Usefulness

This method is simple, easy and can be used for the majority of ABGs. It only addresses acid-base balance and considers just 3
values.

 pH,
 PaCO2
 HCO3-

Step 1. Use pH to determine Acidosis or Alkalosis.

   ph
 < 7.35  7.35-7.45  > 7.45
 Normal or
 Acidosis  Alkalosis
Compensated

Step 2. Use PaCO2 to determine respiratory effect.

   PaCO2
 < 35  35 -45 > 45

  Tends toward  Normal   Tends toward

alkalosis acidosis
 Causes high pH  Causes low pH
 Neutralizes low or  Neutralizes high
pH pH
Compensated

Step 3. Assume metabolic cause when respiratory is ruled out.

 You'll be right most of the time if you remember this simple table:

 High pH Low pH
 Alkalosis Acidosis
 High PaCO2 Low PaCO2 High PaCO2 Low PaCO2
 Metabolic Respiratory Respiratory Metabolic

 If PaCO2 is abnormal and pH is normal, it indicates compensation.

o pH > 7.4 would be a compensated alkalosis.
o pH < 7.4 would be a compensated acidosis.

Step 4. Use HC03 to verify metabolic effectNormal

HCO3- is 22-26

Please note:Remember, the first three steps apply to the majority of cases, but do not take into account:

o the possibility of complete compensation, but those cases are usually less serious, and
o instances of combined respiratory and metabolic imbalance, but those cases are pretty rare.
 "Combined" disturbance means HCO3- alters the pH in the same direction as the PaCO2.
 High PaCO2 and low HCO3- (acidosis) or
 Low PaCO2 and high HCO3- (alkalosis).