Lecture 4-Anesthesia And Renal Physiology Flashcards
Acid-base physiology is all about ___ ion concentrations
H+
Normal ECF H+ concentration is ~ ___ mEq/L
~40 mEq/L
PH is ___ (directly/indirectly) related to the H+ concentration—therefore, a low pH corresponds to a ___ (low/high) H+ concentration; a high pH corresponds to a ___ (low/high) H+ concentration
PH is indirectly related to the H+ concentration—therefore, a low pH corresponds to a high H+ concentration; a high pH corresponds to a low H+ concentration
The normal pH of arterial blood is ___
7.4
The pH of venous blood and interstitial fluids is about ___ because of the extra amounts of CO2 released from the tissues to form H2CO3 (carbonic acid) in these fluids
7.35
Because the normal pH of arterial blood is 7.4, a person is considered to have ___osis when the pH falls below this value and ___osis when the pH rises above 7.4
Acidosis when the pH falls below this value and alkalosis when the pH rises above 7.4
The lower limit of pH at which a person can live more than a few hours is about ___; the upper limit is about ___
6.8; 8.0
An acid is defined as a proton (H+) ___ (donor/acceptor); a base acts as a proton ___ (donor/acceptor)
An acid is defined as a proton (H+) donor; a base acts as a proton acceptor
A strong acid almost completely dissociates into ___ and a conjugate anion while a strong base avidly binds ___
A strong acid almost completely dissociates into H+ and a conjugate anion while a strong base avidly binds H+
The ___ equation describes the relationship between pH, PaCO2, and serum bicarbonate; from this equation, it is apparent that an increase in HCO3- concentration causes the pH to ___ (increase/decrease), shifting the acid-base balance toward ___osis; an increase in PCO2 causes the pH to ___ (increase/decrease), shifting the acid-base balance toward ___osis
Henderson-Hasselbalch equation
An increase in HCO3- concentration causes the pH to increase, shifting the acid-base balance toward alkalosis
An increase in PCO2 causes the pH to decrease, shifting the acid-base balance toward acidosis
The HCO3- concentration is regulated mainly by the ___
Kidneys
The PCO2 in extracellular fluid is controlled by the rate of ___
Respiration
The respiratory system can adjust rapidly to changes in pH; the kidneys take 2-3 days to kick in—T/F?
True
Based on the Henderson-Hasselbalch equation, we know that the pH of a solution is related to the ratio of the dissociated ___ to the undissociated ___
Dissociated anion to the undissociated acid
Solutions of weak acids or bases act as ___, as they minimize pH changes by donating or accepting electrons
Buffers
Buffers are most efficient when ___ = ___
PH = pKa
___ and ___ act as buffers in our bodies
Albumin and bicarb
Respiratory acid-base disorders are initiated by an increase or a decrease in ___
PCO2
Metabolic disorders are initiated by an increase or decrease in ___
HCO3-
Body buffers—___; ___globin; intracellular ___; ___; ___
Bicarbonate (H2CO3/HCO3); hemoglobin; intracellular proteins; phosphate (H2PO4-/HPO42-); ammonia (NH3/NH4)
Three primary systems that regulate H+ concentration in the body fluids to prevent acidosis or alkalosis: 1) the chemical acid-base buffer systems of the body fluids, which immediately combine with an acid or a base to prevent excessive changes in ___ concentration; 2) the respiratory center, which regulates the removal of ___ (and therefore, ___) from the extracellular fluid; and 3) the kidneys, which can excrete either ___ or ___ urine, thereby readjusting the extracellular fluid H+ concentration toward normal during acidosis or alkalosis
1) the chemical acid-base buffer systems of the body fluids, which immediately combine with an acid or a base to prevent excessive changes in H+ concentration
2) the respiratory center, which regulates the removal of CO2 (and therefore, H2CO3) from the extracellular fluid
3) the kidneys, which can excrete either acidic or alkaline urine, thereby readjusting the extracellular fluid H+ concentration toward normal during acidosis or alkalosis
Although the kidneys are relatively slow to respond compared with the other defenses, over a period of hours to several days, they are by far the most powerful of the acid-base regulatory systems—T/F?
