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Questions and Answers
Before performing an arterial blood gas (ABG) draw, which test should be conducted to assess adequate collateral circulation in the hand?
Before performing an arterial blood gas (ABG) draw, which test should be conducted to assess adequate collateral circulation in the hand?
- Capillary Refill Test
- Ulnar Nerve Conduction Study
- Allen Test (correct)
- Brachial Artery Palpation
What is the normal range for arterial blood pH?
What is the normal range for arterial blood pH?
- 7.35 - 7.45 (correct)
- 7.46 - 7.55
- 7.25 - 7.34
- 7.15 - 7.24
A patient on room air has an arterial blood gas with a PaO2 of 75 mm Hg. How would you interpret this result?
A patient on room air has an arterial blood gas with a PaO2 of 75 mm Hg. How would you interpret this result?
- Hypoxemia (correct)
- This result is not possible on room air
- Normal oxygenation
- Hyperoxemia
What is the normal range for pH in arterial blood?
What is the normal range for pH in arterial blood?
Which of the following arterial blood gas (ABG) values indicates adequate ventilation?
Which of the following arterial blood gas (ABG) values indicates adequate ventilation?
What is the primary mechanism by which the body eliminates acid to maintain acid-base homeostasis?
What is the primary mechanism by which the body eliminates acid to maintain acid-base homeostasis?
A patient's ABG results show a pH of 7.30 and a PaCO2 of 50 mmHg. How would you classify this acid-base disorder?
A patient's ABG results show a pH of 7.30 and a PaCO2 of 50 mmHg. How would you classify this acid-base disorder?
Following a traumatic injury, a patient presents with the following ABG results while on a non-rebreather mask (100% FiO2): pH 7.49, PaCO2 42 mmHg, PaO2 88 mmHg, HCO3 32 mEq/L, and O2 saturation 97%. What is the most appropriate interpretation of oxygenation in this patient?
Following a traumatic injury, a patient presents with the following ABG results while on a non-rebreather mask (100% FiO2): pH 7.49, PaCO2 42 mmHg, PaO2 88 mmHg, HCO3 32 mEq/L, and O2 saturation 97%. What is the most appropriate interpretation of oxygenation in this patient?
A patient's arterial blood gas (ABG) shows a pH of 7.54. Which condition does this indicate?
A patient's arterial blood gas (ABG) shows a pH of 7.54. Which condition does this indicate?
Which combination of arterial blood gas (ABG) values represents uncompensated metabolic alkalosis?
Which combination of arterial blood gas (ABG) values represents uncompensated metabolic alkalosis?
Which of the following conditions would result in respiratory acidosis?
Which of the following conditions would result in respiratory acidosis?
A patient's ABG reveals the following: pH 7.30, PaCO2 60 mmHg, PaO2 60 mmHg, HCO3 30 mEq/L. The patient is on 2L of oxygen via nasal cannula. Which of the following interventions is most appropriate, considering the ABG results and clinical context?
A patient's ABG reveals the following: pH 7.30, PaCO2 60 mmHg, PaO2 60 mmHg, HCO3 30 mEq/L. The patient is on 2L of oxygen via nasal cannula. Which of the following interventions is most appropriate, considering the ABG results and clinical context?
Calculate the anion gap for a patient with the following lab values: Na+ = 140 mEq/L, Cl- = 96 mEq/L, HCO3- = 24 mEq/L.
Calculate the anion gap for a patient with the following lab values: Na+ = 140 mEq/L, Cl- = 96 mEq/L, HCO3- = 24 mEq/L.
In metabolic alkalosis, which of the following compensatory mechanisms is least likely to occur?
In metabolic alkalosis, which of the following compensatory mechanisms is least likely to occur?
A patient presents with a pH of 7.30, pCO2 of 55 mm Hg, and HCO3- of 26 mEq/L. What is the most likely acid-base disturbance?
A patient presents with a pH of 7.30, pCO2 of 55 mm Hg, and HCO3- of 26 mEq/L. What is the most likely acid-base disturbance?
A rare genetic defect causes a complete lack of carbonic anhydrase in erythrocytes. Assuming no other compensatory mechanisms, predict the most likely acid-base disturbance this individual would experience.
