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# ABG TUTORIAL

## SEMIRA ABDI M. Clin.Pharm (UKM), Bpharm (AAU)

The primary parameter for determining whether a patient has acidemia or alkalemia include A. Arterial PH B. Venous bicarbonate concentration C. Arterial carbondioxide concentration D. A & B E. C& D
1.

Arterial PH

2. The primary parameter for determining whether a patient has respiratory acidosis or alkalosis include A. Plasma haemoglobin. B. Percentage of oxygen saturation. C. Arterial carbondioxide concentration. D. A&B E. A&C

C.

## Arterial carbondioxide concentration.

3. In compensating for respiratory alkalosis, the body excretes more: A. ammonium ions. B. bicarbonate ions. C. dihydrogen phosphate ions. D. carbonic acid. E. hydrogen ions.

B. bicarbonate ions.

4. Given the following arterial blood gas values: PH :7.56 PCO2 :31 mmHg HCO3 : 27 mEq/L PaO2: 56 mmHg What is (are) the most likely acid base state(s) in the patient? A. B. C. D. E. Acute respiratory alkalosis. Chronic respiratory alkalosis. Respiratory alkalosis and metabolic alkalosis. Respiratory acidosis and metabolic acidosis. Respiratory alkalosis and metabolic acidosis.

c.

## Respiratory alkalosis and metabolic alkalosis.

5. A 37-year-old man presents to hospital with shallow and slow breathing due to heroin overdose. His arterial blood gas results were as follows.

Arterial blood gases (ABG): pH: 7.30 PaCO2: 55 mm/Hg HCO3-: 27 mEq/L
What kind of acid base disorder is he having? Is there adequate compensation?

Acute Respiratory Acidosis use winters formula to assess whether there is adequate compensation or not?

PCO2= 1.5 (HCO3) 8 2 = 1.5 (27) + 8 2 = 48.5 2 = (46.5- 50.5) There is no adequate compensation since the actual measure CO2 is 55.

6. A 77-year-old man presents with anxiety of psychosomatic origin. He has a very rapid breathing and slurred speech. His ABG results are as follows. Arterial blood gases (ABG): pH: 7.57 PaCO2: 23 mmHg HCO3-: 21 mEq/L what kind of acid base problem is this patient having?

## Acute Respiratory Alkalosis

7. A 70 year old man with history of CHF presents with increased shortness of breath and leg swelling.
Arterial blood gases (ABG): pH : 7.24 PCO2 : 60 mmHg PO2:52 HCO3: 27

## RESPIRATORY ACIDOSIS WITH INADEQUATE COMPENSATION (METABOLIC ALKALOSIS)

The pH is low, (less than 7.35) therefore by definition, patient is acidemic. PCO2 and HCO3- are abnormal in the same direction, therefore less likely a mixed acid base disorder but not yet ruled out. PCO2 is high and represents acidosis and is consistent with the pH (Respiratory Acidosis). The high normal HCO3- must be the compensatory response.

8.

A 23-year-old woman with gastroenteritis experiences nausea and vomiting. Arterial blood gas analysis is done 1 hour after the onset of symptoms. Which of the following sets of blood gases is most likely. pH 7.30; PCO2 50; HCO3 - 24 pH 7.28; PCO2 40; HCO3 - 18 pH 7.56; PCO2 40; HCO3 - 35 pH 7.51; PCO2 45; HCO3 - 35

A. B. C. D.

Choice D is the best answer. Vomiting causes loss of stomach acid leading to metabolic alkalosis. The rise in pH will inhibit the peripheral chemoreceptor for pH located in the carotid bodies leading to hypoventilation (increased PCO2), which is compensatory.

9. Point x indicates the acid base status of a healthy person at sea level. Point y indicates Data from a patients ABG analysis. Urine PH is 4.5. what is the most likely cause of the condition indicated by point y?
A. B. C. D. E. Adaptation to high altitude COPD Diabetic ketoacidosis Infusion of sodium lactate Severe prolonged vomiting

Answer is c. pH was slightly below 7.4 (compensation is usually not complete and does not overshoot) AND the stem stated that urine pH was acidic. With respiratory alkalosis, the kidneys are excreting bicarbonate and pH is normally alkaline.

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