True
Bicarbonate buffer—the hydration of CO2 is catalyzed by ___
Carbonic anhydrase
The bicarbonate buffer is effective against ___ but not ___ acid-base disturbances
Effective against metabolic but not respiratory acid-base disturbances
The pKa of bicarbonate is ___
6.1–rather far from plasma pH
Bicarbonate is a good buffer because it is present in ___ (low/high) concentrations in the ECF and because PaCO2 and HCO3- are closely regulated by the ___ and ___
Because it is present in high concentrations in the ECF and because PaCO2 and HCO3- are closely regulated by the lungs and kidneys
The pH of the system is the same as the pKa when each of the components constitute ___% of the total concentration of the buffer system
50%
The ___ buffer system is the most powerful extracellular buffer in the body
Bicarbonate
Renal compensation during acidosis—___ (increased/decreased) HCO3- reabsorption
Increased HCO3- reabsorption
Renal compensation during acidosis—bicarbonate reabsorption—CO2 combines with ___ to form ___, which rapidly dissociates into ___ and ___
CO2 combines with water to form H2CO3 (carbonic acid), which rapidly dissociates into H+ and HCO3-
Renal compensation during acidosis—bicarbonate reabsorption—H+ is ___ into the ___ tubule and bicarbonate is ___; H+ in the tubule combines with filtered ___ to form ___; ___ hydrolyzes this to water and CO2, which goes into the cell to replace the original CO2
H+ is secreted into the proximal tubule and bicarbonate is reabsorbed into the blood; H+ in the tubule combines with filtered HCO3- to form carbonic acid; carbonic anhydrase hydrolyzes this to water and CO2, which goes into the cell to replace the original CO2
Renal compensation during acidosis—for each HCO3- reabsorbed, a ___+ must be secreted
H+
H2CO3 = ___
Carbonic acid
HCO3- = ___
Bicarb
Proximal tubule—reabsorption/secretion of bicarbonate—the epithelial cells of the proximal tubule, the thick segment of the ascending loop of Henle, and the early distal tubule all secrete ___+ into the tubular fluid by ___-___ counter-transport
All secrete H+ into the tubular fluid by sodium-hydrogen counter-transport
Proximal tubule—reabsorption/secretion of bicarbonate—bicarbonate combines with ___+ to form carbonic acid; carbonic acid dissociates into ___ and ___ and is then removed from the body…this is how the body responds to high ___+ concentration, ___osis
Bicarbonate combines with H+ to form carbonic acid; carbonic acid dissociates into CO2 and water and is then removed from the body…this is how the body responds to high H+ concentration, acidosis
Reabsorption and secretion of bicarbonate: 1) sodium ions are reabsorbed from the filtrate in exchange for ___+ by an antiport mechanism in the apical membranes of cells lining the renal tubule; 2) the cells produce ___ ions that can be shunted to peritubular capillaries; 3) when ___ is available, the reaction is driven to the formation of carbonic acid, which dissociates to form a ___ ion and a ___+ ion; 4) the ___ ion passes into the peritubular capillaries and returns to the blood; the ___+ ion is secreted into the filtrate, where it can become part of new water molecules and be reabsorbed as such, or removed in the urine
This process occurs during ___osis in the renal tubule/vasa recta that allows the body to secrete ___ ions and reabsorb ___ ions
1) sodium ions are reabsorbed from the filtrate in exchange for H+ by an antiport mechanism in the apical membranes of cells lining the renal tubule
2) the cells produce bicarbonate ions that can be shunted to the peritubular capillaries
3) when CO2 is available, the reaction is driven to the formation of carbonic acid, which dissociates to form a bicarbonate ion and a H+ ion
4) the bicarbonate ion passes into the peritubular capillaries and returns to the blood; the H+ ion is secreted into the filtrate, where it can become part of new water molecules and be reabsorbed as such, or removed in the urine
This process occurs during acidosis in the renal tubule/vasa recta that allows the body to secrete H+ ions and reabsorb bicarbonate ions
80-90% of filtered bicarbonate is reabsorbed in the ___ tubule
Proximal
10-20% of filtered bicarbonate is reabsorbed in the ___ tubule
Distal tubule
In the distal tubule, a ___+ pump exists which can establish a steep gradient for ___ifying urine
In the distal tubule, a H+ pump exists which can establish a steep gradient for acidifying urine
Intercalated cells of the collecting duct—H+ secreting cell—___+ is exchanged for H+ with ATP; H+ binds with ___, forms ___ acid, ___, and ___
