Download - Arterial blood gases Rafiq Suleman BScN
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Arterial Blood Gases
Made Easy
Prepared by:
Rafiq SulemanBScN
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Purpose of ABGPurpose of ABG
Assess degree to which
LungsLungs are able to provide adequate O2 & remove
CO2 and
KidneysKidneys are able to reabsorb or excrete HCO3 .
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You Must Know What is Normal to be Able to Know What is Abnormal
pH = 7.35 to 7.45
PaC02 = 35 to 45 mm Hg
PaO2 = 80 to 100 mm Hg
HCO3 = 22 – 26 mEq/l Feb 1st, 2014.3 Rafiq Suleman BScN
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What You Must Look At To Interpret ABGs
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Look at Your pH
Is it normal?
Is it high ?
Is it low?
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ExamplespH = 7.36
pH = 7.23
pH = 7.47
A high pH indicates alkalosis.
A low pH indicates acidosis.Feb 1st, 2014.6 Rafiq Suleman BScN
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Look at Your PaCO2
Is it normal ?
Is it high ?
Is it low ?
This is the respiratoryrespiratory component.
An abnormality in the PaCO2 will
indicate
a respiratory problem.Feb 1st, 2014.7 Rafiq Suleman BScN
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ExamplesPaCO2 = 40 mm Hg
PaCO2 = 23 mm Hg
PaCO2 = 48 mm Hg
A high PaCO2 indicates acidity.
A low PaCO2 indicates alkalosis.Feb 1st, 2014.8 Rafiq Suleman BScN
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PaCO2
Lungs will increase or decrease
ventilation to remove the appropriate
amount of CO2 .
Lung compensation begins quickly.
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Now Look at Your HCO3
Is it normal ?
Is it high ?
Is it low ?
This is the metabolicmetabolic component.An abnormality in the HCO3 indicates a
metabolic problem.Feb 1st, 2014.10 Rafiq Suleman BScN
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Examples
HCO3 = 25 mEq/l
HCO3 = 19 mEq/l
HCO3 = 32 mEq/l
A low HCO3 indicates acidity.
A high HCO3 indicates alkalosis.Feb 1st, 2014.11 Rafiq Suleman BScN
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HCO3
The kidneys excrete Hydrogen
(acid) & retain bicarbonate (base) to
help maintain pH.
Renal compensation is slow.
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Let’s Look at the 4 Situations that Can Occur
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Acidosis
Develops when:
Excess accumulation of acid
Decreased amount of alkali.
Can be respiratory or metabolic.
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Metabolic AcidosisABGs:
Low pH (below 7.35).
Decreased HCO3 (below 22)
PaCO2 will be normal.
Remember both the pH & HCORemember both the pH & HCO33 will be low. will be low.
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Metabolic AcidosisCaused by too much acid in the body or loss
of bicarbonate.
Diarrhea (loss of HCO3).
Diabetic ketoacidosis.
Renal failure.
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Respiratory AcidosisABGs:
Low pH (below 7.35)
Increased PaCO2 (above 45)
HCO3 will be normal.
Remember the pH will be low & PaCORemember the pH will be low & PaCO22 will be will be
elevated (opposite).elevated (opposite).Feb 1st, 2014.17 Rafiq Suleman BScN
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Respiratory AcidosisCaused by acid buildup due to lungs not
eliminating CO2 .
Anything that decreased. respirations can cause
respiratory acidosis.
Chronic respiratory disease.
CNS depression.
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Alkalosis
Develops when:
Excess accumulation of bicarbonate.
Loss of acid.
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Metabolic AlkalosisABGs:
Increase in pH (greater than 7.45)
Increased HCO3 (greater than 26)
PaCO2 will be normal.
Remember both the pH & the HCORemember both the pH & the HCO33 will be elevated will be elevated.
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Metabolic Alkalosis
Loss of acid or increase in HCO3
Vomiting or NG drainage
(loss of Hydrogen).
Excessive use of antacids.
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Respiratory AlkalosisABGs:
Increase in pH (greater than 7.45)
Decrease in PaCO2 (less than 35)
HCO3 will be normal.
Remember the pH will be high & PaCORemember the pH will be high & PaCO22 will be low will be low
(opposite).(opposite).
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Respiratory Alkalosis
Caused by too much CO2 being
excreted
by the lungs.
