Yahoo, goupmates, These concepts are needed in interpreting ABGs.

You have to read the introductory part before going to the steps on how to interprete ABGS. Take note of the normal values. Dr. Alma Banua A. Acid Base Regulation: Principles of acid-base balance 1. Acid-base balance is the ratio of acids & bases in the body necessary to maintain a chemical balance conducive to life 2. Acid-base ratio: 20 base to 1 acid. ( 20 part HCO3 to 1 part carbonic acid. If the ratio is no longer maintained, acid-base imbalance results. 3. Plasma pH is an indicator of H+ concentration & is measured by arterial blood samples & recorded as blood pH. Range is 7.35-7.45 4. H+ concentration a. the greater the concentration the more acidic the solution & the lower the pH b. the lower the concentration the more alkaline the solution & the higher the pH 5. Deviation from normal hydrogen ion concentration can upset normal reactions of cellular metabolism by: a. Altering the effectiveness of enzymes, hormones and other chemical regulators of cell function. b. Affecting the normal distribution of other ions between the ICF and ECF, thereby disturbing a variety of cell and tissue ion dependent functions. B. Regulatory mechanisms 1. The body controls the pH balance by use of: a. chemical buffer system b. Lungs c. Cells d. Kidneys 2. The chemical buffer system a. A buffer is a substance that reacts to keep pH within normal. It functions only when excessive base or acid is present. b. Chemical buffers are paired (for example with weakly ionized acid or base balanced with a fully ionized salt) Pairing prevents excessive changes in normal acid-base balance Buffers release or absorb hydrogen ions as needed c. The buffer systems in the extracellular fluid react quickly with acids & bases to minimize changes in pH Once they react they are used up If further stress occurs, the body is less able to cope 3. Lungs a. Next to react b. Takes 10-30 minutes for lungs to inactivate molecules by converting them to water molecules c. Carbonic acid by neutralizing bicarbonate is taken to the lungs d. There it is reduced to carbon dioxide & water & exhaled e. Therefore when there is excessive acid in the body, the RR increases in order to blow off excessive carbon dioxide & water f. When there is too much bicarbonate or base in the body RR becomes deeper & slower.

This process build up the level of carbonic acid The result is the strength of the excessive bicarbonate is neutralized 4. Cells Absorb or release extra hydrogen ions React in 2-4 hours 5. Kidneys Most efficient regulatory mechanism Function within hours to days as integral part of buffering system Blood pH is maintained by balance of 20 part of bicarbonate to 1 part of carbonic acid 4 processes are involved in acid-base regulation: + - Dissociation of H from H2CO3 + - Reabsorption of Na from urine + filtrate (Na & H change places - Formation & conservation of Na HCO3 - NH3 from metabolic process enters + kidneys tubular cell & adds an H ion & then exchanges as ammonia + + with Na (Na & NH4) + + H & K compete with each other in exchange for Na+ in the tubular urine + - In acidosis, The H ion + concentration is increased & K ion must wait to be excreted as hydrogen has preference + + - In alkalosis, the H ion is low & K is excreted in larger amounts Acids Consist of molecules that can yield Hydrogen ion to another molecules Have pH <7 (acidic) Example: Carbonic acid (H2CO3) Strong acids completely ionize in water and readily liberate hydrogen ions Example: hydrochloric acid (HCl) 99.9% of HCl molecules ionize in pure H2O Weak acids partly ionize in water. Bases Consist of molecules that can accept Hydrogen ions Have pH >7 (alkaline) Example: Bicarbonate (HCO3) Strong base binds hydrogen ions readily. Example: hydroxides such as sodium hydroxide (NaOH) contain the hydroxyl (OH-) ion, a strong base. Weak base binds hydrogen ions less readily. Example: sodium bicarbonate Measuring pH Solution containing more base than acid has fewer Hydrogen ions and with higher pH Solution containing more acid than base has more Hydrogen ions and with lower pH Interpreting normal pH Normal pH (7.35 7.45) amount of acid is balanced with amount of base pH <7.35 abnormally acidic pH >7.45 abnormally alkaline Acidosis Decrease in pH below 7.35 May be caused by increase in bloods Hydrogen ion concentration or decrease in bloods HCO3 level Alkalosis Increase in pH above 7.45

