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Simple Method of Acid Base Balance Interpretation
A FOUR STEP METHOD FOR INTERPRETATION OF ABGS
Usefulness
This method is simple, easy and can be used for the majority of ABGs. It onlyaddresses acid-base balance and considers just 3 values.
•
pH
,
 
•
PaCO2
 
•
HCO3-
 
Step 1. Use pH to determineAcidosisor Alkalosis.
 
ph
< 7.35
 
7.35-7.45
 
> 7.45Acidosis
 
 Normal or CompensatedAlkalosis
Step 2. Use PaCO2 to determinerespiratory effect.
 
PaCO2
 
< 35 35 -45> 45
•
 
Tendstowardalkalosis
 
•
Causeshigh pH
 
•
Neutralizeslow pH
 
Normal
or Compensated
•
 
Tendstowardacidosis
 
•
Causes lowpH
 
•
Neutralizeshigh pH
 
Step 3. Assumemetabolic causewhen respiratory is ruled out.
•
You'll be right
most
of the time if you remember this simple table:
 
High pHLow pH
AlkalosisAcidosis
 
High PaCO2Low PaCO2High PaCO2Low PaCO2
 
 
MetabolicRespiratoryRespiratoryMetabolic
•
If 
PaCO2
is abnormal and
pH
is normal, it indicates compensation.
 
o
pH > 7.4 would be a compensated alkalosis.
 
o
pH < 7.4 would be a compensated acidosis.
 
These steps will make more sense if we apply them to actual ABG values.
Clickhere to interpret some ABG values using these steps.
You may want to refer back to these steps (click on "linked" steps or use "BACK" button on your browser)or print out this page for reference.
Step 4. UseHC03to verify metabolic effect
•
Normal
HCO3-
is 22-26
 
Please note:
•
Remember, the first three steps apply to the majority of cases, but do not takeinto account:
 
o
the possibility of complete compensation, but those cases are usuallyless serious, and
 
o
instances of combined respiratory and metabolic imbalance, but thosecases are pretty rare.
 
"Combined" disturbance means
HCO3-
alters the pH in the samedirection as the
PaCO2.
 
High
PaCO2
and low
HCO3-
(acidosis) or 
Low
PaCO2
and high
HCO3-
(alkalosis).
 
•
Example 1
 
ABG ValueWhich step?
 
Rationale
 
pH
 
7.39Step 1
 
 Normal pH
 
PaCO2
 
40Step 2
 
 NormalPaCO2
 
Interpretation
 
NormalABG
(acid base is
 
 balanced;there are no pH changes,so if therespiratoryacid is normal,the metabolic base cannot becausingchangeseither.)
•
Example 2
 
ABG ValueWhich step?
 
Rationale
 
pH
 
7.2Step 1
 
Low
pH
indicatesacidosis 
PaCO2
 
50
 
Step 2
 
High
PaCO2
indicatesrespiratorycause for acidosis 
Interpretation
 
respiratoryacidosis
•
Example 3
 
ABG ValueWhich step?
 
Rationale
 
pH
 
7.49Step 1
 
High
pH
 
indicatesalkalosis 
PaCO2
 
30
 
Step 2
 
Low
PaCO2
indicatesrespiratorycause for alkalosis (lorespiratoryacid is causinghigher pH) 
Interpretation
 
respiratoryalkalosis
•
Example 4
of 00

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Caleigh McCaffrey

great site!! really helps :)

reply04 / 26 / 2012
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