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 acidbase imbalance is STILL THERE!!!

Compensatory
Mechanisms

The body has three means to try to

compensate for an acid-base
imbalance

Chemical

Respiratory

Renal

Chemical Compensation

Chemicals within the blood act within

seconds to correct respiratory or
metabolic imbalances
Used up quickly not effective longterm
Chemical 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 in one of three ways

Uncompensated

Partially compensated

Fully compensated

Degrees of
Compensation

Uncompensated

Body has made no attempt to correct the

acid-base imbalance

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
Acid-Base
Imbalance

Uncompensated
Imbalance

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

If PaCO2 is abnormal

Problem is respiratory

If HCO3- is abnormal

Problem is metabolic

Uncompensated
Imbalance

Uncompensated
respiratory
acidosis

Uncompensated
respiratory
alkalosis

pH
< 7.35
PaCO2 > 45
HCO3- WNL

pH
> 7.45
PaCO2 < 35
HCO3- WNL

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

Uncompensated
Imbalance

Uncompensated
metabolic acidosis

Uncompensated
metabolic alkalosis

pH
< 7.35
PaCO2 WNL
HCO3- < 22

pH
> 7.45
PaCO2 WNL
HCO3- > 26

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

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

Partially
Compensated
Respiratory
Alkalosis

pH
pH
< 7.35
> 7.45
PaCO2 > 45
PaCO2 < 35
In the case of Partially Compensated Resp Acidosis, the pH is low, indica
- it<
acid
environmentwhen
PaCO2,
too22
is acidic, which is
HCO
> 26 you look at the
HCO
3
3

know that you have a respiratory acidosis. With the HCO3 being high, y
deduce that the body is raising its base to counteract the acid represent
therefore, partially compensated respiratory acidosis.

Partially Compensated
Imbalances

Partially
Compensated
Metabolic Acidosis

Partially
Compensated
Metabolic Alkalosis

pH
pH
< 7.35
> 7.45
PaCO2 < 35
PaCO2 > 45
HCO3 HCO3<
22
> 26
With partially compensated metabolic acidosis, you notice first that the pH

Ask yourself, which number is representative of an acid condition. In this c

base (HCO3), so you know you have a metabolic acidosis. You know it is pa
because the PaCO2 is low indicating that CO2 (an acid) is being lost from t
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

Compensated
Respiratory
Alkalosis

pH
WNL but
WNL but
closer to
closer to
7.35
7.45
PaCO2 > 45
PaCO2 < 35
In
pH tends
to<
range
compensated
HCO3- respiratory
> 26 acidosis,theHCO
22 between 7.35 a
3

pH

But in the normal pH range. When you look at the PaCO2, you notice that
The HCO3 is also high, indicating that the body has compensated and norm

Compensated Imbalances

Compensated
Metabolic Acidosis

Compensated
Metabolic Alkalosis

pH

pH

WNL but
closer to
7.35
PaCO2 < 35
HCO3- < 22

WNL but
closer to
7.45
PaCO2 > 45
HCO3- > 26

Mixed Imbalances

Occur when patient has both

metabolic and respiratory disorders
that cause an acid-base imbalance
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

Mixed alkalosis

pH
< 7.35
PaCO2 > 45
HCO3- < 22

pH
> 7.45
PaCO2 < 35
HCO3- > 26

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

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Effects of Acid Base on Oxygenation