May be caused by increase in bloods HCO3 level or decrease in bloods Hydrogen ion concentration I. Maintaining acid-base balance Body activates compensatory mechanisms that minimize pH changes Mainly involves metabolic or respiratory system adjustments Deviation in pH can compromise electrolyte balance, activity of critical enzymes, muscle contraction, and basic cellular function regulate pH: chemical buffers, three systems, respiratory system and kidneys J. Acid- base Imbalances 1. Metabolic disturbance When lack of HCO3 causes acidosis, lungs increase rate of breathing to lower CO2 and raise pH to normal When excess HCO3 causes alkalosis, lungs decrease rate of breathing to retain CO2 and lower pH to normal 2. Respiratory system disturbance Kidneys compensate by altering levels of HCO3 and Hydrogen ion When PaCO2 is high (acidosis), kidneys retain HCO3 and excrete more acid to raise pH When PaCO2 is low (alkalosis), kidneys excrete HCO3 and retain acid to lower pH 3. Obtaining ABG sample For radial artery, needle should enter bevel up at 45-degree angle For brachial artery, needle should enter at 60degree angle, bevel up For femoral artery, needle should enter at 90degree angle, bevel up 4. ABG analysis Assesses effectiveness of breathing and overall acid-base balance Monitors response to treatment Normal test results: pH, 7.35 7.45; PaCO2, 35 to 45 mm Hg; HCO3, 22 to 26 mEq/L a. PaCO2 Indicates effectiveness of breathing Level moves in opposite direction from pH b. HCO3 Represents metabolic component of bodys acid-base balance Level moves in same direction as pH c. (PaO2) Normal range: 80 to 100 mm Hg Varies with age; after age 60, may drop below 80 mm Hg without signs of hypoxia d. Arterial Oxygen Saturation (SaO2) Normal range: 95% to 100% 4. Interpreting ABG results Step 1: Check pH level Step 2: Determine PaCO2 level Step 3: Watch HCO3 level Step 4: Look for signs of compensation Step 5: Determine PaO2 and SaO2 levels a. Check pH level If abnormal, determine if result reflects acidosis (<7.35) or alkalosis (>7.45) b. Determine PaCO2 Provides information about respiratory component of acid-base balance If abnormal, determine if low (<35 mm Hg) or high (>45 mm Hg)

If abnormal, determine if it corresponds with change in pH (if pH is high, expect low PaCO2 hypocapnia; if pH is low, expect high PaCO2 hypercapnia c. Watch HCO3 level Provides information about metabolic component of acid-base balance If abnormal, determine if low (<22 mEq/L) or high (>26 mEq/L) If abnormal, determine if it corresponds with change in pH (if pH is high, expect high HCO3, if low, expect low HCO3) d. Look for compensation May see change in both PaCO2 and HCO3 levels (one indicates primary source of pH change; other indicates bodys compensation effort) Complete compensation occurs when compensation is so effective that pH falls within normal range Partial compensation occurs when pH remains outside normal range Determine PaO2 and SaO2 Provide information about oxygenation status If abnormal, determine if values are low (PaO2, <80 mm Hg; SaO2 <95%) or high (PaO2 > 100 mm Hg)

4. Acid-base imbalances Metabolic Alkalosis pH : HCO3: PCO2: Normal Metabolic Acidosis pH : HCO3: PCO2: Normal Respiratory Alkalosis pH : HCO3: PCO2: Normal Respiratory Acidosis pH : HCO3: PCO2: Normal Compensation 7.40 > 40 Compensation 7.40 <40 Compensation 7.40 < 24 Compensation 7.40 >24

> 7.40
> 24

40 < 7.40
< 24

40 > 7.40 < 40 24 < 7.40

>40

24