Acid-Base work book - Precious Bodily Fluids - Free Printable
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Step-by-step solution for: Acid-Base work book - Precious Bodily Fluids
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Step-by-step solution for: Acid-Base work book - Precious Bodily Fluids
To determine the primary acid-base disorder in each case, we analyze arterial blood gas (ABG) values using the following steps:
- pH < 7.35: Acidemia (acidosis)
- pH > 7.45: Alkalemia (alkalosis)
- pH 7.35–7.45: Normal
- If pCO₂ is abnormal → respiratory component
- ↑ pCO₂ = Respiratory acidosis
- ↓ pCO₂ = Respiratory alkalosis
- If HCO₃⁻ is abnormal → metabolic component
- ↑ HCO₃⁻ = Metabolic alkalosis
- ↓ HCO₃⁻ = Metabolic acidosis
- In acute vs. chronic disorders, kidneys or lungs compensate.
- But for primary disorder, we look at which parameter is *driving* the pH change.
---
Let’s go through each one:
---
- pH ↓ → Acidemia
- pCO₂ ↓ → Respiratory alkalosis? No — but it's low, so it's compensatory
- HCO₃⁻ ↓ → Metabolic acidosis
✔ Primary: Metabolic acidosis (low HCO₃⁻), with respiratory compensation (low pCO₂)
---
- pH ↓ → Acidemia
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ normal (26) → no metabolic compensation yet
✔ Primary: Respiratory acidosis
---
- pH ↑ → Alkalemia
- pCO₂ ↑ → Respiratory acidosis? But pH is high → contradiction
- HCO₃⁻ ↑ → Metabolic alkalosis
→ pCO₂ is elevated → could be compensation
But pH is normal to high, HCO₃⁻ is high → Metabolic alkalosis with partial respiratory compensation (retained CO₂)
✔ Primary: Metabolic alkalosis
---
- pH ↓ → Acidemia
- pCO₂ ↓ → Respiratory alkalosis (compensatory)
- HCO₃⁻ ↓ → Metabolic acidosis
✔ Primary: Metabolic acidosis (severe), with respiratory compensation
---
- pH ↓ → Acidemia (slightly)
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ ↑ → Metabolic alkalosis (but mild)
But pH is still acidic, and pCO₂ is high → likely Respiratory acidosis
HCO₃⁻ is slightly elevated → possible partial renal compensation
✔ Primary: Respiratory acidosis
---
- pH ↓ → Acidemia
- pCO₂ ↑ ↑ → Severe respiratory acidosis
- HCO₃⁻ ↑ ↑ → Renal compensation (metabolic alkalosis)
But pH is acidic, so primary driver is high pCO₂
✔ Primary: Respiratory acidosis (chronic, compensated)
---
- pH ↓ → Acidemia
- pCO₂ ↓ → Respiratory alkalosis (compensation)
- HCO₃⁻ ↓ → Metabolic acidosis
✔ Primary: Metabolic acidosis, with respiratory compensation
---
- pH ↓ → Acidemia
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ normal
→ Slight acidosis, pCO₂ elevated, HCO₃⁻ unchanged → Respiratory acidosis
✔ Primary: Respiratory acidosis
---
- pH ↑ → Alkalemia (mild)
- pCO₂ ↑ → Respiratory acidosis? But pH is high → not matching
- HCO₃⁻ ↑ → Metabolic alkalosis
→ pCO₂ is slightly high → may be compensation for metabolic alkalosis
✔ Primary: Metabolic alkalosis
---
- pH ↑ → Alkalemia
- pCO₂ ↑ → Respiratory acidosis? But pH is high → not consistent
- HCO₃⁻ ↑ ↑ → Metabolic alkalosis
→ High HCO₃⁻, high pCO₂ → Metabolic alkalosis with respiratory compensation (retention of CO₂)
✔ Primary: Metabolic alkalosis
---
- pH ↑ → Alkalemia
- pCO₂ ↓ → Respiratory alkalosis
- HCO₃⁻ ↓ → Metabolic acidosis
But pH is high, pCO₂ is low → Respiratory alkalosis
HCO₃⁻ is low → compensation (renal excretion of HCO₃⁻)
