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ABG
In Brief
Part 1
Clinical Club
Clinical Club
Clinical Club ClinicalClubCE
https://clinicalclub-
pharmacy.blogspot.com
Alexandria Hepatology, Gastroenterology and
Fever Hospital
ZamZam Hospital
Dr/Gawad Nephrology Clinic
Msc. Clinical Pharmacy
DINAZAKIMOHAMED
ZAKI
Presented by
What is acid?
Acids are H+ donors.
HCL H+ + Cl
(Acid) (Hydrogen ion)(Conjugate base)
What is base?
Bases are H+ acceptors
NH3 + H NH4+
(Base) (Conjugate acid)
BloodPH
BloodandExtracellularFluidhasa
PHof(7.35-7.45)
Bloodis 1)Acidic 2)Basic
Physiologicalsourcesofacidsinblood
(CO2, CHO, FAT metabolism,
Sulphuric acids, Metabolism of
proteins,Lacticacid)
Acidexcretion:Lung(CO2),Kidneys
(Nonvolatileacidsasammonium
andphosphate)
Physiologicalsourcesofbasesin
blood
HCO3fromkidneys(Productionand
reclamation)
NORMALARTERIALBLOOD
GASVALUE
AnequationtocalculatethepHofabuffersolutionwas
derivedbyLawrenceJosephHendersonin1908.Karl
AlbertHasselbalchrewrotethisformulainlogarithmic
termsin1917.
HENDERSON–HASSELBALCH
EQUATION
CO2=Acidosis HCO3=Alkalotic
CO2=Alkalosis HCO3=Acidosis
Calculate
anion gap
AcidBaseDisorder
Acidosis
Alkalosis
Metabolic acidosis
(due to in bicarbonate)
Respiratory acidosis
(due to in carbonic acid)
Metabolic alkalosis
(due to in bicarbonate)
Respiratory alkalosis
(due to in carbonic acid)
Acidosis if PH< 7.35
If PCO2 is elevated, the primary
disorder is respiratory acidosis.
If HCO3 is decreased, the
primary disorder is metabolic
acidosis.
Assess PH, PCO2, and
HCO3
Alkalosis if PH> 7.45
If PCO2 is decreased, the
primary disorder is respiratory
alkalosis.
If HCO3 is elevated, the primary
disorder is metabolic alkalosis.
Assess PH, PCO2, and
HCO3
METABOLICACIDOSIS
1.2 mm Hg decrease in PCO2 for each 1 mmol/l fall in HCO3
Expected Compensation
PCO2=1.2* HCO3
METABOLICACIDOSIS
Expected Compensation
PCO2=15 + HCO3
METABOLICACIDOSIS
Expected Compensation
PCO2=Last 2 digits of PH
Calculatetheaniongap(AG)
140 meq/l
12 meq/l
24 meq/l
104 meq/l
Calculatetheaniongap(AG)
140 meq/l
12 meq/l
24 meq/l
104 meq/l
AG= Na+ - (Cl- + HCO3-)
Corrected AG
If there is any
hypoalbuminemia
(4-serum alb)* 2.5 +
calculated AG
Calculatetheaniongap(AG)
140 meq/l
12 meq/l
24 meq/l
104 meq/l
Wide AG
Normo-Chloremic
acidosis
Calculatetheaniongap(AG)
140 meq/l
12 meq/l
24 meq/l
104 meq/l
Normal AG
Hyper-Chloremic
acidosis
Calculatetheaniongap(AG)
Normal AG
Hyper-Chloremic
acidosis
Wide AG
Normo-Chloremic
acidosis
Normal
Calculatetheaniongap(AG)
Anion Gap= Na+ - (Cl- + HCO3-)
Normal range is 6 - 12 meq/l
If AG is> 12, there is a primary metabolic acidosis regardless of PH or
HCO3
Some patients have a mixed acid-base disorder in which they have
more than one primary disorder.
NB: Hypoalbuminemia the AG by 2.5-3 meq/l for every
1 g/dl in serum albumin< 4g/dl
Calculatetheexcess(AG)
Excess (AG)= Total AG - Normal AG
Add excess AG to serum bicarbonate
If the sum is> a normal serum bicarbonate (example, > 30 meq/l), there
is also an AG metabolic alkalosis (this can occur in addition to other
primary disorders)
If the sum is< a normal serum bicarbonate (example, < 23 meq/l), there
is an underlying non-AG metabolic acidosis
Comprehensive Clinical Nephrology
ACCP critical care
REFERENCES
THANKYOU
FORLISTENING!
willbecontinuedinpart2

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Narcotic and Non Narcotic Analgesic..pdf
 

ABG in Brief ( Part 1 )