A rare genetic defect causes a complete lack of carbonic anhydrase in erythrocytes. Assuming no other compensatory mechanisms, predict the most likely acid-base disturbance this individual would experience.
A patient has the following arterial blood gas (ABG) results: pH 7.30, PaCO2 55 mm Hg, HCO3 25 mEq/L. Which of the following is the primary disturbance?
A patient has the following arterial blood gas (ABG) results: pH 7.30, PaCO2 55 mm Hg, HCO3 25 mEq/L. Which of the following is the primary disturbance?
What is the normal range for HCO3 (bicarbonate) in arterial blood?
What is the normal range for HCO3 (bicarbonate) in arterial blood?
Which of the following is the primary indication for evaluating the alveolar-arterial oxygen gradient (A-a gradient) using arterial blood gas (ABG) analysis?
Which of the following is the primary indication for evaluating the alveolar-arterial oxygen gradient (A-a gradient) using arterial blood gas (ABG) analysis?
A patient breathing room air has an arterial blood gas (ABG) with the following values: pH 7.48, PaCO2 30 mmHg, PaO2 95 mmHg, HCO3 22 mEq/L. Which of the following is the most appropriate interpretation?
A patient breathing room air has an arterial blood gas (ABG) with the following values: pH 7.48, PaCO2 30 mmHg, PaO2 95 mmHg, HCO3 22 mEq/L. Which of the following is the most appropriate interpretation?
Which of the following arterial blood gas (ABG) values would be expected in a patient with uncompensated respiratory alkalosis?
Which of the following arterial blood gas (ABG) values would be expected in a patient with uncompensated respiratory alkalosis?
A patient is hyperventilating due to anxiety. Which of the following arterial blood gas (ABG) abnormalities is most likely?
A patient is hyperventilating due to anxiety. Which of the following arterial blood gas (ABG) abnormalities is most likely?
What does FiO2 represent in the context of arterial blood gas (ABG) interpretation?
What does FiO2 represent in the context of arterial blood gas (ABG) interpretation?
A patient with severe chronic obstructive pulmonary disease (COPD) typically adapts to chronically elevated PaCO2 levels. Which of the following arterial blood gas (ABG) findings would be most concerning in such a patient?
A patient with severe chronic obstructive pulmonary disease (COPD) typically adapts to chronically elevated PaCO2 levels. Which of the following arterial blood gas (ABG) findings would be most concerning in such a patient?
A patient presents with chronic obstructive pulmonary disease (COPD) and the following arterial blood gas (ABG) results: pH 7.36, PaCO2 60 mmHg, HCO3 34 mEq/L, PaO2 55 mmHg. Which of the following best describes the acid-base disturbance?
A patient presents with chronic obstructive pulmonary disease (COPD) and the following arterial blood gas (ABG) results: pH 7.36, PaCO2 60 mmHg, HCO3 34 mEq/L, PaO2 55 mmHg. Which of the following best describes the acid-base disturbance?
A patient with severe vomiting loses a significant amount of gastric acid. Which acid-base imbalance is most likely to develop if there is no compensation?
A patient with severe vomiting loses a significant amount of gastric acid. Which acid-base imbalance is most likely to develop if there is no compensation?
Following an episode of severe vomiting, a patient's ABG reveals a high pH and elevated bicarbonate level. Which compensatory mechanism is most likely to be activated in this scenario?
Following an episode of severe vomiting, a patient's ABG reveals a high pH and elevated bicarbonate level. Which compensatory mechanism is most likely to be activated in this scenario?
A patient's ABG shows a pH of 7.50, PaCO2 of 50 mmHg, and HCO3 of 40 mEq/L. Which of the following best describes the acid-base disturbance and the expected compensation?
A patient's ABG shows a pH of 7.50, PaCO2 of 50 mmHg, and HCO3 of 40 mEq/L. Which of the following best describes the acid-base disturbance and the expected compensation?
A patient has the following arterial blood gas (ABG) results: pH 7.20, PaCO2 65 mmHg, PaO2 55 mmHg, and HCO3 24 mEq/L. Which of the following clinical presentations is least likely to be associated with these findings?