✔ Primary: Respiratory alkalosis
---
- pH ↓ → Acidemia
- pCO₂ ↓ → Respiratory alkalosis (compensation)
- HCO₃⁻ ↓ → Metabolic acidosis
→ Low HCO₃⁻ drives acidosis; low pCO₂ is compensatory
✔ Primary: Metabolic acidosis
---
- pH ↓ → Acidemia
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ normal
→ Respiratory acidosis (pCO₂ high, pH low)
✔ Primary: Respiratory acidosis
---
- pH ↓ → Acidemia
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ ↑ → Metabolic alkalosis (compensation)
→ Primary is Respiratory acidosis with renal compensation
✔ Primary: Respiratory acidosis
---
- pH ↓ → Acidemia
- pCO₂ normal
- HCO₃⁻ ↓ → Metabolic acidosis
→ Metabolic acidosis (no respiratory compensation yet)
✔ Primary: Metabolic acidosis
---
- pH ↑ → Alkalemia
- pCO₂ ↑ → Respiratory acidosis? But pH is high → contradiction
- HCO₃⁻ ↑ → Metabolic alkalosis
→ Metabolic alkalosis with respiratory compensation (retained CO₂)
✔ Primary: Metabolic alkalosis
---
- pH ↑ → Alkalemia
- pCO₂ ↓ → Respiratory alkalosis
- HCO₃⁻ normal
→ Respiratory alkalosis (pCO₂ low, pH high)
✔ Primary: Respiratory alkalosis
---
- pH ↑ → Alkalemia
- pCO₂ ↑ → Respiratory acidosis? But pH is high → not matching
- HCO₃⁻ ↑ → Metabolic alkalosis
→ Metabolic alkalosis with respiratory compensation (CO₂ retention)
✔ Primary: Metabolic alkalosis
---
- pH ↓ → Acidemia
- pCO₂ ↓ → Respiratory alkalosis (compensation)
- HCO₃⁻ ↓ → Metabolic acidosis
→ Metabolic acidosis with respiratory compensation
✔ Primary: Metabolic acidosis
---
- pH ↓ → Acidemia
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ ↑ → Metabolic alkalosis (compensation)
→ Respiratory acidosis with renal compensation
✔ Primary: Respiratory acidosis
---
| # | Primary Acid-Base Disorder |
|---|----------------------------|
| 1 | Metabolic acidosis |
| 2 | Respiratory acidosis |
| 3 | Metabolic alkalosis |
| 4 | Metabolic acidosis |
| 5 | Respiratory acidosis |
| 6 | Respiratory acidosis |
| 7 | Metabolic acidosis |
| 8 | Respiratory acidosis |
| 9 | Metabolic alkalosis |
| 10 | Metabolic alkalosis |
| 11 | Respiratory alkalosis |
| 12 | Metabolic acidosis |
| 13 | Respiratory acidosis |
| 14 | Respiratory acidosis |
| 15 | Metabolic acidosis |
| 16 | Metabolic alkalosis |
| 17 | Respiratory alkalosis |
| 18 | Metabolic alkalosis |
| 19 | Metabolic acidosis |
| 20 | Respiratory acidosis |
---
- Metabolic acidosis: HCO₃⁻ ↓, pH ↓, pCO₂ ↓ (compensatory)
- Respiratory acidosis: pCO₂ ↑, pH ↓, HCO₃⁻ ↑ (compensatory)
- Metabolic alkalosis: HCO₃⁻ ↑, pH ↑, pCO₂ ↑ (compensatory)
- Respiratory alkalosis: pCO₂ ↓, pH ↑, HCO₃⁻ ↓ (compensatory)
The primary disorder is determined by which value is most abnormal and driving the pH change.
Let me know if you'd like a chart or mnemonic!
Step 1: Evaluate pH
- pH < 7.35: Acidemia (acidosis)
- pH > 7.45: Alkalemia (alkalosis)
- pH 7.35–7.45: Normal
Step 2: Identify the primary cause
- If pCO₂ is abnormal → respiratory component
- ↑ pCO₂ = Respiratory acidosis
- ↓ pCO₂ = Respiratory alkalosis
- If HCO₃⁻ is abnormal → metabolic component
- ↑ HCO₃⁻ = Metabolic alkalosis
- ↓ HCO₃⁻ = Metabolic acidosis
Step 3: Determine compensation
- In acute vs. chronic disorders, kidneys or lungs compensate.
- But for primary disorder, we look at which parameter is *driving* the pH change.
