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Arterial Blood Gases

Acid-Base Balance

Components


Arterial partial pressure of oxygen (PaO2)




Measures the amount of oxygen dissolved in the plasma Value is directly dependent upon the alveolar oxygen pressure (PAO2) Measures the amount of CO2 dissolved in the plasma The negative logarithm of the hydrogen ion concentration

Arterial pressure of carbon dioxide (PaCO2)




pH


Components, cont


Bicarbonate (HCO3-)
 

Calculated from the CO2 and pH using the HendersonHasselbach equation Allows assessment of the metabolic component of acidbase balance Reflects A measure of the amount of acid or alkali that must be added to a sample under standard conditions to return the pH to 7.4 Calculated from the pH and PaCO2

 

Total CO2


Base excess (or deficit)




Interpreting ABGs


Assess pH:


normal, alkalotic, acidotic PaCO2 >45 = respiratory acidosis PaCO2 <35 = respiratory alkalosis HCO3 > 28 = metabolic alkalosis HCO3 < 22 = metabolic acidosis

Assess the respiratory component


 

Assess the metabolic component


 

Determine if there is metabolic or respiratory compensation occurring

Anion Gap
The difference between the main positive and negative ions  (Na + K) (Cl + HCO3)  Normal is 10-18  Increased anion gap indicates an accumulation of organic acids (ketoacids, lactic acid, other acids)


Acid-Base Balance
  

Intracellular enzymes function best when the pH is 7.25 7.45 Most metabolic processes produce acids Acid production increases with dx:
  

Lactic acid from ischemia/anaerobic metabolism Ketoacids from diabetes Methanol from alcohol ingestion

  

Renal/respiratory/liver failure decrease acid removal from the body Loss of acid occurs with vomiting/NG suctioning Loss of bicarb occurs with diarrhea

Disorders of Acid-Base Balance




Metabolic acidosis


With a normal anion gap


 Renal

bicarb loss  Loss of bicarb from the gut  Decreased renal hydrogen ion secretion


Increased anion gap (acid accumulation)


 Lactic
 

acidosis

Type A: sepsis, cardiac arrest, hypotension, methanol Type B: insulin deficiency, decreased hepatic metabolism

 Ketoacidosis:

insulin deficiency, starvation  Exogenous acids: salicylates

Disorders, cont


Metabolic alkalosis
Hydrogen ion loss: vomiting, renal loss, diuretics, hypokalemia, low Cl states  Bicarb gain: sodium bicarb administration, citrate administration


Respiratory acidosis
Airway obstruction, pneumonia, ARDS, PE  Respiratory muscle weakness  Trauma  Respiratory depression


Disorders, cont


Respiratory alkalosis
High levels of anxiety or pain  Altitude  Excessive mechanical ventilation  Respiratory stimulants/salicylate overdose  Pulmonary embolism, asthma, edema


Control of acid-base balance




The body prevents pH changes by regulating 2 pathways for eliminating acid


Respiratory  Renal


100 times more acid equivalents are expired each day in the form of CO2 than are excreted by the kidney  Buffers bind or release hydrogen ion according to the pH to limit the change in pH that occurs when acid is added to the blood


Main body buffers




Bicarbonate
CO2 combines with water to form carbonic acid which dissociates into bicarb and hydrogen ion  CO2 + H2O = H2CO3 = HCO3- + H+  The normal ratio of bicarb to CO2 is 20:1as long as this ratio remains 20:1, the pH will be 7.4


Hemoglobin


Especially deoxygenated Hb

Relationship between pH, PaCO2, HCO3


When CO2 changes persist, pH is slowly corrected by renal compensation (retention or elimination of bicarb)  Metabolic changes can be corrected by respiratory compensation but metabolic alkalosis is not compensated as it would require a drop in ventilation  Mixed conditions (acidosis or alkalosis) can occur