Blood Gas Interpretation Guide
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Blood Gas Interpretation Guide
- 2. Blood Gas Interpretation Components of blood gas (BG) analysis Normal arterial BG (ABG) Indications for BG analysis Abnormalities in ABG Stepwise analysis of ABG * RS
- 3. Components of BG pH PaCO2 PaO2 HCO3 O2Sat BE * RS
- 4. Components of BG Blood Gas Oxygenation Ventilation Acid-Base PaO2 SaO2 PCO2 pH HCO3-BE * RS
- 5. Normal ABG pH 7.35 - 7.45 PCO2 35 – 45 mmHg PO2 70 - 100 mmHg SaO2 ≥ 93 % HCO3 22 - 26 mEq/L BE -2 - +2 mEq/L * RS
- 6. Indications Assessment of ventilation and oxygenation status in patients with respiratory disease Assessment of acid-base imbalance in sepsis, metabolic, and renal diseases * RS
- 8. ↓ PaO2 ↓ O2 Saturation Causes: Respiratory: RDS, Pneumonia Cardiac: Cyanotic CHD, CHF Abnormal Hemoglobins * RS
- 10. Primary acid-base disorders Compensation Mixed acid-base disorders * RS
- 11. One of the four acid-base disturbances that is manifested by an initial change in HCO3 - or PaCO2 Types: Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis * RS
- 12. A primary disorder where the first change is an elevation of PaCO2, resulting in decreased pH. Causes: Airway: e.g. laryngeal edema, severe micrognathia (jaw undersized) Lungs: e.g. RDS, pneumonia CNS: respiratory depression due to medications, CNS infection, hemorrhage, etc. * RS
- 13. A primary disorder where the first change is a lowering of PaCO2, resulting in an elevated pH. Rare in neonates Causes: Iatrogenic: for ventilated babies Hyperventilation: e.g. urea cycle disorders * RS
- 14. A primary acid-base disorder where the first change is a lowering of HCO3 -, resulting in decreased pH. Causes: Dehydration Shock Sepsis Metabolic disorders * RS
- 15. A primary acid-base disorder where the first change is an elevation of HCO3-, resulting in increased pH. Causes: Iatrogenic: loop diuretics Rare diseases: cystic fibrosis, congenital chloride diarrhea (Genetic disorder –chromosome 7) * RS
- 16. The body tries to overcome either a respiratory or metabolic dysfunction in an attempt to return the pH into the normal range. For respiratory disorders (i.e. resp. acidosis or alkalosis) the body develops metabolic compensation through the kidney (i.e. HCO3). For metabolic disorders (i.e. metabolic acidosis or alkalosis) the body develops respiratory compensation through the lungs (i.e. CO2). * RS
- 17. Combination of two primary acid-base disorder with different range of compensation. Usually happen in patients with chronic diseases or multiple primary pathologies * RS
- 18. Step One: Assess the pH to determine if the blood is within normal range, alkalotic or acidotic. If it is above 7.45, the blood is alkalotic. If it is below 7.35, the blood is acidotic. * RS
- 19. Step Two: If the blood is alkalotic or acidotic, we now need to determine if it is caused primarily by a respiratory or metabolic problem. To do this, assess the PaCO2 level. Remember that with a respiratory problem, as the pH decreases below 7.35, the PaCO2 should rise. If the pH rises above 7.45, the PaCO2 should fall. Compare the pH and the PaCO2 values. If pH and PaCO2 are indeed moving in opposite directions, then the problem is primarily respiratory in nature. * RS
- 20. Step Three Assess the HCO3 value. Recall that with a metabolic problem, normally as the pH increases, the HCO3 should also increase. Likewise, as the pH decreases, so should the HCO3. Compare the two values. If they are moving in the same direction, then the problem is primarily metabolic in nature. * RS
