6 steps to interpretate ABG by d.

Radwan Aly Radwan internal mediciene resident El Sahel teaching hospital

First at all, normal values of ABG are as follow:

PH Pco2 Po2 So2 Hco3

7.40(7.35-7.45) 40mmhg (35-45) 80-100 mmhg in room air >95% in room air

24mmol/l(22-28)

BE(base excess) this value is specified to metabolic disorders (advanced) (BE is a calculation of the amount of base needed to be added to or removed from a sample of blood to achieve a neuteral ph at 37c after Pco2 corrected to 40 mmh g) normal value is -2 to +2 if BE is negative this means that there is less base than normal(metabolic acido sis) if BE is positive this means that there is more base than normal(metabolic alkal osis)

NOTE NOTE NOTE ONLY

1: HCO3 is the only value that is equal in arterial blood and venous blood 2: ph is slightly lower in venous blood than arterial blood 3: NEVER JUDGE GAS EXCHANGE STATUS FROM VENOUS SAMPLE NEVER NEVER NEVER FROM ARTERIAL SAMPLE

NOW LETS START THE 6 STEPS OF ABG ANALYSIS......

##################1-IS THE PATIENT IS ACIDEMIC OR ALKALOTIC?

look at PH if ph less than 7.35 if ph more than 7.45

the pt is acidemic the pt is alkalotic

NOTE: a-if ph is (7.35-7.4) in case of other abnormal values or mixed disorders the primary disorder will be acidosis disorder

b-if ph is (7.4-7.45) in case of other abnormal values or mixed disorders the primary disorder will be alkalotic disorder c-if ph is (7.35-7.45) and the other values are normal,the acid base status is w ithin normal

############2-IF THERE IS ACID BASE DISORDER, IS IT METABOLIC OR RESPIRATORY?

Any primary change in pCo2 will cause respiratory disorder and will change the p h in opposite direction (in respiratory disorders, pco2 increases ph decreases and vice versa ) Any primary change in Hco3 will cause metabolic disorder and will change the ph in the same direction (in metabolic disorders, hco3 increases ph increases and vice versa ) for example : a-metabolic acidosis : b-metabolic alkalosis : c-respiratory acidosis : pensation) d_respiratory alkalosis: pensation) ph decrease hco3 decrease co2 decrease (compensation) ph increase hco3 increase co2 increase (compensation) ph decrease co2 increase hco3 increase (very slow com ph increase co2 decrease hco3 decrease (very slow com

###############3-IF THERE IS METABOLIC DISORDER,IS RESPIRATORY COMPENSATION APPR OPRIATE OR NOT?

Metabolic disorders usually are compensated by respiratory system quickly while respiratory disorders are compensated by renal system but very slowly A-FOR METABOLIC ACIDOSIS, THE PRIMARY DISORDER IS DECREASED HCO3 OR INCREASED ME TABOLIC ACID PRODUCTION LEADING TO ACIDOSIS. SO RESPIRATORY STIMULATION OCCURS TO WASH CO2 TO DECREASE THE ACIDITY OF BLOOD FOR CALCULATION OF RESPIRATORY COMPENSATION WE CALCULATE EXPECTED CO2 EXPECTED PCO2=(1.5[HCO3]+8)2 OR SIMPLY last two digits of ph(the first way is more accurate) B-FOR METABOLIC ALKALOSIS, RETENTION OF CO2 OCCURS TO DECREASE THE ALKALINITY OF BLOOD EXPECTED PCO2 = 6 mm for 10 mEq. rise in HCO3 ABOVE 24 Suspect if ............. actual PaCO2 is more than expected : additional actual PaCO2 is less than expected : additional

respiratory acidosis respiratory alkalosis

##############4-If there is metabolic acidosis, is there a HIGH anion gap ?

ANION GAP IS CALCULATED AS FOLLOW: Na-(Cl+ HCO3) =8-12 this is normal anion gap acidosis the most important causes are severe diarrhea and renal tubular acidosis and adr enal insufficiency If >12, THERE IS HIGH Anion Gap Acidosis MOST IMPORTANT CAUSES ARE :(MUDPIES) M ethanol U remia## D iabetic Ketoacidosis## P araldehyde I nfection OR Sepsis (lactic acid)## E thylene Glycol S alicylate ##THE MOST common in our ER

###############5-IF THERE IS RESPIRATORY DISORDERS, IS IT ACUTE OR CHRONIC? ALSO IS IT COMPENSATED OR NOT?

for respiratory disorder ,we are more concerned about it is acute or chronic rat her than if it is compensated as compensation by renal system takes placws very slowly A-in case of respiratory acidosis and respiratory alkalosis: 10 mm Change leads to PaCO2(above or below 40) 0.08 change in pH ( Acute ) 0.03 change in pH (Chronic)

B-respiratorty acidosis will be compensated by increase of hco3 by 1mmol in acut e condition. and 4mmol in chronic condition (this for each 10 mmhg in pco2 above 40) C-respiratory alkalosis will be compensated by decrease of hco3 by 2mmol in acut e condition . and 5mmol in chronic condition (this for each 10 mmhg in pco2 belo w 40)

###############6-evaluation of gas exchange status a- at first look at po2 if above 80, it is normal.

if (60-80) there is hypoxia if below 60 there is respiratory failure b-to know type of respiratory failure, look to pco2 if low pco2 type1 RF is present(hypoxic hypocapnic) if high pco2 type2 RF is present(hypoxic hypercapnic)

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