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Compensated Metabolic Acidosis Example

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Arterial Blood Gas (abg) Interpretation For Medical Students, Osces And Mrcp Paces

Arterial Blood Gas (ABG) interpretation for medical students, OSCEs and MRCP Arterial Blood Gas (ABG) interpretation for medical students, OSCEs and MRCP PACES This section presents how to interpret arterial blood gases. It explains each component in turn followed by clinical examples to work through. The most important points when assessing a patient are the history, examination and basic observations. Investigations such as arterial blood gases add to the information you have already gained to guide your management. Arterial blood gas analysis can be used to assess gas exchange and acid base status as well as to provide immediate information about electrolytes. It is also useful to have access to any previous gases. This is particularly important if your patient is known to have chronic respiratory disease with existing chronic ABG changes. Normal values for arterial blood gas (ABG) Normal values are given below. Note that these may vary slightly between analysers. Be sure to know the normal ranges and units for the analyser you will be using. Click here for related pages: ABG examples and ABG exam questions pH is a logarithmic scale of the concentration of hydrogen ions in a so Continue reading >>

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Popular Questions

  1. sonias

    3 This is my topic for this week in nursing school, respiratory & metabolic acidosis/ alkalosis. I am having trouble breaking it down. Can someone please help me understand this please? Any and all help is greatly appreciated.

  2. Esme12

    Normal values:
    PH = 7.35 - 7.45
    C02 = 35 - 45
    HC03 = 21-26
    Respiratory acidosis = low ph and high C02
    hypoventilation (eg: COPD, narcs or sedatives, atelectasis)
    *Compensated by metabolic alkalosis (increased HC03)
    For example:
    ph 7.20 C02 60 HC03 24 (uncompensated respiratory acidosis)
    ph 7.33 C02 55 HC03 29 (partially compensated respiratory acidosis)
    ph 7.37 C02 60 HC03 37 (compensated respiratory acidosis)
    Respiratory alkalosis : high ph and low C02
    hyperventilation (eg: anxiety, PE, pain, sepsis, brain injury)
    *Compensated by metabolic acidosis (decreased HC03)
    examples:
    ph 7.51 C02 26 HC03 25 (uncompensated respiratory alkalosis)
    ph 7.47 C02 32 HC03 20 (partially compensated respiratory alkalosis)
    ph 7.43 C02 30 HC03 19 (compensated respiratory alkalosis)
    Metabolic acidosis : low ph and low HC03
    diabetic ketoacidosis, starvation, severe diarrhea
    *Compensated by respiratory alkalosis (decreased C02)
    examples:
    ph 7.23 C02 36 HC03 14 (uncompensated metabolic acidosis)
    ph 7.31 C02 30 HC03 17 (partially compensated metabolic acidosis)
    ph 7.38 C02 26 HC03 20 (compensated metabolic acidosis)
    Metabloic alkalosis = high ph and high HC03
    severe vomiting, potassium deficit, diuretics
    *Compensated by respiratory acidosis (increased C02)
    example:
    ph 7.54 C02 44 HC03 29 (uncompensated metabolic alkalosis)
    ph 7.50 C02 49 HC03 32 (partially compensated metabolic alkalosis)
    ph 7.44 C02 52 HC02 35 (compensated metabolic alkalosis)
    *Remember that compensation corrects the ph.
    Now a simple way to remember this......
    CO2 = acid, makes things acidic
    HCO3 = base, makes things alkalotic
    Remember ROME
    R-Respiratory
    O-Opposite
    M-Metabolic
    E-Equal
    Ok always look at the pH first...
    pH<7.35 = acidosis
    pH>7.45 = alkalosis
    Then, if the CO2 is high or low, then it is respiratory...If the HCO3 is high or low then it is metabolic. How you remember that is that the respiratory system is involved with CO2 (blowing air off or slowing RR), and the kidneys (metabolic) are involved with HCO3 (excreting or not excreting).
    Here is how you think thru it: pH = 7.25 CO2 = 40 HCO3 = 17
    Ok, first, the pH is low so think acidosis. CO2 is WNL. HCO3 is low. Draw arrows if it helps. The abnormal values are both low (think Equal). Metabolic imbalances are equal. So, this must be metabolic acidosis!
    Now, for compensation...If you have a metabolic imbalance, the respiratory system is going to try to compensate. Respiratory = CO2. If the CO2 is normal in the ABG, then there is no compensation going on. Compensation in acidosis will decrease the CO2 because you want to get rid of the acid (CO2). In alkalosis, it will increase because you want to add more acid (CO2)
    If you have a respiratory imbalance, the kidneys will try to compensate. Kidneys = HCO3. If the HCO3 is normal in the ABG, then there is no compensation going on. Compensation in acidosis will increase HCO3 because you want to hold on to the base to make it more alkalotic. In alkalosis, it will decrease because you want to excrete the base to make it more acidic.

