Respiratory acidosis is suggested by Pco2> 40 mm Hg; HCO3 should

compensate acutely by increasing 3 to 4 mEq/L for each 10 mm Hg rise in

Pco2 sustained for 4 to 12 h (there may be no increase or only 1 to 2 mEq/L,
which slowly increases to 3 to 4 mEq/L over days). Greater increase in HCO 3
implies a primary metabolic alkalosis; lesser increase suggests no time for
compensation or coexisting primary metabolic acidosis.
Metabolic alkalosis is suggested by HCO3> 28 mEq/L. The Pco2 should
compensate by increasing about 0.6 to 0.75 mm Hg for each 1 mEq/L
increase in HCO3 (up to about 55 mm Hg). Greater increase implies
concomitant respiratory acidosis; lesser increase, respiratory alkalosis.
Respiratory alkalosis is suggested by Pco2< 38 mm Hg. The HCO3 should
compensate over 4 to 12 h by decreasing 5 mEq/L for every 10 mm Hg
decrease in Pco2. Lesser decrease means there has been no time for
compensation or a primary metabolic alkalosis coexists. Greater decrease
implies a primary metabolic acidosis.
Nomograms (acid-base maps) are an alternative way to diagnose mixed
disorders, allowing for simultaneous plotting of pH, HCO 3, and Pco2.