ABG

ABG 
  

ABG       pH PaCO2 PaO2 HCO3O2sat BEefc .

70-100 mmol/day HCO310~20 .000 mmol/day     ² nonvolatile acids -.20.   (Buffers) ² (buffer capacity) 15 mmol/kg BW   ² volatile acid (CO2) -.

1 + log ([HCO3-] / PCO2 x 0.Henderson-Hasselbach equation H+ + HCO3H2O + CO2 pH = 6.03) .

BEefc   BEefc= -8mmol/L 8 mmol HCO3- .

40 -(PaCO ± 40)/200] 2  measured pH PaCO2 BE    BE < s3 mmol/L BE > s10 mmol/L .(PCO2 .40 .(Base Excess / Deficit )  ² (buffering availability) BE = {pH -[ 7.40) z 200 ]} x100  PaCO variance = (PaCO ± 40) 2 2  Predicted pH = [7.

   ) ) P(A-a)O2 8-10mmHg.2 .25) .O2    Hypoxemia ( Hypoxia ( A-a gradient=P(A-a)O2 .27 x age) PAO2: ( ) x FiO2 ² (PaCO2 x 1.(0. . PaO2: 104.

1 g of Hgb can combine with 1.39 ml of O2 .

Calculate A-a Gradient       pH = 7.7 .(51x1.21.25)= 76.3 P(A-a)O2=76.3-67=9.225 paO2 = 67 PaCO2 = 51 : 760 mmHg PAO2= (760-47) x 0.

.

If hypoxemia PaO2<80mmHg .

acidosis or alkalosis? @ Respiratory or metabolic? @ ? ? ? ? .ABG  ? @ PaO2 and O2 sat?  PaO2 (80-100 mmHg) O2sat (95-98%) A-a gradient     @ pH.

45   <7.  pH: 7.45 .35 >7.35-7.

  PH  CO2 CO2  PH   PaCO2 (40 mmHg) HCO3.(24 mmol/L) .

003 x (PaCO2 .008 x (40 .008 x (PaCO2 .40) Acute respiratory alkalosis: pH increase = 0.40) Chronic respiratory acidosis: pH decrease = 0.PaCO2) .PaCO2) Chronic respiratory alkalosis pH increase = 0. acute or chronic       Acute respiratory acidosis: pH decrease = 0.002 x (40 .

trauma        Setting . Respiratory acidosis       Respiratory alkalosis       Trauma CVA Brain tumor Drug overdose Muscle fatique Myopathy Guillain-Barre syndrome Restrictive lung dx Obstructive lung dx      Anxiety pregnancy Drug Liver Sepsis CNS infection.

5 x HCO3-) + (8 ± 2) check blood anion gap  Blood AG=Na-(Cl+HCO3) =12+2   blood AG urine AG=Na+K-Cl   check urine AG HCO3 loss or impairment of NH4+ RTA HCO3 loss diarrhea.   PaCO2 = (1. fistula : :  high blood AG MUDPLIERS .

         M: methanol U: uremia D: DKA (ketoacidosis) P: paraldehyde L: lactic acidosis I: INH E: ethylene glycol R: rhabdomyolysis S: salicylate intoxication .

HCO3 :Mg. Anion gap  + AG= = =Na-(Cl+HCO3)     = +  :Na.Ca.phosphate .Cu :protein.K :Cl.Al.

loss Cl- AG . albumin).. phosphate.g.[HCO3-] 12s2 mEq/L anionic plasma proteins (e. sulfate. AG    ²  HCO3.[Cl-] . HCO3-) AG = [Na+] .(Anion Gap Concept )    Major plasma cation (Na+) major plasma anions (Cl-.

phosphate PO4o. paraldehyde . ethylene glycol. alcoholic. high dose penicillin Toxins ± Salicylates. organic anions Excessive organic salt therapy ± Ringer¶s lactate. retained sulfate SO4o. methanol. DM. starvation Renal failure ± GFR <20~30 ml/min.Anion Gap Acidosis (AGo)           ² Hyperlactatemia (lactateo) Hyperketonemia ± Ketoneo.

5 Diagnosis Normal RTA Diarrhea .[Cl-]u   NH4+ (unmeasured urinary cation) Negative UAG high NH4+ excretion UAG Negative Positive Negative Urine pH <5.Urinary Anion Gap UAG = [Na+]u + [K+]u .5 >5.5 >5.

Batter syndrome. Cushing syndrome. defiency of K.   PaCO2 = (0. mg .7 x HCO3-) + (21 ± 2) check urine Cl  Urine Cl<20meq/L saline response type     NG free drainage Vomitting Diuretics  Urine Cl>20meq/L saline resistant type  Hyperaldosteronism.

0-7.hypovolemia.NG drainage or vomiting  HCO3.55 40% ICU metabolic alkalosis ²  -.Metabolic Alkalosis    metabolic acidosis ²  pH =7.depletion  Cl ECF  HCO3total anion equivalency HCO3metabolic alkalosis²  excess HCO3- . Cl.2 pH >7.-.

HCO3 PCO2.   PCO2.HCO3 AG/ HCO3=1-2 pure metabolic acidosis AG/ HCO3<1 high AG metabolic acidosis+normal AG metabolic acidosis AG/ HCO3>2 high AG metabolic acidosis+metabolic alkalosis  Check blood AG high AG    .

loss   gap-gap ratio 0~1 Mixed metabolic acidosis & alkalosis   >1  High AG acidosis Na2CO3 High Cl acidosis $0 Acidosis-Alkalosis >1 High AG acidosis (AG/(HCO3$1 Mixed acidosis (AG/(HCO30b1 .loss   gap-gap ratio }0 Lactic acidosis + HCO3.deficit = (AG-12)/(24HCO3-)  Lactic acidosis   gap-gap ratio =1  Lactate HCO3-    HCO3.Gap-Gap Ratio AG excess/HCO3.