CLINICAL CHEMISTRY 2 (LECTURE)

KEY TERMS - Rapid and short-term compensation

- increased carbon dioxide will make the body
 Acid: A substance that can yield a hydrogen ion
acidic because it participates in the production
or hydronium ion when dissolved in water.
of carbonic acid (H2CO3).
o Strong acids: pKa less than 3.0
exhaling the carbon dioxide will lessen the
 Base: A substance that can yield hydroxyl ion
acidity of our body
when dissolved in water.
- Too much exhalation will result in alkaline or the
o The relative strengths of acids and bases,
body will be basic.
their ability to dissociate in water, are
described by their dissociation constant
Kidneys
(Ka), also known as ionization constant
value (pKa). - Analyte controlled: bicarbonate
o pKa: –log of the ionization constant. - Help maintain acid-base balance through
o Strong bases: pKa greater than 9.0 reabsorption or excretion of bicarbonate
 Buffer: The combination of a weak acid or weak - Slow but long term compensation
base and its salt. It is a system that resists - More hydrogen ions makes the body acidic.
changes in pH. - Once kidneys release more hydrogen ions in our
 Respiration: Process to supply cells with oxygen urine, then our body will be more alkaline.
for metabolic processes and remove the carbon
dioxide produced during metabolism. Buffer Systems: Regulation of H+
 Partial pressure: In a mixture of gases, partial - The third one responsible for the regulation of
pressure is the amount of pressure contributed hydrogen ions in our body are the buffer
by each gas to the total pressure exerted by the systems.
mixture. - There are different buffer systems:
 Partial pressure of carbon dioxide (PCO2): o Phosphate buffer system
Measured in blood as mmHg o Protein buffer system
 Acidemia: Occurs when arterial blood pH <7.35 o Hemoglobin Oxyhemoglobin buffer
o Reference value for Arterial blood system
plasma pH: 7.4 o Bicarbonate-carbonic acid buffer system
 Alkalemia: Occurs when arterial blood pH >7.45
 Hypercapnia: Increased blood PCO2 Bicarbonate-carbonate acid buffer system
 Hypocapnia: Decreased blood PCO2 - All buffers consist of a weak acid (carbonic acid
 Concentration of dissolved carbon dioxide [H2CO3] regulated by lungs), and its salt or
(cdCO2): Includes undissociated carbonic acid conjugate base (bicarbonate [HCO3] regulated
(H2CO3) and carbon dioxide dissolved in blood by kidneys).
(represented by PCO2). - Most important buffer system in the body
 Concentration of total carbon dioxide (ctCO2): - Principal mammalian buffer system
Includes bicarbonate (primary component), - It is the body’s first line of defense against
carbamino-bound CO2, carbonic acid, and extreme changes in hydrogen ion concentration.
dissolved carbon dioxide - Importance:
o carbonic acid dissociates into carbon
dioxide and water, allowing carbon
dioxide to be eliminated by the lungs
- Important in order to maintain the pH within the
and hydrogen ions as water.
normal range (7.35-7.45)
o changes in the carbon dioxide modify
- Any hydrogen ion value that is outside this range
the ventilation rate or respiratory rate
will cause alterations in the rate of chemical
o bicarbonate concentration can be
reactions within the cell and affect the metabolic
altered by the kidneys.
processes of the body and can lead to alterations
- Bicarbonate-carbonic ratio must be 20:1 in order
in consciousness, neuromuscular irritability,
to maintain normal pH
tetany, coma, and even death.
- Increase in H+ decreases the pH
- Decrease in H+ increases the pH Henderson-Hasselbalch Equation
- describes the relationship between blood pH
and the components of the bicarbonate-
REGULATION OF ACID-BASE BALANCE
carbonic acid buffering system.
- For us to prevent any problems with the acid- - The qualitative description of acid-base
base balance, lungs, kidney, and different buffer physiology allows the metabolic component to
systems are responsible for the regulation of the be separated from the respiratory components
hydrogen ions in our body. of acid-base balance.
- pH means Power of Hydrogen - States the relationship between lungs, kidneys
o more hydrogen ions = acidic and pH
o more hydroxide ions = alkaline - pK = 6.1
- Bicarbonate = total carbon dioxide minus
Lungs
carbonic acid
- Analytes controlled: oxygen and carbon dioxide - Carbonic acid = partial pressure of carbon
- Help maintain acid-base balance through gas dioxide x 0.0307
exchange or respiration
 CLINICAL CHEMISTRY 2 (LECTURE)