K+ is exchanged for H+ with ATP
H+ binds with bicarbonate, forms carbonic acid, CO2, and water
Intercalated cells of the collecting duct—HCO3- secreting cell—bicarb is exchanged for ___- to be excreted
Cl-
Renal compensation continued—increased titratable acid excretion—H+ secreted in tubule lumen can combine with HPO42- to form H2PO4- that is not ___ and becomes trapped in ___
That is not reabsorbable and becomes trapped in urine
HPO42- = ___
Hydrogen phosphate
H2PO4- = ___
Dihydrogen phosphate
Phosphate buffer—phosphate has pKa of ___, which in acidic urine is more effective buffer; generates ___
6.8, which in acidic urine is more effective buffer; generates bicarbonate
The renal phosphate buffer system—the ___hydrogen phosphate ion (HPO42-) enters the renal tubular fluid in the glomerulus; a H+ combines with the HPO42- to form ___ and is then excreted into the urine in combination with Na+; the HCO3- moves into the ___ fluid, along with the Na+ that was exchanged during secretion of the H+
The monohydrogen phosphate ion (HPO42-) enters the renal tubular fluid in the glomerulus; a H+ combines with the HPO42- to form H2PO4- and is then excreted into the urine in combination with Na+; the HCO3- moves into the extracellular fluid, along with the Na+ that was exchanged during secretion of the H+
___ is an important tubular fluid buffer—it is in the ___ tubule, ___ loop of Henle, and ___ tubule
Ammonium (NH4)—it is in the proximal tubule, thick ascending loop of Henle, and distal tubule
Ammonium ion is synthesized from ___, which comes mainly from the metabolism of ___ in the liver; ___ is generated in the ammonium synthesis process
Glutamine, which comes mainly from the metabolism of amino acids in the liver; bicarbonate is generated in the ammonium synthesis process
In the collecting tubules, the production of ammonium (NH4) occurs by a different mechanism—T/F?
True
In the collecting tubules, NH4 is synthesized when ___+ combines with ___; once NH4 is produced, it is ___; ___ is also generated in this synthesis process
H+ combines with NH3 (ammonia); once NH4 is produced, it is excreted; bicarbonate is also generated in this synthesis process
The glutamine delivered to the kidneys is transported into the epithelial cells of the ___ tubules, ___ limb of the loop of Henle, and ___ tubules
Proximal tubules, thick ascending limb of the loop of Henle, and distal tubules
Therefore, with chronic acidosis, the dominant mechanism by which acid is eliminated is excretion of ___; this process also provides the most important mechanism for generating new ___ during chronic acidosis
With chronic acidosis, the dominant mechanism by which acid is eliminated is excretion of NH4+ (ammonium); this process also provides the most important mechanism for generating new bicarbonate during chronic acidosis
One of the most important features of the renal ammonium-ammonia buffer system is that it is subject to ___ control; an increase in extracellular fluid H+ concentration stimulates renal ___ metabolism and therefore increases the formation of ___ and new ___ to be used in H+ buffering; a decrease in H+ concentration has the opposite effect
It is subject to physiologic control; an increase in extracellular fluid H+ concentration stimulates renal glutamine metabolism and therefore increases the formation of NH4+ and new bicarbonate to be used in H+ buffering; a decrease in H+ concentration has the opposite effect
Renal compensation for alkalosis—large amounts of ___ can be excreted if necessary
Bicarbonate
Metabolic alkalosis is mainly possible in 2 situations: 1) ___+ depletion and 2) ___ (increased/decreased) aldosterone activity
1) Na+ depletion
2) increased aldosterone activity
Metabolic alkalosis—Na+ depletion—___ (more/less) sodium is reabsorbed in the proximal tubule, and as this occurs, ___- moves with it to preserve electroneutrality; as ___- in the tubule increases, ___- must be reabsorbed; this is a so-called “contraction alkalosis” that can occur with long-term ___ use
Na+ depletion—more sodium is reabsorbed in the proximal tubule, and as this occurs, Cl- moves with it to preserve electroneutrality; as Cl- in the tubule increases, HCO3- must be reabsorbed; this is a so-called “contraction alkalosis” that can occur with long-term diuretic use
Metabolic alkalosis—increased aldosterone (mineralocorticoid) activity—___ (increases/decreases) Na+ reabsorption and ___+ secretion in the distal tubule
Increases Na+ reabsorption and H+ secretion in the distal tubule (causing alkalosis)
In alkalosis, the loss of ___- helps return the plasma pH toward normal
