Acid-Base Tutorial - Classical Examples

Classical Examples:

Acute Respiratory
1. Acidosis || 2. Alkalosis

Chronic Respiratory
3. Acidosis || 4. Alkalosis

Metabolic
5. Acidosis || 6. Alkalosis

Combined
7. Acidosis || 8. Alkalosis

Complex Examples
Case 9 || Case 10

Case 11 || Case 12

Instructions:

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9. Chronic Respiratory Acidosis with Acute Metabolic Acidosis.

This patient with chronic obstructive pulmonary disease normally has a PCO2 of 60 mmHg. With this chronic respiratory acidosis he normally has a compensatory metabolic alkalosis (SBE= 7 mMol/L).

Following femoral bypass surgery his initial recovery is satisfactory. During the night the graft occludes and he develops an ischemic lactic acidosis which alters his SBE from his usual value to SBE = 0 mMol./L

These acid-base results in isolation appear to be typical of an acute respiratory acidosis with no compensation. Knowledge of the patient and familiarity with his usual values allows the results to be interpreted correctly: A patient with chronic respiratory acidosis accompanied by a developing metabolic acidosis.

The diagram shows the position of the principal zones. These zones are based on the review of the literature described by Schlichtig, Grogono, and Severinghaus. The arrows indicate typical acidosis and alkalosis. The labels in the black circles correspond to the legend in the table below.

Acidosis		Slope
AR	Acute Respiratory Acidosis:	SBE = 0
CR	Chronic Respiratory Acidosis:	SBE = 0.4 x PCO₂
M	Metabolic Acidosis:	PCO₂ = 1.0 x SBE

Alkalosis		Slope
AR	Acute Respiratory Alkalosis:	SBE = 0
CR	Chronic Respiratory Alkalosis:	SBE = 0.4 x PCO₂
M	Metabolic Alkalosis:	PCO₂ = 0.6 x SBE

Classical Acid-Base Examples

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Classical Examples:

Instructions:

Classical Zones