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Objectives
Whats an ABG? Understanding Acid/Base Relationship General approach to ABG Interpretation Clinical causes Abnormal ABGs Case studies Take home
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 acid-base abnormalities
What Is An ABG?
pH [H+] PCO2 Partial pressure CO2 PO2 Partial pressure O2
HCO3 Bicarbonate
BE Base excess
SaO2
Oxygen Saturation
Acid/Base Relationship
This relationship is critical for homeostasis Significant deviations from normal pH ranges are poorly tolerated and may be life threatening
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
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 base bicarbonate Na HCO3 Process of kidneys excreting H+ into the urine and reabsorbing HCO3- into the blood from the renal tubules 1) active exchange Na+ for H+ between the tubular cells and glomerular filtrate 2) carbonic anhydrase is an enzyme that accelerates hydration/dehydration CO2 in renal epithelial cells
Acid/Base Relationship
H2O + CO2
H2CO3
HCO3 + H+
Acidosis
pH < 7.35
Alkalosis
pH > 7.45
Respiratory Acidosis
Think of CO2 as an acid failure of the lungs to exhale adequate CO2 pH < 7.35 PCO2 > 45 CO2 + H2CO3 pH
narcosis
respiratory arrest
airway obstruction
Metabolic Acidosis
failure of kidney function blood HCO3 which results in availability of renal tubular HCO3 for H+ excretion
Respiratory Alkalosis
too much CO2 exhaled (hyperventilation) PCO2, H2CO3 insufficiency = pH pH > 7.45 PCO2 < 35
Metabolic Alkalosis
plasma bicarbonate
hypokalemia
excessive alkali intake
NL
= 80 100 mmHg
NL = 7.35 7.45 Acidotic <7.35 Alkalotic >7.45 NL = 35 45 mmHg Acidotic >45 Alkalotic <35 NL = 22 26 mmol/L Acidotic < 22 Alkalotic > 26
3. PCO2
4. HCO3
~ PaCO pH Relationship
2
80 60 40 30 20
ABG Interpretation
Acidosis CO2 Change c/w Abnormality CO2 Normal CO2 Change opposes Abnormality
CO2 Expected
Metabolic
Metabolic
Acidosis
Respiratory Acidosis
ABG Interpretation
Alkalosis
CO2 Change c/w Abnormality CO2 Normal CO2 Change opposes Abnormality
CO2 Expected
Metabolic Alkalosis
Respiratory Alkalosis
Respiratory Acidosis
pH 7.30
PaCO2
HCO3
60
26
Respiratory Alkalosis
pH 7.50
PaCO2
HCO3
30
22
Metabolic Acidosis
pH PaCO2 HCO3 7.30 40 15
Metabolic Alkalosis
pH 7.50
PCO2
HCO3
40
30
In respiratory conditions, therefore, the kidneys will attempt to compensate and visa 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.
ABG Results
pH PCO2 PO2 HCO3 BE K+ 7.62 30 mmHg 85 mmHg 30 mmol/L 10 mmol/L 2.5 mmol/L BP Pulse RR VT MV 115/80 mmHg 88/min 10/min 1000ml 10L
Interpretation: Acute alveolar hyperventilation (resp. alkalosis) and metabolic alkalosis with corrected hypoxemia.
BP Pulse RR VT MV
Interpretation:
pH 7.44 BP 135/95 mmHg PCO2 63 mmHg Pulse 110/min PO2 52 mmHg RR 22/min HCO3 42 mmol/L BE +16 mmol/L MV 10L SaO2 86% . Interpretation: Chronic ventilatory failure (resp. acidosis) with uncorrected hypoxemia
Any Questions?
References
1. Shapiro, Barry A., et al; Clinical Application of Blood Gases; 1994 2. American Journal of Nursing1999;Aug99(8):34-6 3. Journal Post Anesthesia Nursing1990;Aug;5(4)264-72 4. Irvine, David;ABG Interpretation, A Rough and Dirty Production
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