22 (fully compensated)

Metabolic alkalosis examples:

pH >7.45 PCO2 35-45 HCO3 >26 (uncompensated)
pH >7.45 PCO2 >45 HCO3 >26 (partially compensated)
pH 7.35-7.45 PCO2 >45 HCO3 >26 (fully compensated)

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