- 21. pH PaCO2 HCO3 Respiratory Acidosis ↓ ↑ normal Respiratory Alkalosis ↑ ↓ normal Metabolic Acidosis ↓ normal ↓ Metabolic Alkalosis ↑ normal ↑ Primary Acid-Base Disorders (No compensation) * RS
- 22. pH PaCO2 HCO3 Respiratory Acidosis ↓ ↑ ↑ Respiratory Alkalosis ↑ ↓ ↓ Metabolic Acidosis ↓ ↓ ↓ Metabolic Alkalosis ↑ ↑ ↑ Partially Compensated Acid-Base Disorders * RS
- 23. pH PaCO2 HCO3 Respiratory Acidosis normal, but < 7.4 ↑ ↑ Respiratory Alkalosis normal, but > 7.4 ↓ ↓ Metabolic Acidosis normal, but < 7.4 ↓ ↓ Metabolic Alkalosis normal, but > 7.4 ↑ ↑ Fully Compensated Acid-Base Disorders * RS
- 24. * RS
Editor's Notes
- Base excess (BE) This is the amount of strong base which would need to be added or subtracted from a substance in order to return the pH to normal (7.40). A value outside of the normal range (-2 to +2 mEq/L) suggests a metabolic cause for the acidosis or alkalosis. In terms of basic interpretation A base excess more than +2 mEq/L indicates a metabolic alkalosis. A base excess less than -2 mEq/L indicates a metabolic acidosis.
- Micrognathia is a condition in which the jaw is undersized. It is a symptom of a variety of craniofacial conditions. Sometimes called mandibular hypoplasia, micrognathia may interfere with your child's feeding and breathing. Micrognathia is somewhat common in infants, but often corrects itself as your child grows.Mar 31, 2014
- A urea cycle disorder or urea cycle defect is a genetic disordercaused by a deficiency of one of the enzymes in the urea cycle which is responsible for removing ammonia from the blood stream.
- Cystic fibrosis (CF) is a genetic disorder that affects mostly the lungs but also the pancreas, liver, kidneys, andintestine.[1][2] Long-term issues include difficulty breathing and coughing up mucus as a result of frequent lung infections. Other signs and symptoms include sinus infections, poor growth, fatty stool, clubbing of the fingers and toes, and infertility in males, among others. Different people may have different degrees of symptoms Congenital chloride diarrhea (CCD, also congenital chloridorrhea or Darrow Gamble syndrome) is a genetic disorder due to an autosomal recessive mutationon chromosome 7. The mutation is in downregulated-in-adenoma (DRA), a gene that encodes a membrane protein of intestinal cells. The protein belongs to thesolute carrier 26 family of membrane transport proteins.[1] More than 20 mutations in the gene are known to date. A rare disease, CCD occurs in all parts of the world but is more common in some populations with genetic founder effects,[2] most notably in Finland.
- Common strong acids[edit] This is a list of strong acids with pKa < -1.74, which is stronger than the hydronium ion, from strongest to weakest. Perchloric acid HClO4 (pKa ≈ −10)[5] Hydroiodic acid HI (pKa = −9.3)[2] Hydrobromic acid HBr (pKa = −8.7)[2] Hydrochloric acid HCl (pKa = −6.3)[2] Sulfuric acid H2SO4 (first dissociation only, pKa1 ≈ −3)[6] p-Toluenesulfonic acid (pKa = −2.8) Organic soluble strong acid Methanesulfonic acid (pKa = −1.92) Liquid organic strong acid[7] a weak acid: Examples in water include carbonic acid (H2CO3) and acetic acid(CH3COOH). At equilibrium, both the acid and the conjugate base are present in solution. Strong Base : Lithium hydroxide (LiOH) Sodium hydroxide (NaOH) Potassium hydroxide (KOH) Rubidium hydroxide (RbOH) Cesium hydroxide (CsOH) Magnesium hydroxide (Mg(OH) Calcium hydroxide (Ca(OH) Strontium hydroxide (Sr(OH) Barium hydroxide (Ba(OH) Examples[edit] Alanine, Ammonia, NH3 Methylamine, CH3NH2, C5H8O2 Other weak bases are essentially any bases not on the list of strong bases