Compensation:

Interpreting ABGs If:

pH < 7.35 pH > 7.35 ΔPCO2/ΔHCO3
=
Acidosis Alkalosis CO2/HCO3ratio
Then it IS comp.

pCO2 > 40 HCO3 < 24 pCO2 < 40 HCO3 > 24

Respiratory Metabolic Respiratory Metabolic

Acute
Acute
PaCO2 ↑10 PaCO2 ↓12 PaCO2 ↓10 PaCO2 ↑7
→HCO3 ↑1 →HCO3 ↓2
→HCO3 ↓10 →HCO3 ↑10
Chronic
=Na - (Cl+HCO3) Chronic
PaCO2 ↑10 PaCO2 ↓10
→HCO3 ↑4 →HCO3 ↓4 Urine Cl < 10 Urine Cl > 10
Anion Gap < 12 Anion Gap > 12 Cl Responsive Cl Unresponsive
Non-Anion Gap Anion Gap

HCO3 loss Extra H+

Diarrhea (2xNa) + (Glu/18) +

Renal tubular acidosis (BUN/2.8) = calculated

Acetazolamide
serum osmoles Excess body fluids:
Total parenteral nutrition Exogenous steroids
Ureteral diversion Cushing’s syndrome
Osm Gap > 10
Pancreas transplant Anxiety/pain Hyperaldosteronism
Methanol
Sepsis Bartter’s syndrome
Ethylene Glycol
CNS depressants CNS (stroke)
Neuromuscular disorder Osmolar Gap < 10 Aspirin OD Loss of body fluids:
Thoracic cage abnormalities Ketoacidosis Chronic liver disease Vomiting
Obstructive lung disease Lactic acidosis Pulmonary embolism Nasogastric suctioning
Obesity/hypoventilation syndrome Uremia Pregnancy Diuretic use
Myxedema coma Aspirin/salicylate tox Hyperthyroidism