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WHAT IS AN ABG?
An arterial blood gas (ABG) is a blood test that is performed specifically on arterial blood from the radial or femoral arteries. It is used to determine the concentrations of CO2, O2, HCO3 and the PH of the blood
A high PCO2 (respiratory acidosis) indicates hypoventilation, a low PCO2 (respiratory alkalosis) indicates hyperventilation.
respiratory system is working to compensate for a metabolic issue so as to normalize the blood pH.
A normal HCO3 is 22-27 mmHg A low HCO3- indicates metabolic acidosis, a high HCO3- indicates metabolic alkalosis.
kidneys are working to compensate for a respiratory issue so as to normalize the blood pH.
PO2 : A low O2 indicates that the patient is not respiring properly, and is hypoxemic. The normal PO2 80-100 mmHg
4.
matches it is the primary imbalance. 6. Check the value opposite the PH this is the compensation So, ask yourself, if the PH is academic what is alkalemic? This is the compensated Then ask, is it complete compensation=does the PH go back to the normal range? Or is it partial=The PH is not in the normal range
THE PH:
7.40
acidosis
compensated
alkalosis
compensated
7.35 7.45 Anything less is anything more is Uncompensated uncompensated OR partially compensated
PH
CASE 1
y Mr. abdulla is a 60 year-old with pneumonia. He is
admitted with dyspnea, fever, and chills. His blood gas is below: pH 7.28 CO2 56 PO2 70 HCO3 25 SaO2 89% y What is your interpretation?
Answer to case1
y Mr. abdulla has an uncompensated respiratory
acidosis with hypoxemia as a result of his pneumonia. This is due to inadequate ventilation and perfusion.
Respiratory acidosis
y It is due to Alveolar hypoventilation y Hypercapnia and respiratory acidosis occur when
impairment in ventilation occurs and the removal of CO2 by the lungs is less than the production of CO2 in the tissues.
Chronic respiratory acidosis: secondary to many disorders causes are: 1. COPD 2. obesity hypoventilation syndrome 3. severe restrictive ventilatory defects as observed in interstitial fibrosis and thoracic deformities.
CASE 2
y Ms. sara was admitted for a drug overdose. She is
being mechanically ventilated and a blood gas is obtained to assess her for weaning. The results are as follows: pH 7.42 CO2 18 pO2 100 HCO3 11 SaO2 98% y What is your interpretation?
Answer to case 2
y Mrs. Sara is being overventilated which caused a
Respiratory alkalosis
y results from hyperventilation leading to decreased PCO2 concentration. y the alkalosis may disrupt calcium ion balance, and cause the symptoms of hypocalcaemia, such as tetany and fainting with no fall in total serum calcium levels.
Causes: 1. Hypoxemia: high altitudes 2. CNS stimulation: Anxiety and stress 3. Caffeine overdose, nicotine 4. Stimulation of chest receptors: pulmonary embolism
Chronic respiratory alkalosis: HCO3 decreases by 4 mmol/l for each 10 mmHg decrease in PCO2
CASE 3
y Ms. nada is a 24 year-old college student. She has a
history of Crohn's disease and is complaining a of a four day history of bloody-watery diarrhea. A blood gas is obtained to assess her acid/base balance: pH 7.28 CO2 43 pO2 88 HCO3 20 SaO2 96% y What is your interpretation?
Answer to case 3
Ms. nada has an uncompensated metabolic acidosis. This is due to excessive bicarbonate loss from her diarrhea. It is interesting to note that she has no compensation. Normally, the respiratory center compensates quickly for metabolic disorders
Metabolic acedosis
y increased production of H+ by the body or the
inability of the body to form HCO3- in the kidney. its consequences can be serious, including coma and death. y The anion gap is important for the DDX of metabolic acidosis=( [Na+] ) - ( [Cl-]+[HCO3-] ) As sodium is the main extracellular cation, and chloride and bicarbonate are the main anions, the result should reflect the remaining anions.
proximal(type2)renal tubular acedosis(RTA) and acetazolamide ingestion 3. Decreased renal H Excretion: distal(type1) RTA and (type 4) RTA 4. Increased HCL production: ammonium chloride ingestion
High anion gap metabolic acedosis: > 16 mmol/l Causes: MUDPILES: y M-Methanol y U-Uremia y D-Diabetic Ketoacidosis y P-Paraldehyde y I-Infection, Iron, Isoniazid y L-Lactic acidosis y E-Ethylene Glycol y S-Salicylates AG > 25: ingestion of a poison (mostly an _ol)
CASE 4
y Ms. farah is a 17 year-old with intractable vomiting.
She has some electrolyte abnormalities, so a blood gas is obtained to assess her acid/base balance. pH 7.49 CO2 40 pO2 92 HCO3 29 SaO2 97% y What is your interpretation?
Answer to case 4
y Ms. farah has an uncompensated metabolic
alkalosis. This is due to vomiting that results in excessive loss of stomach acid. Treatment consists of fluids, anti-emetics, and management of her electrolyte disorders.
Metabolic alkalosis
y Either because of decreased hydrogen ion
Retention of bicarbonate
Alkalotic agents :
IN SUMMARY
y The 6 steps to ABG interpretation are? y CO2 primary changes tell us that the problem is
respiratory y HCO3 primary changes tell us that the problem is metabolic y Respiratory compensation is faster that metabolic compensation