A patient has the following arterial blood gas (ABG) results: pH 7.20, PaCO2 65 mmHg, PaO2 55 mmHg, and HCO3 24 mEq/L. Which of the following clinical presentations is least likely to be associated with these findings?
A patient’s ABG shows a pH of 7.32, PaCO2 of 30 mmHg, HCO3- of 15 mEq/L. Which of the following best describes the acid-base disorder?
A patient’s ABG shows a pH of 7.32, PaCO2 of 30 mmHg, HCO3- of 15 mEq/L. Which of the following best describes the acid-base disorder?
A researcher is studying a novel drug that selectively inhibits carbonic anhydrase in the kidneys, but not in red blood cells. Assuming the body does not compensate, what arterial blood gas (ABG) change would they most likely observe?
A researcher is studying a novel drug that selectively inhibits carbonic anhydrase in the kidneys, but not in red blood cells. Assuming the body does not compensate, what arterial blood gas (ABG) change would they most likely observe?
An arterial blood gas (ABG) is drawn on a patient and reveals a normal PaO2 but a significantly decreased SaO2. Which of the following conditions is the most likely explanation for this discrepancy?
An arterial blood gas (ABG) is drawn on a patient and reveals a normal PaO2 but a significantly decreased SaO2. Which of the following conditions is the most likely explanation for this discrepancy?
Which of the following pH values represents acidosis?
Which of the following pH values represents acidosis?
What is the primary role of the lungs in maintaining acid-base balance?
What is the primary role of the lungs in maintaining acid-base balance?
A patient has a PaCO2 of 50 mm Hg. What condition does this indicate?
A patient has a PaCO2 of 50 mm Hg. What condition does this indicate?
If a patient's arterial blood gas (ABG) shows a pH of 7.50 and the primary disturbance is metabolic, what is the appropriate term for this condition?
If a patient's arterial blood gas (ABG) shows a pH of 7.50 and the primary disturbance is metabolic, what is the appropriate term for this condition?
Which of the following changes would indicate respiratory alkalosis?
Which of the following changes would indicate respiratory alkalosis?
A patient presents with a pH of 7.28 and a normal HCO3 level. Which of the following is the most likely primary acid-base disorder?
A patient presents with a pH of 7.28 and a normal HCO3 level. Which of the following is the most likely primary acid-base disorder?
What change in bicarbonate (HCO3) levels would you expect to see in a patient with metabolic acidosis?
What change in bicarbonate (HCO3) levels would you expect to see in a patient with metabolic acidosis?
What is the expected compensatory response in the respiratory system for a patient experiencing metabolic alkalosis?
What is the expected compensatory response in the respiratory system for a patient experiencing metabolic alkalosis?
A patient's arterial blood gas (ABG) shows a pH of 7.54, PaCO2 of 30 mmHg, and HCO3 of 24 mEq/L. Which of the following conditions is most likely?
A patient's arterial blood gas (ABG) shows a pH of 7.54, PaCO2 of 30 mmHg, and HCO3 of 24 mEq/L. Which of the following conditions is most likely?
A chemist discovers a novel buffer system in human blood, distinct from bicarbonate, that contributes significantly to pH regulation but is not directly measurable by standard ABG machines. If, in a patient, this buffer becomes saturated by excess acid, but the ABG values (pH, PaCO2, HCO3) remain within normal limits, what potentially life-threatening condition might be masked by the ABG results?
A chemist discovers a novel buffer system in human blood, distinct from bicarbonate, that contributes significantly to pH regulation but is not directly measurable by standard ABG machines. If, in a patient, this buffer becomes saturated by excess acid, but the ABG values (pH, PaCO2, HCO3) remain within normal limits, what potentially life-threatening condition might be masked by the ABG results?
Why is documenting the FiO2 important when interpreting an arterial blood gas (ABG)?
Why is documenting the FiO2 important when interpreting an arterial blood gas (ABG)?
What does PaCO2 directly reflect regarding a patient's respiratory function?
What does PaCO2 directly reflect regarding a patient's respiratory function?
Which of the following parameters is least useful when evaluating a patient for a possible ventilation issue?
Which of the following parameters is least useful when evaluating a patient for a possible ventilation issue?
A patient has an O2 saturation of 85%. What other ABG value is most important to consider in conjunction with this?