- 0.0307 = combination of the solubility constant Loss of stomach acid

for pCO2 and the factor to convert mmHg to (vomiting), Bicarbonate Respiratory
Metabolic
excess: excessive intake compensation:
millimoles alkalosis
of antacid, diuretics, Hypoventilation
severe hydration
Formula:
( )
pH = 6.1 + log Metabolic Acidosis
( )

- pH is directly proportional to bicarbonate (an Primary Bicarbonate Deficit

increase in bicarbonate causes an increase the - In metabolic acidosis, the bicarbonate
pH and vice versa) concentration decreases, causing a decrease in
- pH is indirectly proportional to partial pressure the 20:1 ratio between cHCO3 and cdCO2, which
of carbon dioxide (an increase in pCO2 causes a results in a decrease in the blood pH.
decrease in pH and vice versa) - Metabolic acidosis may be caused by organic
acid production or when ingestion exceeds the
excretion rate.
- Compensation: Hyperventilation
Acid-base disturbances or Acid-base imbalances - Disorders include diabetic ketoacidosis
(normochloromic)
ACIDOSIS AND ALKALOSIS - Seen also in hyperkalemia and hyperchloremia
- Changes in pH can be caused by:
o defect in the lungs (respiratory problem) Metabolic Alkalosis
o Defect in the kidneys (metabolic Primary Bicarbonate Excess
problem) - In metabolic alkalosis, the bicarbonate
- Because the body’s cellular and metabolic concentration increases, causing the increase in
activities are pH dependent, the body tries to the 20:1 ratio between cHCO3 and cdCO2, which
restore acid-base homeostasis whenever results in the increase in the blood pH.
imbalance occurs. - Metabolic alkalosis may be caused by ingestion
o Acidosis: Blood pH is below 7.35 of excess base, decreased elimination of base, or
o Alkalosis: Blood pH is above 7.45 loss of acidic fluids.
- This action by the body is termed compensation. o A condition that could cause to a
The body accomplishes this by altering the factor metabolic alkalosis could be vomiting
not primarily affected by the pathologic process (with the loss of Cl- in the stomach)
- Compensation: Hypoventilation
CLASSIFICATION OF ACID-BASE IMBALANCE o For every 10 mEq/L rise in bicarbonate,
Primary pH pCO2 (lungs) HCO3 (kidneys) PCO2 rises by 6 mmHg
Disorder 7.35-7.45 35-45 mmHg 22-29 mEq/L o PCO2 drops 1-1.3 mmHg per mEq/L fall
Respiratory
Acidosis
↓ ↑ N in bicarbonate
Respiratory - Also positive or seen in hypokalemia and
↑ ↓ N
Alkalosis hypochloremia
Metabolic
↓ N ↓
Acidosis
Respiratory Acidosis
Metabolic
↑ N ↑ Primary cdCO2 excess expressed as
Alkalosis
increase in PCO2 (hypercapnia)
Note: - Result of an excessive CO2 accumulation
 Respiratory Imbalances: pH and pCO2 are - Causes: Chronic obstructive pulmonary disease,
opposite with each other (if pH is increased, pCO2 myasthenia gravis, CNS disease, drug overdose
is decreased; vice versa) (morphine, barbiturates, opiates), and also
 Metabolic Imbalances: equal and same direction pneumonia
in terms of pH and HCO3 (If pH is increased, so is - Compensation: retention of bicarbonates
the HCO3; vice versa) o Bicarbonate rises 1 mEq/L for each 10
mmHg rise in partial pressure of CO2
Common Causes Common Mechanisms - Inability of a person to exhale CO2 through the
Inability to exhale CO2: lungs (hypoventilation causes an increase of
Renal compensation:
Emphysema, pulmonary
Respiratory
edema, Airway
HCO3 reabsorption, PCO2)
acidosis Excretion of H+ in urine - The increased PCO2 causes an increase in the
obstruction, COPD,
(ventilation)
pneumonia concentration of dissolved carbon dioxide,
Low CO2: which forms carbonic acid in the blood. This
Renal compensation:
Hyperventilation, decreases the 20:1 ratio between cHCO2 and
Excretion of OH- in
Pulmonary disease,
Respiratory
Psychogenic, Severe
urine, HCO3 excretion cdCO2 which decreases the blood pH
alkalosis in urine - Respiratory acidosis may be caused by chronic
anxiety, Panic attack,
(breathe into a paper
Pain, Aspirin (Salicylate)
bag)
obstructive pulmonary disease, such as chronic
overdose bronchitis and emphysema ingestion of narcotic
Loss HCO3: Severe
and barbiturates, and severe infections of the
diarrhea, failure to
excrete H+, renal failure Respiratory central nervous system such as meningitis.
Metabolic
Excess acid: Diabetic compensation:
acidosis
ketoacidosis, Lactic Hyperventilation
acidosis (alcoholism),
and renal failure
 CLINICAL CHEMISTRY 2 (LECTURE)

