ABG

Arterial blood gases

Made Easy Dont Tell Dont Ask 1433/02/22 26.1.2012

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

.. .. Respiratory Alkalosis ...

ABG Metabolic Acidosis Compensated by ...

ABG

..

...

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

PH " Power of Hydrogen ".. Changes in H concentration PO2 = partial Pressure of O2 " Free un bounded O2 NOT Total O2 " Most of O2 Is Carried on Hb PaO2 = partial Pressure of O2 in Arterial Blood SO2 = O2 Saturation in any Blood SaO2 = O2 Saturation in Arterial Blood " Monitor " Pulse Oximeter

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First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

..

PaCO2 is controlled by Ventilation & the level of Ventlation is adjusted to maintain PaCO2 within tight limits by Respiratory center adjustment

PaCO2

Resp. Center

HYPOXIC DRIVE Chronic high PaCO2 leads to desensitization of receptors SO body relies on PaO2 receptors & Decreased PaO2 level becomes the principal Ventilatory stimulus >>> Correction by O2 may depress Ventilation & increase PaCO2 So O2 must be in acontroled fashion with ABG monitoring

COPD Stimulation

CO2 -

Resp. Center Hypoxia

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

When Hb approaches maximal O2 saturation further increase in PO2 doesn't significantly increase Blood O2 Content

O2

Hb

Both Oxygenation & CO2 elemination depends on Alveolar Ventilation SO Impaired Ventilation leads to DECREASE PaO2 & INCREASE PaCO2

Ventilation Perfusion mismatch & shunting " COLLAPSE OR CONSOLIDATION " leads to INCREASE CO2 elemination but not INCREASE O2 as Hb is maximally saturated SO PaO2 & SaO2 is decreased While PCO2 Doesn't increased

CO2 Hb

O2

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

In Type 1 respiratory failure there is LOW PaO2 with NORMAL or LOW PaCO2 WHILE In Type 2 respiratory failure there is HIGH PaCO2

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: Arterial Blood Gases

ABG ?

Why ABG ?

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

To establish a diagnosis " Respiratory failure & Met. Acidosis " To assess severity of illness To guide & monitor the treatment

Acid base balance

H is generated from breakdown of fats & sugars this produces CO2 which dissolves in blood to form H2CO3

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

H is removed by respiratory system which removes CO2 , Renal " Metabolic " excretes H in urine & reabsorb HCO3

H2O + CO2 << -- >> H2CO3 << -- >> H + HCO3

Increased CO2 = Resp. Acidosis & Its decrease = Resp. Alkalosis WHILE Increased HCO3 = Met. Alkalosis & Its decrease =Met. Acidosis

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

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Metabolic Acidosis

Any process that lowers PH other than Increased Pa CO2 " Accumulation of mat. Acids Excess Ingestion , Production or Reduced Renal Excretion - or excessive loss of HCO3 "

Hyperventilation is a dominant symptom in Met. Acidosis " Resp. compensation "

Anion Gap ( Na + K ) ( Cl + Hco3 ) = 10 18 mmol/ L

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

Gap is made up of un measured anions " phosphate , sulphate & -ve charged Ptn " Rise > 18 mmol/ L = increased un measured anions " lactate & salicylates "

Lactic acidosis when O2 supply is decreased anaerobic metabolites " e.g. lactic acid " are increased

Met. Acidosis with increased anion gap = lactic A. " hyoxia, Shock, Sepses & Infarction " .... Keto A. " DKA, Starvation & Alcohol Excess " .... Renal failure .... Poisoning " Aspirin , Methanol

With Normal Anion gap =

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

Renal Tubular Acidosis, Diarrhea, Ammonium chloride ingestion & Adrenal insufficiency

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Metabolic Alkalosis

Any process that increases PH other than decreased Pa CO2 " Increased loss of Cl, K, & Na " e. g. Diuretics " or sustained Vomiting which leads to H loss

Resp. compensation by increasing Pa CO2 is limited to avoid Hypoxia

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

Loss of Cl, K, or Na leads to Retain Na& K by kidney at expense of H

Met. Alkalosis = Vomiting, K depletation, diarrhea , Cushing's & Conn's Syndrome

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Res. Acidosis is increased Pa CO2 leads to hyperventilation occurs in type 2 Resp. failure or in met. Alkalosis

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

Res. Alkalosis is decreased Pa CO2 caused by hyperventilation or in Met. Acidosis

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Normal values

PH = 7.35 - 7.45 H = 35 - 45 mmol/L PCO2 = 35 - 45 mmHg in Arterial Blood PO2 > 80 mmHg in Arterial Blood in room air

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

HCO3 = 22 - 28 mmol/L Na = 135 145 mmol/L K = 3.5 5 mmol/L Cl = 95 105 mmol/L Lactate = 0.4 1.5 mmol/L

Hypoxia severity SaO2 " 90 94 % Mild , 75 89 % Moderate & < 75 % Sever "

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED

First look at the pH: if it's high, then this is alkalosis, if low it's acidosis, then look at the PCO2 and the HCO3, if they were high in case of acidosis (pointing UP towards the LUNGS) , then it's respiratory, and if they were low (pointing DOWN to the KIDNEYS) then metabolic, the opposite in alkalosis. Now comes the part about compensation, take care cuz it's a bit tricky but the easiest approach is : if the pH was within the normal level and both the HCO3 and the PCO2 were affected, then it's FULLY compensated ( you will determine whether it's acidosis or alkalosis based on whether the pH is above or below 7.4 but still within normal range), but if the pH was outside the normal range, and BOTH the PCO2 and HCO3 were affected then it's PARTIALLY compensated and the last option is that you find the pH outside the normal range with only one of them ( the PCO2 and HCO3 that is ) affected, in this case it's UNCOMPENSATED