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ABGINTERPRETATION,DebbieSanderPAS-II,Objectives,WhatsanABG?UnderstandingAcid/BaseRelationshipGeneralapproachtoABGInterpretationClinicalcausesAbnormalABGsCasestudiesTakehome,WhatisanABG,ArterialBloodGasDrawnfromartery-radial,brachial,femoralItisaninvasiveprocedure.Cautionmustbetakenwithpatientonanticoagulants.Helpsdifferentiateoxygendeficienciesfromprimaryventilatorydeficienciesfromprimarymetabolicacid-baseabnormalities,WhatIsAnABG?,pHH+PCO2PartialpressureCO2PO2PartialpressureO2HCO3BicarbonateBEBaseexcessSaO2OxygenSaturation,Acid/BaseRelationship,ThisrelationshipiscriticalforhomeostasisSignificantdeviationsfromnormalpHrangesarepoorlytoleratedandmaybelifethreateningAchievedbyRespiratoryandRenalsystems,CaseStudyNo.1,60y/omalecomesERc/oSOB.Tachypneic,tachycardic,diaphoreticandCyanotic.Dxacuteresp.failureandABGsShowPaCO2wellbelownl,pHabovenl,PaO2isverylow.ThebloodgasdocumentResp.failureduetoprimaryO2problem.,CaseStudyNo.2,60y/omalecomesERc/oSOB.Tachypneic,tachycardic,diaphoreticandCyanotic.Dxacuteresp.failureandABGsShowPaCO2veryhigh,lowpHandPaO2ismoderatelylow.ThebloodgasdocumentResp.failureduetoprimarilyventilatoryinsufficiency.,TherearetwobuffersthatworkinpairsH2CO3NaHCO3CarbonicacidbasebicarbonateThesebuffersarelinkedtotherespiratoryandrenalcompensatorysystem,Buffers,RespiratoryComponent,functionofthelungsCarbonicacidH2CO3Approximately98%normalmetabolitesareintheformofCO2CO2+H2OH2CO3excessCO2exhaledbythelungs,MetabolicComponent,FunctionofthekidneysbasebicarbonateNaHCO3ProcessofkidneysexcretingH+intotheurineandreabsorbingHCO3-intothebloodfromtherenaltubules1)activeexchangeNa+forH+betweenthetubularcellsandglomerularfiltrate2)carbonicanhydraseisanenzymethataccelerateshydration/dehydrationCO2inrenalepithelialcells,H2O+CO2H2CO3HCO3+H+,Acid/BaseRelationship,NormalABGvalues,pH7.357.45PCO23545mmHgPO280100mmHgHCO32226mmol/LBE-2-+2SaO295%,AcidosisAlkalosis,pH45HCO37.45PCO226,RespiratoryAcidosis,ThinkofCO2asanacidfailureofthelungstoexhaleadequateCO2pH45CO2+H2CO3pH,CausesofRespiratoryAcidosis,emphysemadrugoverdosenarcosisrespiratoryarrestairwayobstruction,MetabolicAcidosis,failureofkidneyfunctionbloodHCO3whichresultsinavailabilityofrenaltubularHCO3forH+excretionpH26,CausesofMetabolicAlkalosis,lossacidfromstomachorkidneyhypokalemiaexcessivealkaliintake,HowtoAnalyzeanABG,PO2NL=80100mmHg2.pHNL=7.357.45Acidotic7.45PCO2NL=3545mmHgAcidotic45Alkalotic26,Four-stepABGInterpretation,Step1:ExaminePaO2ClinicalApplicationofBloodGases;19942.AmericanJournalofNursing1999;Aug99(8):34-63.JournalPostAnesthesiaNursing1990;Aug;5(4)264-724.Irvine,David;ABGInterpretation,ARoughandDirtyProduction,PracticeABGs,PaO290SaO295pH7.48PaCO232HCO324PaO260SaO290pH7.32PaCO248HCO325PaO295SaO2100pH7.30PaCO240HCO318PaO287SaO294pH7.38PaCO248HCO328PaO294SaO299pH7.49PaCO240HCO3306.PaO262SaO291pH7.35PaCO248HCO327PaO293SaO297pH7.45PaCO247HCO329PaO295SaO299pH7.31PaCO238HCO315PaO265SaO289pH7.30PaCO250HCO32410.PaO2110SaO2100pH7.48PaCO240HCO330,AnswerstoPracticeABGs,RespiratoryalkalosisRespiratoryacidosisMetabolicacidosisComp
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