Respiratory Alkalosis - The amount of functional hemoglobin available

Primary cdCO2 deficit expressed as in the blood can be altered due to decreased red
decrease in PCO2 (hypocapnia) blood cells or presence of nonfunctional
hemoglobin
- Occurs due to excessive CO2 loss
- Decreased PCO2 results from an accelerated rate
or depth of respiration or a combination of both. BLOOD COLLECTION FOR
- Excessive exhalation of CO2 (hyperventilation) BLOOD GAS AND pH ANALYSIS
reduces the PCO2, causing a decrease in the - Laboratory Test: ABG (Analysis of Blood Gas)
concentration of dissolved CO2, which forms less - Preferred specimen: Arterial whole blood using
carbonic acid in the blood (i.e., less hydrogen heparin as the anticoagulant
ions). This increases the 20:1 ratio between o it has more uniform composition than
cHCO3 and cdCO2, which increases the blood pH. venous blood
- Respiratory alkalosis may be caused by hypoxia, o When collecting blood for ABG, it is from
anxiety, nervousness, excessive crying, the pulse
pulmonary embolism, pneumonia, congestive  Brachial artery
heart failure, salicylate overdose, and so on.  Radial artery
o The conditions that could result in  Femoral artery
respiratory alkalosis are anxiety, severe  Inguinal artery
pain, aspirin overdose, hepatic cirrhosis. Blood Collection
- Compensation: decreased reabsorption of  Usually collected by respiratory therapist (RT)
Bicarbonate  During blood collection, an ABG syringe is used
o Bicarbonate falls 2mEq/L for each  ABG syringe: coated w/ heparin
10mmHg fall in PCO2  The phlebotomist could also manually add/coat
heparin in the syringe
- Respiratory alkalosis is also positive for
 ABG needle gauge is usually 80-120 for brachial
hypokalemia artery (angle should be 45-60°)
 90° if femoral or inguinal artery
ACIDOSIS AND ALKALOSIS  Usually, plunger is not needed to be pull since blood
will rapidly enter/rise on its own if artery is hit
- When the lungs have problems, the kidneys will correctly and precisely
compensate. When the kidneys have problems,  After collecting enough sample, compress the
the lungs will compensate. puncture site for 3-5 minutes, and don’t leave the
- For the compensation, the organs that will patient
 Arteries have thicker walls, therefore needing a
compensate should be the organ that are not prolonged time of checking
primarily affected by the problem
- Fully compensated implies that the pH has - Venous blood usually 0.03 pH units lower than
returned to the normal range (20:1). arterial blood
- Partially compensated implies that the pH is o Venous and capillary blood can also be
approaching normal. used for analysis, provided that they
undergo arterialization
Acid-Base Disturbances
Organ
Primary Cause
Organ to Primary o Arterialization
defective Compensate Compensation
Respiratory Lungs Hypoventilation Kidneys
Bicarbonate  Immerse the puncture site in an
reabsorption
Acidosis
Bicarbonate 45˚C water bath
Metabolic Kidneys Lungs Hyperventilation
Excretion
Bicarbonate
 Wrap the puncture site with a
Respiratory Lungs Hyperventilation Kidneys
Alkalosis
Bicarbonate
Excretion prewarmed towel wetted with
Metabolic Kidneys Lungs Hypoventilation
reabsorption water of 45˚C
- Syringe with rubber stopper; specimen should be
sealed
o Heparinized plastic syringe:
- Oxygen is transported bound to hemoglobin
Disadvantage: leaking gases through
present in red blood cells and in a physically
plastic (should be immediately
dissolved state.
processed)
- Three factors control oxygen transport:
o Glass syringe pretreated with heparin:
o PO2 (partial pressure of oxygen)
Advantage: reusable, most accurate
o Free diffusion of oxygen across the
results obtainable, lesser tendency for
alveolar membrane
bubble formation, but it is rarely used
o Affinity of hemoglobin for oxygen.
- Release of oxygen to the tissues is facilitated by
Anaerobic collection
an increase in H+ concentration and PCO2 levels
at the tissue level. - Do not use vacutainer tube
- Under normal circumstances, the saturation of o Disadvantage: oxygen contamination
hemoglobin with oxygen is 95%. When the PO2 is increases pO2 by the residual O2 present
>110 mmHg, >98% of hemoglobin binds to O2. in the nitrogen-filled vacutainer tube
- When a person's oxygen saturation falls below - Place specimen on ice water or ice bath
95%, either the individual is not getting enough - Should be processed within 3 hours
oxygen or does not have enough functional o This prevents O2 consumption by the
hemoglobin available to transport the oxygen. RBC and release of acidic metabolites
o This is the time where an individual o This will also stabilize the pH and pCO2
would have hypoxemia up to 3 hours
- No to clot, hemolysis, or bubbles
 CLINICAL CHEMISTRY 2 (LECTURE)