A patient has an O2 saturation of 85%. What other ABG value is most important to consider in conjunction with this?
When is the Allen test performed prior to an arterial blood gas (ABG)?
When is the Allen test performed prior to an arterial blood gas (ABG)?
Which of the following blood samples is required when assessing acid-base balance using blood gas analysis?
Which of the following blood samples is required when assessing acid-base balance using blood gas analysis?
What is the appropriate interpretation of the following arterial blood gas (ABG) results obtained while the patient is breathing room air (21% FiO2): pH 7.49, PaCO2 40 mmHg, PaO2 58 mmHg, HCO3 30 mEq/L?
What is the appropriate interpretation of the following arterial blood gas (ABG) results obtained while the patient is breathing room air (21% FiO2): pH 7.49, PaCO2 40 mmHg, PaO2 58 mmHg, HCO3 30 mEq/L?
A 60-year-old male with a history of COPD presents to the emergency department with increased shortness of breath. His ABG on 2L nasal cannula shows pH 7.30, PaCO2 65 mmHg, PaO2 50 mmHg, and HCO3 30 mEq/L. Which of the following is the most appropriate initial intervention?
A 60-year-old male with a history of COPD presents to the emergency department with increased shortness of breath. His ABG on 2L nasal cannula shows pH 7.30, PaCO2 65 mmHg, PaO2 50 mmHg, and HCO3 30 mEq/L. Which of the following is the most appropriate initial intervention?
A patient with end-stage renal disease presents with the following ABG: pH 7.20, PaCO2 30 mmHg, PaO2 90 mmHg, and HCO3 12 mEq/L. What is the likely underlying cause of this acid-base disturbance?
A patient with end-stage renal disease presents with the following ABG: pH 7.20, PaCO2 30 mmHg, PaO2 90 mmHg, and HCO3 12 mEq/L. What is the likely underlying cause of this acid-base disturbance?
A previously healthy 25-year-old female presents to the emergency department complaining of numbness and tingling in her hands and feet, along with lightheadedness. Her respiratory rate is 36 breaths per minute and appears labored. An ABG reveals: pH 7.55, PaCO2 28 mmHg, PaO2 95 mmHg, HCO3 24 mEq/L. What is the most appropriate next step in managing this patient?
A previously healthy 25-year-old female presents to the emergency department complaining of numbness and tingling in her hands and feet, along with lightheadedness. Her respiratory rate is 36 breaths per minute and appears labored. An ABG reveals: pH 7.55, PaCO2 28 mmHg, PaO2 95 mmHg, HCO3 24 mEq/L. What is the most appropriate next step in managing this patient?
Flashcards
Allen Test
Allen Test
Test to ensure adequate blood flow in the ulnar artery before ABG draw.
ABG Components
ABG Components
pH measures blood acidity; PaCO2 indicates CO2 pressure; PaO2 indicates O2 pressure; HCO3 is serum bicarbonate concentration.
Normal pH
Normal pH
Normal range: 7.35-7.45
Normal pCO2
Normal pCO2
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Normal pO2
Normal pO2
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Normal HCO3
Normal HCO3
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Indications for ABG
Indications for ABG
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FiO2
FiO2
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Normal pH Value
Normal pH Value
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Normal pCO2 Value
Normal pCO2 Value
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Normal HCO3 Value
Normal HCO3 Value
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Normal Anion Gap (AG)
Normal Anion Gap (AG)
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Acidosis
Acidosis
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Alkalosis
Alkalosis
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Respiratory Acidosis
Respiratory Acidosis
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CO2 Elimination
CO2 Elimination
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Anion Gap (AG) formula
Anion Gap (AG) formula
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Respiratory Acidosis example
Respiratory Acidosis example
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Metabolic Acidosis example
Metabolic Acidosis example
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Metabolic Alkalosis example
Metabolic Alkalosis example
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Respiratory Alkalosis example
Respiratory Alkalosis example
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Elevated PaCO2 effect
Elevated PaCO2 effect
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Before ABG: What test?
Before ABG: What test?
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What is ABG?
What is ABG?