---
Let’s go through each one:
---
1. pH = 7.27 / pCO₂ = 34 / HCO₃⁻ = 15
- pH ↓ → Acidemia
- pCO₂ ↓ → Respiratory alkalosis? No — but it's low, so it's compensatory
- HCO₃⁻ ↓ → Metabolic acidosis
✔ Primary: Metabolic acidosis (low HCO₃⁻), with respiratory compensation (low pCO₂)
---
2. pH = 7.34 / pCO₂ = 50 / HCO₃⁻ = 26
- pH ↓ → Acidemia
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ normal (26) → no metabolic compensation yet
✔ Primary: Respiratory acidosis
---
3. pH = 7.45 / pCO₂ = 48 / HCO₃⁻ = 32
- pH ↑ → Alkalemia
- pCO₂ ↑ → Respiratory acidosis? But pH is high → contradiction
- HCO₃⁻ ↑ → Metabolic alkalosis
→ pCO₂ is elevated → could be compensation
But pH is normal to high, HCO₃⁻ is high → Metabolic alkalosis with partial respiratory compensation (retained CO₂)
✔ Primary: Metabolic alkalosis
---
4. pH = 7.32 / pCO₂ = 28 / HCO₃⁻ = 14
- pH ↓ → Acidemia
- pCO₂ ↓ → Respiratory alkalosis (compensatory)
- HCO₃⁻ ↓ → Metabolic acidosis
✔ Primary: Metabolic acidosis (severe), with respiratory compensation
---
5. pH = 7.37 / pCO₂ = 50 / HCO₃⁻ = 28
- pH ↓ → Acidemia (slightly)
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ ↑ → Metabolic alkalosis (but mild)
But pH is still acidic, and pCO₂ is high → likely Respiratory acidosis
HCO₃⁻ is slightly elevated → possible partial renal compensation
✔ Primary: Respiratory acidosis
---
6. pH = 7.36 / pCO₂ = 80 / HCO₃⁻ = 44
- pH ↓ → Acidemia
- pCO₂ ↑ ↑ → Severe respiratory acidosis
- HCO₃⁻ ↑ ↑ → Renal compensation (metabolic alkalosis)
But pH is acidic, so primary driver is high pCO₂
✔ Primary: Respiratory acidosis (chronic, compensated)
---
7. pH = 7.32 / pCO₂ = 36 / HCO₃⁻ = 18
- pH ↓ → Acidemia
- pCO₂ ↓ → Respiratory alkalosis (compensation)
- HCO₃⁻ ↓ → Metabolic acidosis
✔ Primary: Metabolic acidosis, with respiratory compensation
---
8. pH = 7.36 / pCO₂ = 48 / HCO₃⁻ = 26
- pH ↓ → Acidemia
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ normal
→ Slight acidosis, pCO₂ elevated, HCO₃⁻ unchanged → Respiratory acidosis
✔ Primary: Respiratory acidosis
---
9. pH = 7.43 / pCO₂ = 45 / HCO₃⁻ = 29
- pH ↑ → Alkalemia (mild)
- pCO₂ ↑ → Respiratory acidosis? But pH is high → not matching
- HCO₃⁻ ↑ → Metabolic alkalosis
→ pCO₂ is slightly high → may be compensation for metabolic alkalosis
✔ Primary: Metabolic alkalosis
---
10. pH = 7.47 / pCO₂ = 54 / HCO₃⁻ = 38
- pH ↑ → Alkalemia
- pCO₂ ↑ → Respiratory acidosis? But pH is high → not consistent
- HCO₃⁻ ↑ ↑ → Metabolic alkalosis
→ High HCO₃⁻, high pCO₂ → Metabolic alkalosis with respiratory compensation (retention of CO₂)
✔ Primary: Metabolic alkalosis
---
11. pH = 7.45 / pCO₂ = 18 / HCO₃⁻ = 12
- pH ↑ → Alkalemia
- pCO₂ ↓ → Respiratory alkalosis
- HCO₃⁻ ↓ → Metabolic acidosis
But pH is high, pCO₂ is low → Respiratory alkalosis
HCO₃⁻ is low → compensation (renal excretion of HCO₃⁻)
✔ Primary: Respiratory alkalosis
---
12. pH = 7.25 / pCO₂ = 14 / HCO₃⁻ = 8
- pH ↓ → Acidemia
- pCO₂ ↓ → Respiratory alkalosis (compensation)
- HCO₃⁻ ↓ → Metabolic acidosis