Hyperventilation.
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Interpreting ABGs
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1st Step Look at pH
Is it normal (7.35 to 7.45)
Does it reflect acidosis ( less than 7.35).
Does it reflect alkalosis (greater than 7.45).
Label accordingly.
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2nd Step Look at PaCO2
This is the respiratory component.
Is it normal.
Does it reflect alkalosis (less than 35).
Does it reflect acidosis (greater than 45).
Label accordingly.
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3rd Step Look at the HCO3
This is the metabolic component
Is it normal.
Does it reflect acidosis (less than 22).
Does it reflect alkalosis (greater than 26).
Label accordingly.Feb 1st, 2014.27 Rafiq Suleman BScN
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Let’s Put It All
Together
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Problems
pH of 7.33
PaCO2 of 40 mmHg
HCO3 of 20 mEq/L
What does this indicate
Break it down Feb 1st, 2014.29 Rafiq Suleman BScN
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pH = Acidosis
PaCO2 = Normal
HCO3 = Acidosis
An abnormal HCO3 indicates a metabolic
problem.Feb 1st, 2014.30 Rafiq Suleman BScN
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Metabolic Acidosis
Way to go!!
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ProblempH of 7.59
PaCO2 of 29 mm Hg
HCO3 of 24mEq/L
What does this indicate
Break it downFeb 1st, 2014.32 Rafiq Suleman BScN
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pH = Alkalosis
PaCO2 = Alkalosis
HCO3 = Normal
An abnormal PaCO2 indicates a respiratory
problem.Feb 1st, 2014.33 Rafiq Suleman BScN
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Respiratory Alkalosis
Great Job!!
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ProblempH of 7.25
PaCO2 of 61 mmHg
HCO3 of 26 mEq/L
What does this indicate
Break it downFeb 1st, 2014.35 Rafiq Suleman BScN
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pH = Acidosis
PaCO2 = Acidosis
HCO3 = Normal
An abnormal PaCO2 indicates a respiratory
problem.Feb 1st, 2014.36 Rafiq Suleman BScN
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Respiratory Acidosis
You are doing a
great job !!
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ProblempH of 7.51
PaCO2 of 44mmHg
HCO3 of 56
What does this indicate
Break it downFeb 1st, 2014.38 Rafiq Suleman BScN
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pH = Alkalosis
PaCO2 = Normal
HCO3 = Alkalosis
An abnormal HCO3 indicates a metabolic
problem.Feb 1st, 2014.39 Rafiq Suleman BScN
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Metabolic Alkalosis
You have become an ABG pro!!
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You Are Doing Great
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Compensation
Occurs as the body begins to correct the acid
base imbalance
pH will be normal or near normal if total
compensation
pH will be abnormal if partial compensationFeb 1st, 2014.42 Rafiq Suleman BScN
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Compensation
Both the PaCo2 & HCO3 will be abnormal
Respiratory imbalances are compensated
for by the renal system
Metabolic imbalances are compensated for
by the respiratory system Feb 1st, 2014.43 Rafiq Suleman BScN
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ExamplepH of 7.27
PaCO2 of 27 mm Hg
HCO3 of 10 mEq/l
Note that both the PaCO2 & the HCO3 are low.
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Let’s Break it DownLow pH = Acidosis
Low PaCO2 = Alkalosis
Low HCO3 = Acidosis
HCO3 corresponds with the pH
This is a metabolic problem
Metabolic acidosis with partial compensation.Feb 1st, 2014.45 Rafiq Suleman BScN
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ProblemspH of 7.52
PaCO2 of 47 mmHg
HCO3 of 36 mEq/L
What does this indicate
Break it downFeb 1st, 2014.46 Rafiq Suleman BScN
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pH = Alkalosis
PaCO2 = Acidosis
HCO3 = Alkalosis
Which two go together?
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Metabolic Alkalosis with Partial Compensation
You are doing great!!
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ProblemspH of 7.45
PaCO2 of 50 mmHg
HCO3 of 33 mEq/L
What does this indicate
Break it downFeb 1st, 2014.49 Rafiq Suleman BScN
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pH = Normal
PaCO2 = Acidosis
HCO3 = Alkalosis
Your pH leans toward the alkalosis side.
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Fully Compensated Metabolic Alkalosis
You have done great!!
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