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Objectives
Review the basic mechanisms of acid/base Recall the 4 major types of Acid/base imbalances Analyze a set of blood gas values
pH
Body maintains a slightly alkaline pH
of 7.35 - 7.45 Metabolic and respiratory processes work together to keep hydrogen (H+) levels in a normal range
Regulators of Acid/Base
Buffers Respiratory system Renal system
H2CO3
H+ + HCO3Kidneys
Respiratory
Metabolic
Fast
Slow
Acid-Base Imbalances
Alkalemia
Alkalosis
Acidemia
Acidosis
Metabolic Acidosis
Causes
Metabolic Alkalosis
Causes
Respiratory Acidosis
Causes
Respiratory Alkalosis
Causes
Hyperventilation
Interpretation of ABGs
Evaluate pH: this determines acidosis or alkalosis 7.40 is in the middle of the normal range of 7.35 - 7.45 Value below 7.40 is moving towards acidosis Value above 7.40 is moving towards alkalosis
Interpretation of ABGs
Evaluate respiratory component (PaCO2) If PaCO2 < 35, the value is alkalotic If PaCO2 > 45, the value is acidotic
Interpretation of ABGs
Evaluate the metabolic component (HCO3) If HCO3 > 26 mEq/L, the value is alkalotic If HCO3 < 22 mEq/L, the value is acidotic
Interpretation of ABGs
Determine which component (PaCO2 or HCO3) matches the pH If pH is decreased or increased is the underlying disorder respiratory or metabolic?
Interpretation of ABGs
Respiratory pH, PaCO2 pH, PaCO2 Metabolic pH, HCO3 pH, HCO3
Compensation
Determine the degree of compensation Absent: pH is not within normal range The component that does not match the pH imbalance is still within its normal range
Compensation
Determine the degree of compensation Complete: pH is within the normal range and both components are either above or below normal range
Compensation
Determine the degree of compensation Partial: pH is not within normal range The component that does not match the pH disorder is above or below the normal range
pH
PaCO2
HCO3
Respiratory Acidosis
Compensated Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis Metabolic Alkalosis
Acid/Base MnemonicROME
R (respiratory) O (opposite)
pH pH
PaCO2 PaCO2
alkalosis acidosis
M (metabolic) E (equivalent)
pH pH
HCO3 HCO3
acidosis alkalosis
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