Professional Documents
Culture Documents
Objectives
Whats an ABG? Understanding Acid/Base Relationship General approach to ABG Interpretation Clinical causes Abnormal ABGs Case studies
What is an ABG
Arterial Blood Gas Drawn from artery- radial, brachial, femoral It is an invasive procedure. Caution must be taken with patient on anticoagulants. Helps differentiate oxygen deficiencies from primary ventilatory deficiencies from primary metabolic acidbase abnormalities
Bio-Chem Review
Acid: substance that donates H+
Constantly produced from metabolism of carbs, fats, glucose, and protein
What Is an ABG?
pH [H+]
Acid/Base Relationship
This relationship is critical for homeostasis Significant deviations from normal pH ranges are poorly tolerated and may be life threatening Achieved by Respiratory and Renal systems
Buffers
There are two buffers that work in pairs H2CO3 Carbonic acid NaHCO3 base bicarbonate
These buffers are linked to the respiratory and renal compensatory system Able to change pH by taking up or releasing H+
Respiratory Component
Function of the lungs Carbonic acid H2CO3 Approximately 98% normal metabolites are in the form of CO2 CO2 + H2O H2CO3 Excess CO2 exhaled by the lungs
Metabolic Component
Function of the kidneys and GI tract Acid H+ Base bicarbonate Na HCO3 Process of kidneys excreting H+ into the urine and reabsorbing HCO3- into the blood from the renal tubules
Acidosis
pH PCO2 HCO3 < 7.35 > 45 < 22
Alkalosis
pH PCO2 HCO3 > 7.45 < 35 > 26
Respiratory Acidosis
pH + CO2 Think of CO2 as an acid Failure of the lungs to exhale adequate CO2 pH < 7.35 PCO2 > 45
Metabolic Acidosis
pH + Bicarb 2 main reasons: a. Kidneys inability to excrete H+ b. Loss of HCO3 from GI Mainly failure of kidney function pH < 7.35 HCO3 < 22
Respiratory Alkalosis
pH + CO2 Too much CO2 exhaled (hyperventilation) PCO2, H2CO3 insufficiency = pH pH > 7.45 PCO2 < 35
Metabolic Alkalosis
pH + Bicarb Kidneys failure to excrete HC03 GI r/t loss of gastric secretions (HCL) plasma bicarbonate pH > 7.45 HCO3 > 26
TX: Treat underlying cause. KCL replacement Antiemetics, PPI (proton pump inhibitors)
3. PCO2
4. HCO3
acidosis alkalosis
<7.35 >7.45
R.O.M.E.
Respiratory Opposite Metabolic Equal
Base Excess
Amount of acid or base that needs to be added to 1 liter of arterial blood to get pH 7.4 (to normalize) HCO3: the lower the HCO3 level the more negative the base deficit. Normal: -2 +2 (-) means base deficit (metabolic acidosis) (+) means base excess (metabolic alkalosis)
Anion Gap
Measurement of the difference between Na+ (cation) and HCO 3 & Cl (anions) Allows us to narrow down the possible causes of a patients metabolic acidosis Normal: 8-12
Loss of HCO3 but replaced by Cl so Cl-, or renal tubular necrosis
Respiratory Acidosis
pH PaCO2 HCO3 7.30 60 26
Respiratory Alkalosis
pH PaCO2 HCO3 7.50 30 22
Metabolic Acidosis
pH PaCO2 HCO3 7.30 40 15
Metabolic Alkalosis
pH PCO2 HCO3 7.50 40 30
In respiratory conditions, therefore, the kidneys will attempt to compensate and vise versa. In chronic respiratory acidosis (COPD) the kidneys increase the elimination of H+ and absorb more HCO3. The ABG will Show NL pH, CO2 and HCO3. Buffers kick in within minutes. Respiratory compensation is rapid and starts within minutes and complete within 24 hours. Kidney compensation takes hours and up to 5 days.
Drawing an ABG
A-Line
50-80% have arterial-lines Most post-op patients Difficult sticks and frequent lab draws Different syringe Waste 2-3ml Label and fill out rec No ice, tube to 15th floor lab
Drawing an ABG
Manually
Assess collateral circulation Only perform radial artery Dorsiflex wrist (small towel) Where pulse is the strongest 30-60 angle (not > 45) Automatically fills to pre-set volume (1-3mL) Pressure for 5 min or bleeding stops Expel air out of syringe through cap
Any Questions?
Practice ABGs
1. PaO2 2. PaO2 3. PaO2 4. PaO2 5. PaO2 6. PaO2 7. PaO2 8. PaO2 9. PaO2 10. PaO2 90 60 95 87 94 62 93 95 65 110 SaO2 95 SaO2 90 SaO2 100 SaO2 94 SaO2 99 SaO2 91 SaO2 97 SaO2 99 SaO2 89 SaO2 100 pH 7.48 pH 7.32 pH 7.30 pH 7.38 pH 7.49 pH 7.35 pH 7.45 pH 7.31 pH 7.30 pH 7.48 PaCO2 32 PaCO2 48 PaCO2 40 PaCO2 48 PaCO2 40 PaCO2 48 PaCO2 47 PaCO2 38 PaCO2 50 PaCO2 40 HCO3 HCO3 HCO3 HCO3 HCO3 HCO3 HCO3 HCO3 HCO3 HCO3 24 25 18 28 30 27 29 15 24 30