Loss of HCO3-
___ is defined as the amount of acid or base that must be added to return blood pH to 7.4 with PaCO2 = 40 mm Hg and temp 37 C
Base excess
Base excess—a positive value indicates ___
Metabolic alkalosis
Base excess—a negative value indicates ___
Metabolic acidosis
The most important stimuli for increasing H+ secretion [removal] by the tubules in acidosis are: 1) an ___ (increase/decrease) in PCO2 of the extracellular fluid in respiratory acidosis; 2) an ___ (increase/decrease) in H+ concentration of the extracellular fluid (___ [increased/decreased] pH) as in respiratory or metabolic acidosis
1) an increase in PCO2 of the extracellular fluid in respiratory acidosis
2) an increase in H+ concentration of the extracellular fluid (decreased pH) as in respiratory or metabolic acidosis
Any kind of acidotic state is going to cause the body to secrete [remove] ___ ions
Hydrogen
Acid-base balance—increased H+ secretion/HCO3- reabsorption would occur in response to…___ (increased/decreased) PCO2; ___ (increased/decreased) H+; ___ (increased/decreased) HCO3-; ___ (increased/decreased) angiotensin II; ___ (increased/decreased) aldosterone; ___kalemia
- Increased PCO2
- Increased H+
- Decreased HCO3-
- Increased angiotensin II
- Increased aldosterone
- Hypokalemia
Acid-base balance—decreased H+ secretion/HCO3- reabsorption would occur in response to…___ (increased/decreased) PCO2; ___ (increased/decreased) H+; ___ (increased/decreased) HCO3-; ___ (increased/decreased) angiotensin II; ___ (increased/decreased) aldosterone; ___kalemia
- Decreased PCO2
- Decreased H+
- Increased HCO3-
- Decreased angiotensin II
- Decreased aldosterone—aldosterone causes rebasorption of Na+/water, excretion of H+/K+
- Hyperkalemia
Metabolic alkalosis, characterized by hyperbicarbonatemia (> ___ meq/L) and usually by an alkalemic pH (> ___), occurs d/t ___ and ___ administration
Bicarb > 27, pH > 7.45
Occurs d/t vomiting and diuretic administration
Factors that maintain metabolic alkalosis—___ (increased/decreased) GFR; ___kalemia; ___chloremia; ___ (mineralocorticoid)
Decreased GFR; hypokalemia; hypochloremia; aldosterone
Metabolic alkalosis is associated with ___kalemia, ionized ___calcemia, secondary ventricular ___, ___ (increased/decreased) digoxin toxicity, and compensatory ___ventilation (___carbia)
Hypokalemia, ionized hypocalcemia, secondary ventricular arrhythmias, increased digoxin toxicity, and compensatory hypoventilation (hypercarbia)
Alkalemia may reduce tissue oxygen availability by shifting the oxyhemoglobin dissociation curve to the ___ (right/left) and by ___ (increasing/decreasing) cardiac output
Left and by decreasing cardiac output
During anesthetic management, inadvertent addition of iatrogenic respiratory alkalosis (from hyperventilating the patient) to pre-existing metabolic alkalosis may produce severe ___emia and precipitate cardiovascular ___, ___, and ___kalemia
May produce severe alkalemia and precipitate cardiovascular depression, dysrhythmias, and hypokalemia
If you have metabolic alkalosis, the body will try to compensate by retaining ___
CO2
Treatment of metabolic alkalosis—expansion of intravascular volume with ___ to dose-dependently increase serum ___ and decrease serum ___; or administration of ___
Expansion of intravascular volume with 0.9% normal saline to dose-dependently increase serum chloride and decrease serum bicarb; or administration of potassium
Differential diagnosis of metabolic acidosis—what (3) diseases will show metabolic acidosis with an elevated anion gap?—___ia, ___acidosis, ___ acidosis
- Uremia
- Ketoacidosis
- Lactic acidosis
Differential diagnosis of metabolic acidosis—what (4) toxins will show metabolic acidosis with an elevated anion gap?—___ol, ___ glycol, ___ates, ___aldehyde
- Methanol
- Ethylene glycol (antifreeze)
- Salicylates
- Paraldehyde
The following conditions may cause metabolic acidosis with a ___ (increased/decreased/normal) anion gap—renal tubular acidosis; diarrhea; carbonic anhydrase inhibition; ureteral diversions; early renal failure; hydronephrosis; HCl administration; saline administration
Normal anion gap
Physiologic effects of acidosis—potassium increases ___ meq/L for each ___ unit decrease in pH
Potassium increases 0.6 meq/L for each 0.1 unit decrease in pH
Physiologic effects of acidosis—a ___ward (left/right) shift is seen in the oxyhemoglobin dissociation curve
Rightward shift—so oxygen is released from hemoglobin
