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20 PCO2 (mmHg)

Acidosis

Alkalosis pH

FIGURE 6 Bicarbonate-pH diagrams. (A) Blood-buffer line (B-A-C) shows pH and [HCO—] changes with changes in Pco2; blue lines are PCO2 isobars. Base excess equals the vertical distance between blood-buffer lines (e.g., A and D). (B) pH and [HCO—] changes with respiratory and metabolic acidosis and alkalosis. See text for details. (After Davenport, The ABC of acid base chemistry. Chicago: University of Chicago Press, 1974.)

20 PCO2 (mmHg)

Acidosis

Alkalosis pH

FIGURE 6 Bicarbonate-pH diagrams. (A) Blood-buffer line (B-A-C) shows pH and [HCO—] changes with changes in Pco2; blue lines are PCO2 isobars. Base excess equals the vertical distance between blood-buffer lines (e.g., A and D). (B) pH and [HCO—] changes with respiratory and metabolic acidosis and alkalosis. See text for details. (After Davenport, The ABC of acid base chemistry. Chicago: University of Chicago Press, 1974.)

base excess is the amount of base necessary to titrate a blood sample with a metabolic disturbance back to pH = 7.4 at Pco2 = 40 mm Hg. A negative base excess (which occurs with a metabolic alkalosis as described later) may be referred to as a base deficit.

In reality, it is rare to find a pure respiratory, or a pure metabolic, pH disturbance. Ventilatory and renal control mechanisms tend to return arterial pH to the normal value of 7.4. There are four primary forms of pH disturbance, and compensatory responses accompany each of them. These primary disturbances and secondary compensations follow characteristic pathways on the

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