  3. Esme12

    Check out this tutorial
    Interactive Online ABG's acid base

  4. -> Continue reading
read more
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Arterial Blood Gases - Indications And Interpretation

Severely unwell patients from any cause - affects prognosis. Arterial blood can be obtained by direct arterial puncture most usually at the wrist (radial artery). Alternatives to the radial artery include the femoral and brachial artery - both of which are usually used in emergency settings. The dorsalis pedis artery and ulnar artery may also be used. It is important to ensure good collateral circulation (see below), as there is a theoretical risk of thrombus occlusion. If multiple samples are required then an indwelling arterial cannula can be placed. Allow the patient to titrate with the oxygen for 5-10 minutes (30 minutes if they have chronic obstructive pulmonary disease (COPD)) before taking a sample. If the radial artery is to be used, perform Allen's test to confirm collateral blood flow to the hand. Elevate the hand and make a fist for approximately 30 seconds. Apply pressure over the ulnar and the radial arteries occluding both (keep the hand elevated). Release pressure on the ulnar artery and look for perfusion of the hand (this takes under eight seconds). If there is any delay then it may not be safe to perform radial artery puncture. Explain the procedure to the patien Continue reading >>

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Popular Questions

  1. sonias

    3 This is my topic for this week in nursing school, respiratory & metabolic acidosis/ alkalosis. I am having trouble breaking it down. Can someone please help me understand this please? Any and all help is greatly appreciated.

  2. Esme12

    Normal values:
    PH = 7.35 - 7.45
    C02 = 35 - 45
    HC03 = 21-26
    Respiratory acidosis = low ph and high C02
    hypoventilation (eg: COPD, narcs or sedatives, atelectasis)
    *Compensated by metabolic alkalosis (increased HC03)
    For example:
    ph 7.20 C02 60 HC03 24 (uncompensated respiratory acidosis)
    ph 7.33 C02 55 HC03 29 (partially compensated respiratory acidosis)
    ph 7.37 C02 60 HC03 37 (compensated respiratory acidosis)
    Respiratory alkalosis : high ph and low C02
    hyperventilation (eg: anxiety, PE, pain, sepsis, brain injury)
    *Compensated by metabolic acidosis (decreased HC03)
    examples:
    ph 7.51 C02 26 HC03 25 (uncompensated respiratory alkalosis)
    ph 7.47 C02 32 HC03 20 (partially compensated respiratory alkalosis)
    ph 7.43 C02 30 HC03 19 (compensated respiratory alkalosis)
    Metabolic acidosis : low ph and low HC03
    diabetic ketoacidosis, starvation, severe diarrhea
    *Compensated by respiratory alkalosis (decreased C02)
    examples:
    ph 7.23 C02 36 HC03 14 (uncompensated metabolic acidosis)
    ph 7.31 C02 30 HC03 17 (partially compensated metabolic acidosis)
    ph 7.38 C02 26 HC03 20 (compensated metabolic acidosis)
    Metabloic alkalosis = high ph and high HC03
    severe vomiting, potassium deficit, diuretics
    *Compensated by respiratory acidosis (increased C02)
    example:
    ph 7.54 C02 44 HC03 29 (uncompensated metabolic alkalosis)
    ph 7.50 C02 49 HC03 32 (partially compensated metabolic alkalosis)
    ph 7.44 C02 52 HC02 35 (compensated metabolic alkalosis)
    *Remember that compensation corrects the ph.
    Now a simple way to remember this......
    CO2 = acid, makes things acidic
    HCO3 = base, makes things alkalotic
    Remember ROME
    R-Respiratory
    O-Opposite
    M-Metabolic
    E-Equal
    Ok always look at the pH first...
    pH<7.35 = acidosis
    pH>7.45 = alkalosis
    Then, if the CO2 is high or low, then it is respiratory...If the HCO3 is high or low then it is metabolic. How you remember that is that the respiratory system is involved with CO2 (blowing air off or slowing RR), and the kidneys (metabolic) are involved with HCO3 (excreting or not excreting).
    Here is how you think thru it: pH = 7.25 CO2 = 40 HCO3 = 17
    Ok, first, the pH is low so think acidosis. CO2 is WNL. HCO3 is low. Draw arrows if it helps. The abnormal values are both low (think Equal). Metabolic imbalances are equal. So, this must be metabolic acidosis!
    Now, for compensation...If you have a metabolic imbalance, the respiratory system is going to try to compensate. Respiratory = CO2. If the CO2 is normal in the ABG, then there is no compensation going on. Compensation in acidosis will decrease the CO2 because you want to get rid of the acid (CO2). In alkalosis, it will increase because you want to add more acid (CO2)
    If you have a respiratory imbalance, the kidneys will try to compensate. Kidneys = HCO3. If the HCO3 is normal in the ABG, then there is no compensation going on. Compensation in acidosis will increase HCO3 because you want to hold on to the base to make it more alkalotic. In alkalosis, it will decrease because you want to excrete the base to make it more acidic.

