Académique Documents
Professionnel Documents
Culture Documents
What is an ABG?
The Components
pH / PaCO2 / PaO2 / HCO3 / O2sat / BE
Desired Ranges
pH - 7.35 - 7.45 PaCO2 - 35-45 mmHg PaO2 - 80-100 mmHg HCO3 - 21-27 O2sat - 95-100% Base Excess - +/-2 mEq/L
Logistics
When to order an arterial line - Need for continuous BP monitoring Need for multiple ABGs
The Terms
ACIDS
Acidemia Acidosis
Respiratory CO2 Metabolic HCO3
BASES
Alkalemia Alkalosis
Respiratory CO2 Metabolic HCO3
Respiratory Acidosis
ph, CO2, Ventilation Causes
CNS depression Pleural disease COPD/ARDS Musculoskeletal disorders Compensation for metabolic alkalosis
Respiratory Acidosis
Acute vs Chronic
Acute - little kidney involvement. Buffering via titration via Hb for example
pH by 0.08 for 10mmHg in CO2
Chronic - Renal compensation via synthesis and retention of HCO3 (Cl to balance charges hypochloremia)
pH by 0.03 for 10mmHg in CO2
Respiratory Alkalosis
pH, CO2, Ventilation CO2 HCO3 (Cl to balance charges hyperchloremia) Causes
Intracerebral hemorrhage Salicylate and Progesterone drug usage Anxiety lung compliance Cirrhosis of the liver Sepsis
Respiratory Alkalosis
Acute vs. Chronic
Acute - HCO3 by 2 mEq/L for every 10mmHg in PCO2 Chronic - Ratio increases to 4 mEq/L of HCO3 for every 10mmHg in PCO2 Decreased bicarb reabsorption and decreased ammonium excretion to normalize pH
Metabolic Acidosis
pH, HCO3 12-24 hours for complete activation of respiratory compensation PCO2 by 1.2mmHg for every 1 mEq/L HCO3 The degree of compensation is assessed via the Winters Formula
PCO2 = 1.5(HCO3) +8 2
The Causes
Metabolic Gap Acidosis
M - Methanol U - Uremia D - DKA P - Paraldehyde I - INH L - Lactic Acidosis E - Ehylene Glycol S - Salicylate
Metabolic Alkalosis
pH, HCO3 PCO2 by 0.7 for every 1mEq/L in HCO3 Causes
Vomiting Diuretics Chronic diarrhea Hypokalemia Renal Failure
The Steps
Start with the pH Note the PCO2 Calculate anion gap Determine compensation
Sample Problem #1
An ill-appearing alcoholic male presents with nausea and vomiting.
ABG - 7.4 / 41 / 85 / 22 Na- 137 / K- 3.8 / Cl- 90 / HCO3- 22
Sample Problem #1
Anion Gap = 137 - (90 + 22) = 25 anion gap metabolic acidosis Winters Formula = 1.5(22) + 8 2 = 39 2 compensated Delta Gap = 25 - 10 = 15 15 + 22 = 37 metabolic alkalosis
Sample Problem #2
22 year old female presents for attempted overdose. She has taken an unknown amount of Midol containing aspirin, cinnamedrine, and caffeine. On exam she is experiencing respiratory distress.
Sample Problem #2
ABG - 7.47 / 19 / 123 / 14 Na- 145 / K- 3.6 / Cl- 109 / HCO3- 17 ASA level - 38.2 mg/dL
Sample Problem #2
Anion Gap = 145 - (109 + 17) = 19 anion gap metabolic acidosis Winters Formula = 1.5 (17) + 8 2 = 34 2 uncompensated Delta Gap = 19 - 10 = 9 9 + 17 = 26 no metabolic alkalosis
Sample Problem #3
47 year old male experienced crush injury at construction site. ABG - 7.3 / 32 / 96 / 15 Na- 135 / K-5 / Cl- 98 / HCO3- 15 / BUN- 38 / Cr- 1.7 CK- 42, 346
Sample Problem #3
Anion Gap = 135 - (98 + 15) = 22 anion gap metabolic acidosis Winters Formula = 1.5 (15) + 8 2 = 30 2 compensated Delta Gap = 22 - 10 = 12 12 + 15 = 27 mild metabolic alkalosis
Sample Problem #4
1 month old male presents with projectile emesis x 2 days. ABG - 7.49 / 40 / 98 / 30 Na- 140 / K- 2.9 / Cl- 92 / HCO3- 32
Sample Problem #4
Metabolic Alkalosis, hypochloremic Winters Formula = 1.5 (30) + 8 2 = 53 2 uncompensated