→ Low HCO₃⁻ drives acidosis; low pCO₂ is compensatory
✔ Primary: Metabolic acidosis
---
13. pH = 7.32 / pCO₂ = 46 / HCO₃⁻ = 26
- pH ↓ → Acidemia
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ normal
→ Respiratory acidosis (pCO₂ high, pH low)
✔ Primary: Respiratory acidosis
---
14. pH = 7.28 / pCO₂ = 68 / HCO₃⁻ = 36
- pH ↓ → Acidemia
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ ↑ → Metabolic alkalosis (compensation)
→ Primary is Respiratory acidosis with renal compensation
✔ Primary: Respiratory acidosis
---
15. pH = 7.38 / pCO₂ = 37 / HCO₃⁻ = 21
- pH ↓ → Acidemia
- pCO₂ normal
- HCO₃⁻ ↓ → Metabolic acidosis
→ Metabolic acidosis (no respiratory compensation yet)
✔ Primary: Metabolic acidosis
---
16. pH = 7.44 / pCO₂ = 48 / HCO₃⁻ = 29
- pH ↑ → Alkalemia
- pCO₂ ↑ → Respiratory acidosis? But pH is high → contradiction
- HCO₃⁻ ↑ → Metabolic alkalosis
→ Metabolic alkalosis with respiratory compensation (retained CO₂)
✔ Primary: Metabolic alkalosis
---
17. pH = 7.45 / pCO₂ = 28 / HCO₃⁻ = 22
- pH ↑ → Alkalemia
- pCO₂ ↓ → Respiratory alkalosis
- HCO₃⁻ normal
→ Respiratory alkalosis (pCO₂ low, pH high)
✔ Primary: Respiratory alkalosis
---
18. pH = 7.52 / pCO₂ = 58 / HCO₃⁻ = 34
- pH ↑ → Alkalemia
- pCO₂ ↑ → Respiratory acidosis? But pH is high → not matching
- HCO₃⁻ ↑ → Metabolic alkalosis
→ Metabolic alkalosis with respiratory compensation (CO₂ retention)
✔ Primary: Metabolic alkalosis
---
19. pH = 7.33 / pCO₂ = 34 / HCO₃⁻ = 13
- pH ↓ → Acidemia
- pCO₂ ↓ → Respiratory alkalosis (compensation)
- HCO₃⁻ ↓ → Metabolic acidosis
→ Metabolic acidosis with respiratory compensation
✔ Primary: Metabolic acidosis
---
20. pH = 7.34 / pCO₂ = 56 / HCO₃⁻ = 29
- pH ↓ → Acidemia
- pCO₂ ↑ → Respiratory acidosis
- HCO₃⁻ ↑ → Metabolic alkalosis (compensation)
→ Respiratory acidosis with renal compensation
✔ Primary: Respiratory acidosis
---
✔ Final Answers:
| # | Primary Acid-Base Disorder |
|---|----------------------------|
| 1 | Metabolic acidosis |
| 2 | Respiratory acidosis |
| 3 | Metabolic alkalosis |
| 4 | Metabolic acidosis |
| 5 | Respiratory acidosis |
| 6 | Respiratory acidosis |
| 7 | Metabolic acidosis |
| 8 | Respiratory acidosis |
| 9 | Metabolic alkalosis |
| 10 | Metabolic alkalosis |
| 11 | Respiratory alkalosis |
| 12 | Metabolic acidosis |
| 13 | Respiratory acidosis |
| 14 | Respiratory acidosis |
| 15 | Metabolic acidosis |
| 16 | Metabolic alkalosis |
| 17 | Respiratory alkalosis |
| 18 | Metabolic alkalosis |
| 19 | Metabolic acidosis |
| 20 | Respiratory acidosis |
---
Summary:
- Metabolic acidosis: HCO₃⁻ ↓, pH ↓, pCO₂ ↓ (compensatory)
- Respiratory acidosis: pCO₂ ↑, pH ↓, HCO₃⁻ ↑ (compensatory)
- Metabolic alkalosis: HCO₃⁻ ↑, pH ↑, pCO₂ ↑ (compensatory)
- Respiratory alkalosis: pCO₂ ↓, pH ↑, HCO₃⁻ ↓ (compensatory)
The primary disorder is determined by which value is most abnormal and driving the pH change.
Let me know if you'd like a chart or mnemonic!
Parent Tip: Review the logic above to help your child master the concept of acid base balance practice sheet.