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ABG: Ventilation Indicator
ABG: Ventilation Indicator
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O2 Saturation
O2 Saturation
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FiO2 Definition
FiO2 Definition
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Respiratory Acid-Base Disorder
Respiratory Acid-Base Disorder
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Metabolic Acid-Base Disorder
Metabolic Acid-Base Disorder
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ABG: What device?
ABG: What device?
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What is the Allen's test?
What is the Allen's test?
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Key ABG Components
Key ABG Components
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pH
pH
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HCO3
HCO3
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Anion Gap
Anion Gap
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Respiratory Acidosis/Alkalosis
Respiratory Acidosis/Alkalosis
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Metabolic Acidosis/Alkalosis
Metabolic Acidosis/Alkalosis
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Pulmonary CO2 elimination
Pulmonary CO2 elimination
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Study Notes
- Allen test is necessary prior to ABG draws.
- Arterial blood is drawn for ABG.
- Venous blood is drawn for VBG.
ABG Values
- Arterial blood pH is measured by pH.
- The arterial pressure of CO2 in mmHg is measured by PaCO2 or PCO2.
- The arterial pressure of O2 in mmHg is measured by PaO2 or PO2.
- Serum bicarbonate concentration in mEq/liter is measured by HCO3.
- The percentage of hemoglobin saturated with O2 is measured by O2 saturation.
- The fraction of the inhaled gas that is O2 is measured by FiO2
Normal ABG Values on Room Air
- A normal pH is between 7.35-7.45
- A normal pCO2 is between 35-45
- A normal pO2 is between 80-100
- A normal HCO3 is between 22-26
- A normal sO2 is between 92-100%
Sample ABG Values When Documented in Chart
- An example ABG could be values of 7.49/42/88/32 with 97% O2 saturation on 100% O2.
- To obtain these values, the patient must be on a nonrebreather mask
Indications for ABG
- Acid-base disorders are evaluated using pH and PaCO2
- Measuring the adequacy of ventilation using PacO2.
- Oxygenation status by evaluating PaO2 and SaO2.
- Alveolar-arterial oxygen gradient.
- Oxygen-carrying capacity of blood by measuring PaO2, HbO2, Hb-total, and dyshemoglobins.
- The patient may not be ventilating well if the blood CO2/PCO2 levels are elevated
Normal Values
- A normal HCO3 is 22 - 26 mEq/L
- A normal pH is 7.35 - 7.45
- A normal pCO2 is 35 - 45 mm Hg
- Normal Na levels are 140
- Normal Cl levels are 100
- AG(anion gap) = Sodium - (Chloride + HCO3)
- The normal anion gap is 3 - 11 mEq/L and it varies per lab
- Further analysis is needed to confirm if the cause is pulmonary, or metabolic
- AG or MA?
- Anion Gap or Metabolic Acidosis
Two Abnormalities of Acid-Base Balance
- Acidosis indicates a decrease in blood pH, and can be identified when the pH is less than 7.35
- This results in too much acid, and not enough base
- Alkalosis indicates an increase in blood pH, and can be identified when the pH is greater than 7.45
- This results in too much base, and not enough acid
Examples of pH
- A person who has an ABG pH of 7.28 indicates acidosis.
- A person who has an ABG pH of 7.54, indicates alkalosis.
