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acid-basic disorder
stefanus lembar
ABG analysis
Why do we care ?
Clinical Significance
To evaluate respiratory
failure
type or type
To evaluate acid-basic
disorder
Hypoxia
Mild: 80-60mmHg
Mediate: 6040mmHg
Severe: <40mmHg
Respiratory Failure
PaO2<60mmHg
failure
respiratory
Classification of Respiratory
Failure
PaCO2: The carbon dioxide partial
pressure
of arterial blood
Normal: 35-45mmHg (4.7-6.0kPa)
mean: 40mmHg
Classification of Respiratory
Failure
PaO2 (mmHg)
<60
PaCO2 (mmHg)
>50
Type
<60
50
Type
PH=Pka+l 0.03PaCO
og
20
1
6.1+lo
HCO3- (bicarbonate):
SB (standard bicarbonate)
AB (actual bicarbonate)
SB: the contents of HCO3- of serum of
arterial
blood in 38, PaCO2 40mmHg, SaO2
100%.
Normal: 22-27mmol/L
mean: 24mmol/L
AB: The contents of HCO3- in actual
condition.
In normal person: AB=SB
Classification of Acid-basic
Disorder
Complementary: PH is normal
Dis-complementary: PH is
abnormal.
Classification of Acid-basic
Disorder
PH
HCO3Resp. acidosis
Resp. alkalosis
Meta. acidosis
Meta. alkalosis
PaCO2
Oxygen level
Carbon Dioxide Level
pH
Bicarbonate level
ABG Analysis
pH: 7.35-7.45
PaCO2: 35-45mmHg
HCO3: 22-26/28 mEq/L
PaO2: > 80mmHg
Oxygen Saturation >95%
Analysis
pH
=Alkalosis
pH
=Acidosis
Analysis
PaCO2
= Respiratory
PaCO2
= Respiratory
Comparison
Chart
pH
Resp
Acid.
Resp Alk.
Metab
Acid
Metab
Alk
PaCO2
HCO3
Respiratory Acidosis
Any disease process which decreases
the
ability of the lungs to exchange CO2 for
oxygen.
Increased K+
Pneumonia
Asthma
CHF
Respiratory Acidosis
pH
PaCO2
Respiratory Alkalosis
Anything which greatly increases
respiratory rate.
Fever
Pain
Anxiety
Overvenitilation with a mechanical
venitalator
Decreased K+
Respiratory Alkalosis
pH
PaCO2
Metabolic Acidosis
Anything which increases the
accumulation of acids or decreases the
amount of bicarbonate in the body.
Renal failure
Loss of bases from diarrhea
Increased K+
Diuretic therapy which causes HCO3 loss
Metabolic Acidosis
pH
HCO3
Metabolic Alkalosis
Anything which decreases H ions in
The body or increases bicarbonate.
Prolonged vomiting
Metabolic Alkalosis
pH
HCO3
Determining ABGs
Determining ABGs
A normal pH may indicate perfectly
normal blood gases, or it may be an
indication of a compensated
imbalance.
A compensated imbalance is one in
which the body has been able to
correct the pH by either respiratory or
metabolic changes (depending on the
primary problem)
Example of
compensation
Pt. With primary metabolic acidosis
starts out with a low bicarbonate
level but a normal carbon dioxide
level. Soon afterward, the lungs try
to compensate for the imbalance by
exhaling large amounts of carbon
dioxide. (hyperventilation)
Interpreting ABGs
pH > 7.45 (alkalosis) and the PaCO2 is,
< 35 mmHg, the primary disturbance is
respiratory alkalosis. This occurs when a pt.
hyperventilates and blows off too much
carbon dioxide.
pH > 7.45 (alkalosis) and the HCO2 is > 26
mEq/L, the primary disturbance is metabolic
alkalosis. This situation occurs when the body
gains too much bicarbonate, an alkaline
substance.
Interpreting ABGs
pH <7.35 (acidosis) and the PaCO2 is
> 40mmHg, the primary disturbance
is respiratory acidosis. This situation
occurs when a patient hypoventilates
and thus retains too much carbon
dioxide, an acidic substance.
Interpreting ABGs
pH < 7.35 (acidosis) and the HCO3 is
< 22mEq/L, the primary disturbance
is metabolic acidosis. This situation
occurs when the bodys bicarbonate
level drops , either because of direct
bicarbonate loss or because of gains
of acids such as lactic acid or
ketones.
Determine if compensation
has begun
This is done by looking at the value
other than the primary disorder. If it
is moving in the same direction as
the primary value, compensation is
underway.
Examples
Consider the following gases:
pH
PaCO2
HCO3
1)7.20
60mmHg 24mEq/L
2)7.33
60mmHg 37mEq/L
1) indicates acute respiratory acidosis without
compensation (the PaCO2 is high, the
HCO3 is normal).
2) Indicates chronic respiratory acidosis,
compensation has taken place; that is
HCO3 has elevated to an appropriate level
to balance the high PaCo2 ands produce a
normal pH.
Example of
compensation
A patient with primary respiratory
acidosis starts out with a high carbon
dioxide level; soon afterward, the
kidneys attempt to compensate by
retaining bicarbonate. If the
compensatory maneuver is able to
restore the bicarbonate to carbonic acid
ratio back to 20:1, full compensation
(and thus normal pH) will be achieved.
Thank you