ABG results if these different scenarios here is to occur: pO2 (Partial Pressure of Oxygen)
 Specimen was exposed to room air - Clark electrode: Composed of oxygen
o ↑ O2, ↓ CO2, and ↓ pH permeable membrane with electrode composed
o Reason: Room air is composed of 20- of a platinum cathode and silver-silver chloride
22% O2 anode
o atmospheric air may enter the - Measurement: current flow
specimen, causing an increase in oxygen, - Amperometric/polarographic: the amount of
while displacing the carbon dioxide in current flow is an indication of oxygen present
the process - Gasometric analysis: a calculation from oxygen
 Sealed specimen was left at room temperature saturation, pH, and temperature by means of the
o ↓ O2, ↑ CO2, and ↓ pH standard oxygen dissociation curve. It is a
o Changes are due to the presence of transcutaneous monitoring.
blood cells utilizing glucose and oxygen - Usage of a gasometer:
at room temp causing the formation of o < 1mL: Natelson microgasometer
acid products and carbon dioxide o > 1mL: Van Slyke macrogasometer
 Excess Heparin (when ABG syringe is not used
and manually addition of heparin to the syringe
Bicarbonate and Carbon Dioxide Content
was instead performed)
o ↓ pH - Nomogram from blood gas analyzers
o Heparin is an acid mucopolysaccharide
o It is often used at a concentration of 0.2 CO2 Content
mg/mL of blood - consists of bicarbonate
- undissociated carbonic acid, dissolved carbon
dioxide and carbamino-bound carbon dioxide.
- ABG (Arterial Blood Gas) Testing: - considered as Continuous flow analyzer for Blood Gas Analysis
POCT (Point of Care Testing) and can be done Caprylic alcohol Prevent foaming
bedside. Mercury Separate the sample and other reagent
Lactic acid 10% Releases CO2 from HCO3
- After finding the pulse, take the sample from the 12% NAOH For collecting CO2
artery then transfer it to a cartridge. It should fill Na2CO3 (Sodium
For releasing O2
the required amount of sample. carbonate)
- After that, put the cartridge inside the
equipment, then the result will be shown on the ALTERNATIVE METHOD
read-out device/meter device. (Blood gas
Involves the release of CO2 gas when the sample is added
parameters: pH, pCO2, bicarbonate, and so on).
to H2SO4 (sulfuric acid) with subsequent monitoring of
o There must be no bubbles because it can
this release with a pair of pCO2 electrodes (reference and
affect the results and you have to throw
sample electrodes). The rate of change in pH of the
away the cartridge. (But in real life
buffer inside the pCO2 electrodes is a measure of the
setting, throwing away the cartridge
concentration of its CO2 in the sample
must not be done given that the test is
expensive)
Conditions for Analysis
o ABG syringe: 1mL or 2mL
- All procedures should be considered “STAT”
(short turnaround time)
pH
o If delayed 20-30 mins: pH lowers by 0.01
- Glass electrode: connected to a reference o Avoid glycolysis
electrode (calomel electrode, mercury-mercuric - Specimen must be kept at anaerobic condition
chloride) - Specimen which cannot be analyzed
- Principle: based on holographic principle. immediately must be placed in an ice slurry
- It uses pH meters (used to measure the pH) (samples could be sent out if there is a lack of
- Uses silver-silver electrode and calomel cartridges or if the machine is not working
electrode properly for testing. Just make sure that the
- reference electrode, silver-silver chloride, and specimen should be placed in ice and should be
potassium-chloride solution delivered immediately in the laboratory)

pCO2 (Partial Pressure of Carbon Dioxide)

