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Definition

Arterial Blood Gases

pH = measures acid-base

PaCO2 = partial pressure of CO2 in the blood, affected by CO2 removal in the lungs

HCO3 = measure the bicarbonate content of the blood; affected by renal production of bicarbonate
Definition

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Normal ABG Ranges

pH = 7.35 - 7.45 o pH < 7.35 = acidosis o pH > 7.45 = alkalosis PaCO2 = 35 - 45 o PaCO2 < 35 = alkalosis o PaCO2 > 45 = acidosis HCO3 =22 - 26 o HCO3 < 22 = acidosis o HCO3 > 26 = alkalosis PaO2 =80 - 100

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Definition

Clinical Manifestations of Acidosis

CNS: depressed acitivty, lethargy, confusion, stupor, coma Neuromuscular: o hyporeflexia, skeletal muscle weakness, flaccid paralysis Cardio: o delayed electrical conduction o bradycardia to heart block o Hypotension, thready peripheral pulses Respiratory: o Kussmaul respirations Skin: warm, flushed, dry skin (metabolic acidosis) pale - cyanotic, dry skin (respiratory
o

acidosis)

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Definition

Causes of Respiratory Acidosis

anesthesia drug overdose

pH & PaCO2

COPD pneumonia

HCO3 normal

head & neck trauma muscle weakness airway obstruction electrolyte imbalance inadequate chest expansion

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Definition

Signs & Symptoms of Respiratory Acidosis

hypoventilation hypoxia rapid, shallow respirations

pH & PaCO2

BP w/ vasodilation dyspnea

HCO3 normal

headache hyperkalemia Dysrhythmias ( K+) drowsiness / dizziness / disorientation muscle weakness hyperreflexia
Definition

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Treatment of Respiratory Acidosis

maintain patent airway enhance gas exchange

pH & PaCO2

oxygen therapy bronchodilators

HCO3 normal
Definition

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Causes of Metabolic Acidosis

diarrhea - loss of HCO3 DKA

pH & HCO3

renal failure shock

PaCO2 normal

hypermetabolism
Definition

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Signs & Symptoms of Metabolic Acidosis

headache decreased BP

pH & HCO3

hyperkalemia muscle twitching

PaCO2 normal

warm, flushed skin nausea / vomiting / diarrhea

Changes in LOC: confusion, increased drowsiness Kussmaul respirations

Definition

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Treatment of Metabolic Acidosis

Diarrhea = IV fluids, anti-diarrheals

pH & HCO3

DKA = insulin & IV fluids

PaCO2 normal

Renal failure = dialysis

Definition

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Causes for Respiratory Alkalosis

Too much CO2 being exreted by the lungs

pH & PaCO2

Hyperventilation Fear

HCO3 normal

Anxiety mechanical ventilation

Hypoxemia high altitudes shock

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Definition

Signs & Symptoms of Respiratory Alkalosis

seizures Kussamaul respirations

pH & PaCO2

hyperventilation tachycardia

HCO3 normal

low or Normal BP hypokalemia numbness/ tingling of extremeties lethargy & confusion light headedness nausea / vomiting
Definition

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Causes of Metabolic Alkalosis

Loss of acid increase in HCO3

pH & HCO3

severe vomiting excessive NG drainage / GI suctioning

PaCO2 normal

thiazide diuretics excessive use fo antacids excessive Na+HCO3 Parenteral base administration: blood transfusions, TPN Hyperaldosteronism
Definition

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Signs & Symptoms of Metabolic Alkalosis

nausea / vomiting/ diarrhea tremors / muscle cramps

pH & HCO3

tingling of fingers & toes hypokalemia

PaCO2 normal

restlessness then lethargy dyrhythmia - tachycardia compensatory hypoventilation confusion / decreased LOC / dizzy / irritable
Definition

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Clinical Manifestations of Alkalosis

CNS: increased acitivty anxiety & irritability tetany seizures Positive Chvostek's sign & Trousseau's sign o paresthesia Neuromuscular: o hyperreflexia o muscle cramping & twitching o skeletal muscle weakness Cardio: o increased HR o normal or low BP o Respiratory: o increased rate & depth w/ respiratory alkalosis o decreased effort w/ metabolic alkalosis
o o o o o

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Definition

Partial Compensation

If you're seeing a pH outside the normal range, your disorder is either uncompensated or partially compensated.

Partial compensation prevents the acid-base imbalance from becoming severe or life threatening

Respiratory compensation occurs through the lungs, usually to correct for acid-base imbalances from metabolic problems.

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Definition

Renal compensation
Renal compensation results when a healthy kidney works to correct changes in the blood pH that occur when the respiratory system is overwhelmed or not healthy

Renal compensatory mechanisms are much more powerful than respiratory but are not as rapid

Renal compensation are not fully triggered unless the acid-base imbalance continues for several hours to several days

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Definition

What is it??
Partially compensated respiratory acidosis o pH & PaCO2 match respiratory o HCO3 odd one out o pH is not normal so only partially compensated

pH PaCO2 HCO3

7.25 50 27

pH PaCO2 HCO3

Acidosis Acidosis Alkalosis

Definition

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What is it???

ANSWER:

pH PaCO2 HCO3 7.48 46 30 pH PaCO2 HCO3 Alkalosis Acidosis Alkalosis

Partially compensated metabolic alkalosis o pH & HCO3 match metabolic o PaCO2 odd one out o pH is not normal so only partially compensated

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Definition

What is it??

ANSWER:

pH PaCO2 HCO3

7.45 46 32

N pH PaCO2 HCO3

High Normal Acidosis Alkalosis

Fully compensated metabolic alkalosis o Even though pH is normal it s high normal which would be alkalosis o If pH were alkalosis then HCO3 would match metabolic o pH is normal so fully compensated

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Definition

What is it??

ANSWER:

pH PaCO2 HCO3 7.35 50 27 N pH PaCO2 HCO3 Low Normal Acidosis Alkalosis

Fully compensated respiratory acidosis o Even though pH is normal its low normal which would be acidosis o If pH were acidosis then PaCO2 would match respiratory o pH is normal so fully compensated

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