Step 2b alkalemia with

HCO3 > 24 metabolic alkalosis pC02 < 40 respiratory alkalosis

FIGURE 7 Step 2 in a systematic analysis of acid-base status. Based on whether acidemia or alkalemia is found in step 1, the analysis proceeds to determine the primary acid-base disorder based on the reported values for the concentration of HCO3— and Pco2 in the arterial plasma. (Note that in each substep only one of the two conditions can be true if the values for HCO3— and PCO2 are consistent with the plasma pH according to the Henderson-Hasselbalch equation.) (Adapted with alterations from the scheme of analysis presented in Andreoli TE. Carpenter CCG, Griggs RC, Loscalzo J, eds. Cecil essentials of medicine. Philadelphia: WB Saunders, 2001, p. 249.)

disorders the HCO— concentration varies from normal in the same direction as the H+ concentration, whereas in metabolic disorders they change in the opposite direction. Thus, for example, an acidemia (high H+ concentration) is accompanied by an elevated HCO— if the primary disorder is a respiratory acidosis, but a decreased HCO— if it is metabolic acidosis. Alternatively, one can focus on the Pco2, expecting it to be

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