- Severinghaus electrode: A modified pH
 normal pH: 7.35-7.45
electrode Evaluate
 acidosis: < 7.35
o glass electrode with weak bicarbonate the pH
 alkalosis: > 7.45
solution enclosed in silicone membrane Evaluate  Normal pCO2: 35-45 mmHg
- Principle: based on pH measurement of a the ventilation  respiratory alkalosis: < 35 mmHg
stationary sodium bicarbonate solution, which is (Lungs)  respiratory acidosis: > 45 mmHg
in equilibrium with the test solution and the test Evaluate the  Normal HCO3: 22-29 meq/L
via a carbon dioxide permeable membrane metabolic process  metabolic acidosis: < 22 meq/L
- Measurement: voltage flow (Kidneys)  metabolic alkalosis: > 29 meq/L
- The pCO2 and pH measurement are
potentiometric, in which a change in the voltage
indicates the activity of each analyte
 CLINICAL CHEMISTRY 2 (LECTURE)

Determine which is the Primary Disorder and Steps Given Interpretation

1 Check the pH 7.25 Acidic / Decreased
the Degree of Compensation 2 Check the pCO2 60 mmHg Increased
Degree of Compensation pH pCO2 HCO3 3 Check the HCO3 26 mmol/L Within the normal range
Non-compensation A A/N A/N Decreased
Partial compensation A A A 4 Check the pO2 65 mmHg
(Mild Hypoxemia)
Complete compensation Nearly N A A Uncompensated Respiratory Acidosis
A – Abnormal; N – Normal or Near Normal (+/– 2 of the value) Final Result
with Mild Hypoxemia

Primary Degree of
pH pCO2 HCO3 Example 2
Disorder Compensation
Uncompensated ↓ ↑  A 64-year-old woman with COPD was admitted to the
Respiratory emergency department with extreme shortness of
Partially Compensated ↓ ↑ ↑
acidosis
Fully Compensated  ↑ ↑ breath. She had a bluish color that was particularly
Uncompensated ↑ ↓  pronounced on her lips and nail beds and she displayed
Respiratory
Partially Compensated ↑ ↓ ↓ a weak and persistent cough with diminished, but rattling
alkalosis
Fully Compensated  ↓ ↓
breath sounds. Home medications included
Uncompensated ↓  ↓
Metabolic bronchodilators, steroids, Lasix (a loop diuretic that does
Partially Compensated ↓ ↓ ↓
acidosis conserve plasma potassium), and digitalis. Vital signs:
Fully Compensated  ↓ ↓
Uncompensated ↑  ↑ heart rate, 148 bpm; blood pressure, 100/88 mmHg;
Respiratory
Partially Compensated ↑ ↑ ↑ temperature, 37°C; and respiratory rate, 38/min. Initial
alkalosis
Fully Compensated  ↑ ↑ blood gas results on room air were the following:
ROME: Respiratory are Opposite (pH and pCO2);
Metabolic are Equal (pH and HCO3)  pH = 7.289
 pCO2 = 91 mmHg
Evaluate the Degree of Oxygenation  pO2 = 53 mmHg
- pO2 (Reference Range): 85-105 mmHg (adequate  HCO3 = 43 mmol/L
oxygenation)
Steps Given Interpretation
- If pO2 (partial pressure of oxygen) is given, then 1 Check the pH 7.289 Acidic / Decreased
include it in the interpretation 2 Check the pCO2 91 mmHg Increased
- The term hypoxemia is used because the results 3 Check the HCO3 53 mmol/L Increased
is based in an arterial blood sample. 4 Check the pO2 43 mmHg
Decreased
- Hypoxia: low oxygen level in tissues (Moderate Hypoxemia)
Partially Compensated Respiratory
- Hypoxemia: low oxygen level in the blood Final Result
Acidosis with Moderate Hypoxemia

