ABG

ABG
   

ABG
     

pH PaCO2 PaO2 HCO3O2sat BEefc


 

(Buffers)
(buffer capacity) 15 mmol/kg BW




volatile acid (CO2) -- 20,000 mmol/day


  

nonvolatile acids -- 70-100 mmol/day HCO310~20

Henderson-Hasselbach equation
H+ + HCO3H2O + CO2

pH = 6.1 + log ([HCO3-] / PCO2 x 0.03)

BEefc
 

BEefc= -8mmol/L 8 mmol HCO3-

(Base Excess / Deficit )



(buffering availability) BE = {pH -[ 7.40 - (PCO2 - 40) z 200 ]} x100  PaCO variance = (PaCO 40) 2 2  Predicted pH = [7.40 -(PaCO 40)/200] 2  measured pH PaCO2 BE

  

BE < s3 mmol/L BE > s10 mmol/L

O2
  

Hypoxemia ( Hypoxia ( A-a gradient=P(A-a)O2 , ,

  

) )

P(A-a)O2 8-10mmHg. PaO2: 104.2 - (0.27 x age) PAO2: ( ) x FiO2 (PaCO2 x 1.25)

1 g of Hgb can combine with 1.39 ml of O2

Calculate A-a Gradient

   
 

pH = 7.225 paO2 = 67 PaCO2 = 51 : 760 mmHg

PAO2= (760-47) x 0.21- (51x1.25)= 76.3 P(A-a)O2=76.3-67=9.7

If hypoxemia PaO2<80mmHg

ABG


? @ PaO2 and O2 sat?



PaO2 (80-100 mmHg) O2sat (95-98%) A-a gradient

 

 

@ pH, acidosis or alkalosis? @ Respiratory or metabolic? @ ? ? ? ?

 

pH: 7.35-7.45
 

<7.35 >7.45




PH


CO2 CO2

PH

 

PaCO2 (40 mmHg) HCO3- (24 mmol/L)

acute or chronic
 


Acute respiratory acidosis: pH decrease = 0.008 x (PaCO2 - 40) Chronic respiratory acidosis: pH decrease = 0.003 x (PaCO2 - 40) Acute respiratory alkalosis: pH increase = 0.008 x (40 - PaCO2) Chronic respiratory alkalosis pH increase = 0.002 x (40 - PaCO2)

Respiratory acidosis

   

Respiratory alkalosis

    

Trauma CVA Brain tumor Drug overdose Muscle fatique Myopathy Guillain-Barre syndrome Restrictive lung dx Obstructive lung dx


  

Anxiety pregnancy Drug Liver Sepsis CNS infection,trauma





 




Setting


 

PaCO2 = (1.5 x HCO3-) + (8 2)

check blood anion gap



Blood AG=Na-(Cl+HCO3)

=12+2




blood AG
urine AG=Na+K-Cl
 

check urine AG
HCO3 loss or impairment of NH4+ RTA HCO3 loss diarrhea, fistula

: :

high blood AG MUDPLIERS

        

M: methanol U: uremia D: DKA (ketoacidosis) P: paraldehyde L: lactic acidosis I: INH E: ethylene glycol R: rhabdomyolysis S: salicylate intoxication

Anion gap


+ AG= = =Na-(Cl+HCO3)
   

:Na,K :Cl,HCO3 :Mg,Al,Ca,Cu :protein,phosphate

(Anion Gap Concept )




Major plasma cation (Na+) major plasma anions (Cl-, HCO3-) AG = [Na+] - [Cl-] - [HCO3-] 12s2 mEq/L anionic plasma proteins (e.g., albumin), phosphate, sulfate, AG
 

HCO3- loss

Cl-

AG

Anion Gap Acidosis (AGo)


 











Hyperlactatemia (lactateo) Hyperketonemia Ketoneo, DM, alcoholic, starvation Renal failure GFR <20~30 ml/min, retained sulfate SO4o, phosphate PO4o, organic anions Excessive organic salt therapy Ringers lactate, high dose penicillin Toxins Salicylates, methanol, ethylene glycol, paraldehyde

Urinary Anion Gap UAG = [Na+]u + [K+]u - [Cl-]u



NH4+ (unmeasured urinary cation) Negative UAG high NH4+ excretion UAG Negative Positive Negative Urine pH <5.5 >5.5 >5.5 Diagnosis Normal RTA Diarrhea


 

PaCO2 = (0.7 x HCO3-) + (21 2)

check urine Cl


Urine Cl<20meq/L saline response type


  

NG free drainage Vomitting Diuretics

Urine Cl>20meq/L saline resistant type



Hyperaldosteronism, Batter syndrome, Cushing syndrome, defiency of K, mg

Metabolic Alkalosis


metabolic acidosis  pH =7.0-7.2 pH >7.55 40% ICU metabolic alkalosis  -- NG drainage or vomiting  HCO3- -- hypovolemia, Cl- depletion  Cl ECF  HCO3total anion equivalency HCO3metabolic alkalosis  excess HCO3-


 

PCO2,HCO3 PCO2,HCO3 AG/ HCO3=1-2 pure metabolic acidosis AG/ HCO3<1 high AG metabolic acidosis+normal AG metabolic acidosis AG/ HCO3>2 high AG metabolic acidosis+metabolic alkalosis

Check blood AG high AG

 

Gap-Gap Ratio
AG excess/HCO3- deficit = (AG-12)/(24HCO3-)


Lactic acidosis gap-gap ratio =1



Lactate

HCO3-

  

HCO3- loss gap-gap ratio }0 Lactic acidosis + HCO3- loss gap-gap ratio 0~1 Mixed metabolic acidosis & alkalosis >1


High AG acidosis

Na2CO3 High Cl acidosis $0 Acidosis-Alkalosis >1

High AG acidosis (AG/(HCO3$1 Mixed acidosis (AG/(HCO30b1