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Section 2 of 6 · Open sections

Required section · Section 2 of 6

Use the same worksheet every time

A fixed sequence makes contradictions visible before a label is released. Read pH, inspect PaCO2 and HCO3 directions, name the primary process, check expected compensation, then calculate anion gap and delta. The workflow separates what the method reports from what the pattern may mean.

With acidemia, high PaCO2 supports respiratory acidosis and low HCO3 supports metabolic acidosis. With alkalemia, low PaCO2 supports respiratory alkalosis and high HCO3 supports metabolic alkalosis. The companion value can be compensating, but its direction alone cannot prove adequate compensation.

With potassium excluded, anion gap equals Na − (Cl + HCO3−). Albumin is the largest unmeasured plasma anion, so hypoalbuminemia lowers the measured gap. Write evidence at every worksheet step before stating the pattern.

Illustrative drawing — this picture was drawn rather than captured.

Six boxes list pH, PCO2 direction, HCO3 direction, primary process, expected compensation, and anion gap plus delta.
Figure 1A six-step worksheet for every acid-base result.

Six-step blood-gas interpretation worksheet.

  1. Read pH

    Identify acidemia or alkalemia using the local interval.

  2. Inspect PCO2

    Note respiratory direction.

  3. Inspect HCO3

    Note metabolic direction.

  4. Name primary

    Name the direction explaining pH.

  5. Check compensation

    Use timing and an expected range.

  6. Check gap and delta

    Screen for a second process.

Knowledge checks

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Knowledge check 1

In acidemia with PaCO2 60 and HCO3 27, which primary direction is supported?

Choose one option.

Knowledge check 2

Select the directly measured representative blood-gas values.

Choose at least 2 options.

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