Degree of Oxygenation (pO2)

Adequate Oxygenation 85-105 mmHg OTHER EXAMPLES
Mild: 61-80
Hypoxemia Moderate: 41-60
Primary pH pCO2 (lungs) HCO3 (kidneys)
Severe: 40 or less
Disorder 7.35-7.45 35-45 mmHg 22-29 mEq/L
Respiratory
↓ ↑ N
Final interpretation of acid-base imbalance (in order) Acidosis
1. Degree of compensation (uncompensated, Respiratory
↑ ↓ N
partially compensated, or fully compensated) Alkalosis
Metabolic
2. Primary disorder (respiratory alkalosis, ↓ N ↓
Acidosis
respiratory acidosis, metabolic acidosis, Metabolic
metabolic alkalosis) ↑ N ↑
Alkalosis
3. Degree of oxygenation (adequate oxygenation Degree of Compensation pH pCO2 HCO3
or with hypoxemia [mild, moderate, or severe]) Uncompensated A A/N A/N
Partially Compensated A A A
Fully compensated Nearly N A A
Degree of Oxygenation (pO2)
Example 1 Adequate Oxygenation 85-105 mmHg
A 71-year-old woman walking home from attending Mild: 61-80
Hypoxemia Moderate: 41-60
church mass suddenly faints and falls. The medics were
Severe: 40 or less
called and upon arrival, find her with an oxygen
A – Abnormal; N – Normal or Near Normal (+/– 2 of the value)
saturation of 88% on room air and pinpoint pupils on ROME: Respiratory are Opposite (pH and pCO2);
exam. She is brought into the FUMC ER where an arterial Metabolic are Equal (pH and HCO3)
blood gas (ABG) was performed and revealed the
following: Example 3
 pH = 7.25  pH: 7.34 (decrease/near normal)
 pCO2 = 60 mmHg  pCO2: 24 mmHg (decrease)
 pO2 = 65 mmHg  HCO3: 17 meq/L (decrease)
 HCO3 = 26 mmol/L  pO2: 48 mmHg (moderate)

Answer: Fully Compensated Metabolic Acidosis

with Moderate hypoxemia
 CLINICAL CHEMISTRY 2 (LECTURE)

Example 4 Example 8
 pH: 7.58 (increase/alkalosis)  pH: 7.33 (decrease/nearly normal)
 pCO2: 52 mmHg (increase)  pCO2: 86 mmHg (increase)
 HCO3: 33 meq/L (increase)  HCO3: 58 meq/L (increase)
 pO2: 39 mmHg (severe)  pO2: 37 mmHg (severe)

Answer: Partially Compensated Metabolic Alkalosis Answer: Fully Compensated Respiratory Acidosis
with Severe Hypoxemia with Severe Hypoxemia

Example 5 Example 9
 pH: 7.26 (decrease/acidic)  pH: 7.63 (increase/alkalosis)
 pCO2: 48 mmHg (increase)  pCO2: 28 mmHg (decrease)
 HCO3: 26 meq/L (normal)  HCO3: 25 meq/L (normal)
 pO2: 70 mmHg (mild)

Answer: Uncompensated Respiratory Acidosis Answer: Uncompensated Respiratory Alkalosis

with Mild Hypoxemia

Example 6 Example 10
 pH: 7.69 (increase/alkalosis)  pH: 7.23 (decrease/acidosis)
 pCO2: 59 mmHg (increase)  pCO2: 40 mmHg (normal)
 HCO3: 37 meq/L (increase)  HCO3: 18 meq/L (decrease)
 pO2: 60 mmHg (moderate)  pO2: 95 mmHg (adequate oxygenation)

Answer: Partially Compensated Metabolic Alkalosis Answer: Uncompensated Metabolic Acidosis

with Moderate Hypoxemia with Adequate Oxygenation

Example 7 Example 11
 pH: 7.22 (decrease/acidosis)  pH: 7.46 (increase/near normal)
 pCO2: 63 mmHg (increase)  pCO2: 55 mmHg (increase)
 HCO3: 35 meq/L (increase)  HCO3: 39 meq/L (increase)
 pO2: 58 mmHg (moderate)  pO2: 75 mmHg (mild)

Answer: Partially Compensated Respiratory Acidosis Answer: Fully Compensated Metabolic Alkalosis
with Moderate Hypoxemia with Mild Hypoxemia