Arterial Blood Gas Analysis

Vanessa Klee MSV

at is an ABG?
Te Components
pH / PaCO
2
/ PaO
2
/ HCO
3
/ O
2
sat / BE
Desired Ranges
pH - 7.35 - 7.45
PaCO
2
- 35-45 mmHg
PaO
2
- 80-100 mmHg
HCO
3
- 21-27
O
2
sat - 95-100%
Base Excess - +/-2 mEq/L
y Order an ABG?
Aids in establising a diagnosis
Helps guide treatment plan
Aids in ventilator management
mprovement in acid/base management
allows for optimal function of medications
Acid/base status may alter electrolyte levels
critical to patient status/care
Logistics
en to order an arterial line --
Need for continuous BP monitoring
Need for multiple ABGs
ere to place -- te options
Radial
Femoral
Bracial
Dorsalis Pedis
Axillary
Acid Base Balance
Te body produces acids daily
15,000 mmol CO
2
50-100 mEq Nonvolatile acids
Te lungs and kidneys attempt to
maintain balance
Acid Base Balance
Assessment of status via bicarbonate-
carbon dioxide buffer system
CO
2
+ H
2
O <--> H
2
CO
3
<--> HCO
3
-
+ H
+
p = 6.10 + log ([HCO
3
] / [0.03 x PCO
2
])
Te Terms
ACDS
Acidemia
Acidosis
Respiratory
CO
2
Metabolic
GHCO
3
BASES
Alkalemia
Alkalosis
Respiratory
GCO
2
Metabolic
HCO
3
Respiratory Acidosis
Gp, CO
2,
GVentilation
Causes
CNS depression
Pleural disease
COPD/ARDS
Musculoskeletal disorders
Compensation for metabolic alkalosis
Respiratory Acidosis
Acute vs Cronic
Acute - little kidney involvement. Buffering
via titration via Hb for example
pH Gby 0.08 for 10mmHg in CO
2
Cronic - Renal compensation via
syntesis and retention of HCO
3
(GCl to
balance carges ypocloremia)
pH Gby 0.03 for 10mmHg in CO
2
Respiratory Alkalosis
pH, GCO
2,
Ventilation
G CO
2
G HCO
3
(Cl to balance carges
ypercloremia)
Causes
ntracerebral emorrage
Salicylate and Progesterone drug usage
Anxiety Glung compliance
Cirrosis of te liver
Sepsis
Respiratory Alkalosis
Acute vs. Cronic
Acute - GHCO
3
by 2 mEq/L for every
10mmHg G in PCO
2
Cronic - Ratio increases to 4 mEq/L of
HCO
3
for every 10mmHg G in PCO
2
Decreased bicarb reabsorption and
decreased ammonium excretion to
normalize pH
Metabolic Acidosis
GpH, GHCO
3
12-24 ours for complete activation of
respiratory compensation
GPCO
2
by 1.2mmHg for every 1 mEq/L
GHCO
3
Te degree of compensation is
assessed via te inter's Formula
PCO
2
= 1.5(HCO
3
) +8 I 2
Te Causes
Metabolic Gap
Acidosis
M - Metanol
U - Uremia
D - DKA
P - Paraldeyde
- NH
L - Lactic Acidosis
E - Eylene Glycol
S - Salicylate
Non Gap Metabolic
Acidosis
Hyperalimentation
Acetazolamide
RTA (Calculate urine
anion gap)
Diarrea
Pancreatic Fistula
Metabolic Alkalosis
pH, HCO
3
PCO
2
by 0.7 for every 1mEq/L in HCO
3
Causes
Vomiting
Diuretics
Cronic diarrea
Hypokalemia
Renal Failure
Mixed Acid-Base Disorders
Patients may ave two or more acid-
base disorders at one time
Delta Gap
Delta HCO
3
= HCO
3
+ Cange in anion gap
>24 = metabolic alkalosis
Te Steps
Start wit te pH
Note te PCO
2
Calculate anion gap
Determine compensation
Sample Problem #1
An ill-appearing alcoolic male presents
wit nausea and vomiting.
ABG - 7.4 / 41 / 85 / 22
Na- 137 / K- 3.8 / Cl- 90 / HCO
3
- 22
Sample Problem #1
Anion Gap = 137 - (90 + 22) = 25
anion gap metabolic acidosis
inters Formula = 1.5(22) + 8 I 2
= 39 I 2
compensated
Delta Gap = 25 - 10 = 15
15 + 22 = 37
metabolic alkalosis
Sample Problem #2
22 year old female presents for
attempted overdose. Se as taken an
unknown amount of Midol containing
aspirin, cinnamedrine, and caffeine. On
exam se is experiencing respiratory
distress.
Sample Problem #2
ABG - 7.47 / 19 / 123 / 14
Na- 145 / K- 3.6 / Cl- 109 / HCO
3
- 17
ASA level - 38.2 mg/dL
Sample Problem #2
Anion Gap = 145 - (109 + 17) = 19
anion gap metabolic acidosis
inters Formula = 1.5 (17) + 8 I 2
= 34 I 2
uncompensated
Delta Gap = 19 - 10 = 9
9 + 17 = 26
no metabolic alkalosis
Sample Problem #3
47 year old male experienced crus
injury at construction site.
ABG - 7.3 / 32 / 96 / 15
Na- 135 / K-5 / Cl- 98 / HCO
3
- 15 /
BUN- 38 / Cr- 1.7
CK- 42, 346
Sample Problem #3
Anion Gap = 135 - (98 + 15) = 22
anion gap metabolic acidosis
inters Formula = 1.5 (15) + 8 I 2
= 30 I 2
compensated
Delta Gap = 22 - 10 = 12
12 + 15 = 27
mild metabolic alkalosis
Sample Problem #4
1 mont old male presents wit
projectile emesis x 2 days.
ABG - 7.49 / 40 / 98 / 30
Na- 140 / K- 2.9 / Cl- 92 / HCO
3
- 32
Sample Problem #4
Metabolic Alkalosis, ypocloremic
inters Formula = 1.5 (30) + 8 I 2
= 53 I 2
uncompensated