Physiologic effects of acidosis—cardiac contractility is ___ (increased/decreased); pulmonary vascular resistance is ___ (increased/decreased); systemic vascular resistance is ___ (increased/decreased); there is ___ (increased/decreased) responsiveness to catecholamines
Cardiac contractility is decreased; PVR is increased; SVR is decreased; there is decreased responsiveness to catecholamines
It is important to note that failure of a patient to appropriately ___ventilate in response to metabolic acidosis is physiologically equivalent to ___ acidosis and suggests clinical deterioration
Failure of a patient to appropriately hyperventilate in response to metabolic acidosis is physiologically equivalent to respiratory acidosis and suggests clinical deterioration
If a patient with metabolic acidosis requires mechanical ventilation during general anesthesia, every attempt should be made to maintain an appropriate level of respiratory compensation (hyperventilation) until the primary process can be corrected—T/F?
True
Metabolic acidosis intraoperative management—the CRNA should be concerned about the possibility of exaggerated ___tensive responses to drugs and ___ ventilation
Exaggerated hypotensive responses to drugs and positive pressure ventilation
Metabolic acidosis—in planning IV fluid therapy, consider that balanced salt solutions (i.e.: LR) tend to ___ (increase/decreased) pH and HCO3- by metabolism of lactate to bicarbonate; 0.9% saline tends to ___ (increase/decrease) pH and HCO3-
Balanced salt solutions tend to increase pH and HCO3- by metabolism of lactate to bicarbonate; 0.9% saline tends to decrease pH and HCO3-
Both evidence and opinion suggest that sodium bicarb drip should rarely be used to treat acidemia induced by metabolic acidosis—T/F?
True
In critically ill patients with lactic acidosis, there were no important differences between the physiologic effects (other than changes in pH) of sodium bicarb vs. 0.9% NS; sodium bicarb has not been proven to improve CV response to catecholamines and actually reduces plasma ionized calcium
Treatment of metabolic acidosis—treat ___; can give ___, but do not give to patient with respiratory failure as CO2 will go up; refractory acidosis may require ___
Treat underlying cause—i.e.: hypovolemia, anemia, cardiogenic shock; can give sodium bicarb (push), but do not give to patient with respiratory failure as CO2 will go up; refractory acidosis may require dialysis
Treating alkalosis—IV ___ is used in rare cases; ___ if increased mineralocorticoid activity; ___ are the cause of chloride sensitive metabolic alkalosis; ___kalemia will also augment ___ secretion (and thus perpetuate alkalosis); loss of gastric fluid from ___ or ___ will cause alkalosis through loss of ___
IV HCl is used in rare cases; spironolactone if increased mineralocorticoid activity; diuretics are the cause of chloride sensitive metabolic alkalosis; hypokalemia will also augment H+ secretion; loss of gastric fluid from NG suction or vomiting will cause alkalosis through loss of HCl
How do diuretics cause chloride sensitive metabolic alkalosis?—___ is actively reabsorbed secondary to ECF fluid depletion; ___ goes with it to maintain electroneutrality; not enough ___ is available, so ___ is reabsorbed and ___ is secreted
Na+ is actively reabsorbed secondary to ECF fluid depletion; Cl- goes with it to maintain electroneutrality; not enough Cl- is available, so HCO3- is reabsorbed and H+ is secreted
Respiratory alkalosis may produce ___kalemia, ___calcemia, cardiac ___, broncho___, ___tension, and may potentiate the toxicity of ___
Hypokalemia, hypocalcemia, cardiac dysrhythmias, bronchoconstriction, hypotension, and may potentiate the toxicity of digoxin
Respiratory alkalosis—both brain pH and cerebral blood flow are tightly regulated and respond rapidly to changes in ___
PaCO2
Respiratory alkalosis—doubling minute ventilation reduces PaCO2 to ___ mm Hg and ___ cerebral blood flow
Reduces PaCO2 to 20 mm Hg and halves cerebral blood flow
Conversely, halving minute ventilation ___ PaCO2 and ___ cerebral blood flow
Doubles PaCO2 and doubles cerebral blood flow
In metabolic acidosis, an excess of ___ over ___ occurs in the tubular fluid primarily because of decreased filtration of ___
An excess of H+ over HCO3- occurs in the tubular fluid primarily because of decreased filtration of HCO3-
In respiratory acidosis, the excess ___ in the tubular fluid is due mainly to the rise in extracellular fluid ___, which stimulates ___ secretion
The excess H+ in the tubular fluid is due mainly to the rise in extracellular fluid PaCO2, which stimulates H+ secretion
Metabolic acidosis associated with increased anion gaps require specific treatments—T/F?