  3. Esme12

    Check out this tutorial
    Interactive Online ABG's acid base

  4. -> Continue reading
read more
Share on facebook

More Abg Examples - Resus

This is an elderly man with vomiting for 3 days, who presents with tachycardia. It would be expected that there be a metabolic alkalosis with loss of gastric contents. His pH shows an alkalosis and he has raised bicarb. He is hypokalaemic and hypocloraemic, with a raised BSL. The Na is low, when corrected for increased BSL it is 134. With this metabolic alkalosis the expected pCO2 is (0.9 x HCO3) + 16 = 43. The actual pCO2 is 28.5. Therefore this is a mixed picture ofMetabolic and Respiratory Alkalosis i.e.,he has his metabolic alkalosis but is also breathing up more than he should. Expected Aa gradient is age/4 +4 = 22.5 so a very high Aa gradient indicating a V/Q mismatch, or diffusion defect. So when we think of causes, take both things into account- the vomiting and the Aa. Pneumonia(although afebrile- elderly may be) A 21 year old man is brought in by his father with a one week history of vomiting. He has not been able to keep any food down. He has been diagnosed with Hashimotos thyroiditis by his local doctor 4 months previously. Today his blood pressure is 90/48 and pulse rate 104. These are his venous blood gas results: Is it acidosis or alkalosis? ACIDOSIS What is the pri Continue reading >>

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Popular Questions

  1. sonias

    3 This is my topic for this week in nursing school, respiratory & metabolic acidosis/ alkalosis. I am having trouble breaking it down. Can someone please help me understand this please? Any and all help is greatly appreciated.

  2. Esme12

    Normal values:
    PH = 7.35 - 7.45
    C02 = 35 - 45
    HC03 = 21-26
    Respiratory acidosis = low ph and high C02
    hypoventilation (eg: COPD, narcs or sedatives, atelectasis)
    *Compensated by metabolic alkalosis (increased HC03)
    For example:
    ph 7.20 C02 60 HC03 24 (uncompensated respiratory acidosis)
    ph 7.33 C02 55 HC03 29 (partially compensated respiratory acidosis)
    ph 7.37 C02 60 HC03 37 (compensated respiratory acidosis)
    Respiratory alkalosis : high ph and low C02
    hyperventilation (eg: anxiety, PE, pain, sepsis, brain injury)
    *Compensated by metabolic acidosis (decreased HC03)
    examples:
    ph 7.51 C02 26 HC03 25 (uncompensated respiratory alkalosis)
    ph 7.47 C02 32 HC03 20 (partially compensated respiratory alkalosis)
    ph 7.43 C02 30 HC03 19 (compensated respiratory alkalosis)
    Metabolic acidosis : low ph and low HC03
    diabetic ketoacidosis, starvation, severe diarrhea
    *Compensated by respiratory alkalosis (decreased C02)
    examples:
    ph 7.23 C02 36 HC03 14 (uncompensated metabolic acidosis)
    ph 7.31 C02 30 HC03 17 (partially compensated metabolic acidosis)
    ph 7.38 C02 26 HC03 20 (compensated metabolic acidosis)
    Metabloic alkalosis = high ph and high HC03
    severe vomiting, potassium deficit, diuretics
    *Compensated by respiratory acidosis (increased C02)
    example:
    ph 7.54 C02 44 HC03 29 (uncompensated metabolic alkalosis)
    ph 7.50 C02 49 HC03 32 (partially compensated metabolic alkalosis)
    ph 7.44 C02 52 HC02 35 (compensated metabolic alkalosis)
    *Remember that compensation corrects the ph.
    Now a simple way to remember this......
    CO2 = acid, makes things acidic
    HCO3 = base, makes things alkalotic
    Remember ROME
    R-Respiratory
    O-Opposite
    M-Metabolic
    E-Equal
    Ok always look at the pH first...
    pH<7.35 = acidosis
    pH>7.45 = alkalosis
    Then, if the CO2 is high or low, then it is respiratory...If the HCO3 is high or low then it is metabolic. How you remember that is that the respiratory system is involved with CO2 (blowing air off or slowing RR), and the kidneys (metabolic) are involved with HCO3 (excreting or not excreting).
    Here is how you think thru it: pH = 7.25 CO2 = 40 HCO3 = 17
    Ok, first, the pH is low so think acidosis. CO2 is WNL. HCO3 is low. Draw arrows if it helps. The abnormal values are both low (think Equal). Metabolic imbalances are equal. So, this must be metabolic acidosis!
    Now, for compensation...If you have a metabolic imbalance, the respiratory system is going to try to compensate. Respiratory = CO2. If the CO2 is normal in the ABG, then there is no compensation going on. Compensation in acidosis will decrease the CO2 because you want to get rid of the acid (CO2). In alkalosis, it will increase because you want to add more acid (CO2)
    If you have a respiratory imbalance, the kidneys will try to compensate. Kidneys = HCO3. If the HCO3 is normal in the ABG, then there is no compensation going on. Compensation in acidosis will increase HCO3 because you want to hold on to the base to make it more alkalotic. In alkalosis, it will decrease because you want to excrete the base to make it more acidic.

  3. Esme12

    Check out this tutorial
    Interactive Online ABG's acid base

  4. -> Continue reading
read more

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