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ROSAPAPAN, RN,MANc
- substance that can donate or release hydrogen ions ie Carbonic acid, Hydrochloric acid
** Carbon dioxide combines with water to form carbonic acid
Base
Ie Bicarbonate
TYPES OF BUFFER
1. Bicarbonate (HCO3): carbonic acid buffer (H2CO3) 2. Phosphate buffer 3. Hemoglobin buffer
Kidney
- Regulate bicarbonate level in ECF
1. RESPIRATORY/METABOLIC ACIDOSIS - kidney excrete H and reabsorbs/generates Bicarbonate 2. RESPIRATORY/METABOLIC ALKALOSIS - kidney retains H ion and excrete Bicarbonate
Lung
- Control CO2 and Carbonic acid content of ECF
1. METABOLIC ACIDOSIS - increased RR to eliminate CO2 2. METABOLIC ALKALOSIS - decreased RR to retain CO2
ACIDOSIS
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ALKALOSIS
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Etiology: diarrhea, fistulas, diuretics, renal insufficiency, TPN w/o Bicarbonate, ketoacidosis, lactic acidosis S/sx: headache, confusion, drowsiness, inc RR, dec BP, cold clammy skin, dysrrythmia, shock
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ECG changes
Rx: Bicarbonate for pH < 7.1 and Bicarbonate level < 10
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Etiology: vomiting, diuretic, hyperaldosteronism, hypokalemia, excesive alkali ingestion s/sx: tingling of toes, dizziness, dec RR, inc PR, ventricular disturbances
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inc PaCO2
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ACUTE AND CHRONIC RESPIRATORY ACIDOSIS Ph < 7.35 PaCO2 > 42 mmHg Etiology: pulmonary edema, aspiration, atelectasis, pneumothorax, overdose of sedatives, sleep apnea syndrome, pneumonia s/sx: sudden hypercapnia produces inc PR, RR, inc BP, mental cloudinesss, feeling of fullness in head, papil edema and dilated conjunctival blood vessels
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Normal Value
7.35 7.45
PaCO2
HCO3
35 45 mmHg
22-26mEq/L
O2 saturation
95 - 100%
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radial and ulnar artery Heparinized syringe and container Pressure dressing, no activity at the site and check 5 ps distal to the site of punctured artery Note if patient is under O2 therapy Label the sample and send immediately to the laboratory
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ABG Responsibilities
Arterial blood Radial or ulnar artery Allens test Prepare Heparinized (Syringe, specimen container) Note: 02 therapy, FIO2, temp (bmr, o2) Bring specimen to the LAB (ice)
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After injection
Maintain extension position, no activity 8H Apply pressure 5-15 min
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Vascular assess
Pulselessness Pain
Paresthesia
Poikilothermia Pallor
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Handling of Specimen
Expel all air bubbles immediately Do not agitate the syringe Discard frothy specimen 1:1000 U/ml HEPARIN Place sample in ice Cool sample to 5 C if it can not be analyzed quickly
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Evaluating ABGs
1.
Note the pH pH = 7.35 7.45 (normal) pH = < 7.35 (acidosis) pH = > 7.45 (alkalosis)
Partially compensated if the Co2 and Hco3 are the same, with abnormal pH Fully Compensated if the pH is normal Uncompensated if the Co2 and HCo3 are opposite, with or if one of them is normal, abnormal pH
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2. Determine primary cause of disturbance 2.1 pH > 7.45 a. PaCo2 < 40 mmHg respiratory alkalosis b. HCO3 > 26 mEq/L metabolic alkalosis 2.2 pH < 7.35 a. PaCo2 > 40 mmHg respiratory acidosis b. HCO3 < 26 mEq/L metabolic acidosis
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3. Determine compensation by looking at the value other than the primary disturbance
pH 7.20
7.30
pH
7.21
Dec acid
PaCO2
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Inc acid
HCO3
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Dec acid
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DRILL
pH = 7.40 HCO3 = 20 PaCO2 = 40 Simple Metabolic Acidosis pH = 7.40 HCO3 = 28 PaCO2 = 40 Simple Metabolic Alkalosis
pH = 7.40 HCO3 = 24 PaCO2 = 48 Simple Respiratory Acidosis pH = 7.40 HCO3 = 24 PaCO2 = 32 Simple Respiratory Alkalosis
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ANSWER:
pH = 7.33 HCO3 = 28 PaCO2 = 48 Uncompensated Respiratory Acidosis pH = 7.47 HCO3 = 20 PaCO2 = 32 Uncompensated Respiratory Alkalosis
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ANSWER
pH = 7.40 HCO3 = 18 PaCO2 = 32 Fully Compensated Metabolic Acidosis pH = 7.35 HCO3 = 30 PaCO2 = 48 Partially Compensated Respiratory Acidosis
pH = 7.40 HCO3 = 28 PaCO2 = 48 Fully Compensated Respiratory Acidosis pH = 7.44 HCO3 = 20 PaCO2 = 32 Partially Compensated Respiratory Alkalosis
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Thank You!
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