True
How can we calculate anion gap?
Anion gap = [Na+] - ([Cl-] + [HCO3-])
Sodium - (chloride + bicarb)
Normal anion gap = ___-___ mEq/L
7-14 mEq/L
Normal value 140 - (104+24) = 12 mEq/L
The anion gap is really a measure of ___
Unmeasured anions
An acidosis with a high anion gap is caused by relatively strong non-volatile acids—in this case, ___ consumes ___, and an unmeasured anion accumulates and takes the place of ___; examples include ___ia, ___, and ___
In this case, H+ consumes HCO3-, and an unmeasured anion (anything other than chlorine or bicarb, which are factored into the anion gap) accumulates and takes the place of bicarb; examples include uremia, diabetic ketoacidosis, and lactic acidosis
We calculate the anion gap to differentiate between two types of ___
Two types of metabolic acidosis
The AG is normal (< ___ meq/L) in situations such as ___hea, ___ drainage, and renal tubular ___; bicarbonate is lost externally in these situations
The AG is normal (< 13 meq/L) in situations such as diarrhea, biliary drainage, and renal tubular acidosis
The AG may be normal or reduced in ___chloremic acidosis associated with perioperative infusion of substantial quantities of ___
The AG may be normal or reduced in hyperchloremic acidosis associated with perioperative infusion of substantial quantities of 0.9% NS
Metabolic acidosis associated with a high AG (> ___ meq/L) occurs because of excess production or decreased excretion of organic acids or ingestion of one of several toxic compounds—in this case, bicarbonate ions are ___ in buffering hydrogen ions, while the associated anion replaces bicarbonate in serum
High AG (> 13 meq/L)—bicarbonate ions are consumed in buffering hydrogen ions
Expected level of compensation—in RESPIRATORY ACIDOSIS
Acute: expect a ___ meq/L increase in HCO3- for every ___ mm Hg increase in CO2 (usually from 40 mm Hg)
Chronic: expect a ___ meq/L increase in HCO3- for every ___ mm Hg increase in CO2
Acute: expect a 1 meq/L increase in HCO3- for every 10 mm Hg increase in CO2 (usually from 40 mm Hg)
Chronic: expect a 4 meq/L increase in HCO3- for every 10 mm Hg increase in CO2
~acute is a slower response because it takes time for the kidneys to kick in initially~
Expected level of compensation—in METABOLIC ACIDOSIS
CO2 decreases ___ x the decrease in HCO3- (usually from 24 meq/L)
CO2 decreases 1.2 x the decrease in HCO3-
Expected compensation in RESPIRATORY ALKALOSIS
Acute: expect ___ meq/L decrease in HCO3- for every ___ mm Hg drop in CO2
Chronic: expect ___ meq/L decrease in HCO3- for every ___ mm Hg drop in CO2
Acute: expect 2 meq/L decrease in HCO3- for every 10 mm Hg drop in CO2
Chronic: expect 4 meq/L decrease in HCO3- for every 10 mm Hg drop in CO2
Expected compensation in METABOLIC ALKALOSIS—CO2 increases ___x the increase in HCO3-
CO2 increases 0.7x the increase in HCO3-
ABG interpretation—ABG is uncompensated when CO2 or HCO3- are ___
Normal
ABG interpretation—partial compensation occurs when ___
Nothing is normal
ABG interpretation—fully compensated when ___ is normal
PH is normal—7.40