Abnormalities of pH
- In pulmonary PCO2 should be in a range of 35 - 45
- If pH is low, and PCO2 is greater than 45, the patient is likely experiencing pulmonary acidosis
- If pH is high, and PCO2 is less than 35, the patient is likely experiencing pulmonary alkalosis
- A normal HOO3 range is 22 - 26
Further Summarization
- When Respiratory Acidosis is present, a pH of 7.28 occurs, and is caused by a respiratory disorder, PCO2 is 47, and HCO3 is 22 - 26
- When Metabolic Acidosis is present, a pH of 7.28 occurs, and is caused by a metabolic disorder, HCO3 is 20
- When Metabolic Alkalosis is present, a pH of 7.54 occurs due to a metabolic disorder, HCO3 is 28, with PCO levels that are normal, or high
- When Respiratory Alkalosis is present, a pH of 7.54 occurs, from a respiratory disorder, PCO2 is 31, and HCO3 is normal, or potentially high
CO2, pH balance
- Elimination of CO2 through the lungs is directly correlated with the body's ability to remove acid and regulate acid-base homeostasis
- When CO2 builds up within the blood, and elevated PaCO2 exceeds 45, acid begins to build up, the pH drops, resulting in respiratory acidosis, that may be evident after an episode of hypoventilation
- If there is an increase in CO2 removal, the pH rises, and low PaCO2 sits below 35, a state of respiratory alkalosis develops, that may be evident after hyperventilation
Examples of ABG Interpretations
- One potential cause of respiratory acidosis (ABG 7.32; PCO2: 50) is COPD
- The patient may be hypoventilating
- Another potential ABG is 7.52/PCO2: 20, which indicates hyperventilation
Respiratory Acidosis
- Respiratory Acidosis may arise from many reasons including airway obstruction, pneumonia, or chest trauma/pneumothorax
- Acute drug intoxication from narcotics and sedatives
- Additionally, residual neuromuscular blockade
- CNS disease involving head trauma
- Lung disease that becomes chronic
- Neuromuscular disease
- Pickwickian Syndrome, or being obese and experiencing hypoventilation
- Chest wall deformity
Causes for Respiratory Alkalosis
- Hypoxemia
- Disease that is restrictive to the lungs
- Congestive heart failure that becomes severe
- Experiencing a pulmonary emboli
- Use of drugs
- Sepsis
- Fever
- Thyrotoxicosis
- Pregnancy
- mechanical ventilation that the patient is experiencing becomes too aggressive
- Hepatic failure
Analyzing Acid-Base Disorders
- Step 1: Check pH
- If pH is within 7.35 and 7.45, it is normal
- If pH is less than 7.35, it is acidotic
- If pH is greater than 7.45, it is alkalotic
- Step 2: Check PaCO2
- If PaCO2 is between 35 and 45, it is normal
- If PaCO2 is greater than 45, it is acidotic
- If PaCO2 is less than 35, it is alkalotic
- Step 3: Check HCO3 status
- If HCO3 is within 22 and 26, it is normal
- If HCO3 is less than 22, it is acidotic
- If HCO3 is greater than 26, it is alkalotic
- Step 4: Identify the disorder that lines up with pH
- If the pH is acidotic, and PaCO2 is too, the patient likely has respiratory acidosis
- pH is 7, PaCO2 is a60 and 4003 is a24
- If the pH is alkalotic, and PaCO2 is too, the patient likely has a case of respiratory alkalosis
- pH is 7.55 PaCO2 is 32 whilst03 is 25
- If the pH is acidotic, and HCO3 is too, the patient likely has metabolic acidosis
- pH is 71 HсO3 is 20, and PCO3 is 40
- If the pH is alkalotic, and HCO3 is too, the patient likely has metabolic alkalosis
- pH is 7.8 AC03 is 30 with PCO
- Step 5: Check for compensatory mechanisms
- Step 6: Assess how complete the compensation seems
- The pH is uncompensated if its less than 7.35, compensated if greater than 7.45
- Step 7: If metabolic acidosis is present, look for the presence of anion gap
- DDX = MUDPILES
- You may however find that the patient has more than just one primary disorder active
- For instance when a patient overdoses on Aspirin, you may find both metabolic acidosis, and respiratory alkalosis occurring at the same time.
Review Questions
- A normal teenager who is upset after witnessing a car crash and says they are going to die has an ABG result of
- The pH: 7.42
- PaCO2: 38
- PaO2: 90
- This reading is normal due to all values being within normal ranges
- Hyperventilation from a very anxious patient should result in ABG results consistent with respiratory alkalosis, due to the breathing rate
- A heavy opiate user who took a lot of oxycodone, with a respiration rate of 8, the patient will likely have ABG results that show respiratory acidosis, this is because they are not getting needed ventilation.
- A 12 year old child going to the Emergency Department for breathing trouble is found to have the following readings:
- pH 7.21
- Po₂ 65 mm Hg
- Pco₂ 62 mm Hg
- Hco3 24mEq/liter. -This child is most likely experiencing respiratory acidosis because their pH is low and carbon dioxide is high
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Test your knowledge of ABG interpretation. Questions cover pH ranges, ventilation adequacy, acid-base disorders, and oxygenation. Evaluate understanding through key concepts.
