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# Metabolic Acidosis Lab Values Co2

## Common Laboratory (lab) Values - Abgs

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Laboratory VALUES Home Page Arterial Blood Gases Arterial blood gas analysis provides information on the following: 1] Oxygenation of blood through gas exchange in the lungs. 2] Carbon dioxide (CO2) elimination through respiration. 3] Acid-base balance or imbalance in extra-cellular fluid (ECF). Normal Blood Gases Arterial Venous pH 7.35 - 7.45 7.32 - 7.42 Not a gas, but a measurement of acidity or alkalinity, based on the hydrogen (H+) ions present. The pH of a solution is equal to the negative log of the hydrogen ion concentration in that solution: pH = - log [H+]. PaO2 80 to 100 mm Hg. 28 - 48 mm Hg The partial pressure of oxygen that is dissolved in arterial blood. New Born – Acceptable range 40-70 mm Hg. Elderly: Subtract 1 mm Hg from the minimal 80 mm Hg level for every year over 60 years of age: 80 - (age- 60) (Note: up to age 90) HCO3 22 to 26 mEq/liter (21–28 mEq/L) 19 to 25 mEq/liter The calculated value of the amount of bicarbonate in the bloodstream. Not a blood gas but the anion of carbonic acid. PaCO2 35-45 mm Hg 38-52 mm Hg The amount of carbon dioxide dissolved in arterial blood. Measured. Partial pressure of arterial CO2. (Note: Large A= alveolor CO2). CO2 is called a “volatile acid” because it can combine reversibly with H2O to yield a strongly acidic H+ ion and a weak basic bicarbonate ion (HCO3 -) according to the following equation: CO2 + H2O <--- --> H+ + HCO3 B.E. –2 to +2 mEq/liter Other sources: normal reference range is between -5 to +3. The base excess indicates the amount of excess or insufficient level of bicarbonate in the system. (A negative base excess indicates a base deficit in the blood.) A negative base excess is equivalent to an acid excess. A value outside of the normal r Continue reading >>

## Serum Total Carbon Dioxide - Clinical Methods - Ncbi Bookshelf

We measure serum total CO2 content in lieu of measuring serum bicarbonate. The total CO2 content includes the serum bicarbonate as well as available forms of carbon dioxide (i.e., dissolved CO2 and carbonic acid). Generally, the serum bicarbonate comprises about 95% of the total CO2 content; thus we can use this measurement as an excellent estimator of serum bicarbonate. The total CO2 content normally equals 23 to 30 mEq/L of serum. Most laboratories use an autoanalyzer for measuring total CO2 content. This method measures the amount of CO2 liberated from the sample after adding a strong acid. The CO2 diffuses across a dialysis membrane. A bicarbonate-carbonate buffer solution containing an indicator dye absorbs the CO2. A colorimeter then evaluates the new color, which it converts to a total CO2 measurement. Two potential problems exist with this method: (1) the color reagent may change with time, thus the laboratory must frequently check standardization curves; (2) exposure of the sample to air will allow loss of CO2, as much as 6 mEq/L in an hour. Arterial blood gas reports generally include a bicarbonate value. The blood gas machine measures pH and pCO2 and then calculates a bicarbonate value using the HendersonHasselbalch equation. Generally, a concurrent venous total CO2 content will exceed this value by less than 2 to 4 mEq/L, of which 1 to 2 mEq/L represents the difference between venous and arterial blood; the remaining difference comes from dissolved CO2. The kidneys and lungs maintain daily acidbase balance. Understanding this normal physiology allows us to appreciate abnormalities. This discussion refers to bicarbonate rather than total CO2 content, as we measure total CO2 content as a surrogate for bicarbonate. Bicarbonate and carbonic acid constitute the Continue reading >>

## Co2 Blood Test

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## Acid Base Disorders

Acid base disorders 1. What is normal pH? Normal Values pH = 7.38 - 7.42 [H+] = 40 nM/L for a pH of 7.4 PaCO2 = 40 mm Hg [HCO3] = 24 meq/L 2. What is the definition for acid base disorder? Acid base disorder is considered present when there is abnormality in HCO3 or PaCO2 or pH. 3. What does acidosis or alkalosis refer to? Acidosis and alkalosis refer to in-vivo derangement's and not to any change in pH. 4. What does acidemia or alkalemia refer to? Acidemia (pH < 7.38) and Alkalemia (pH >7.42) refer to derangement's of blood pH. 5. Which organs are key players in maintaining acid base balance? Kidney, Respiratory system and Central nervous system play a key roles in maintaining the acid base status. 6. What are the primary acid base disorders? Primary acid base disorders Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis 7. When would you consider metabolic acidosis? Metabolic acidosis: loss of [HCO3] 0r addition of [H+] 8. When would you consider metabolic alkalosis? Metabolic alkalosis: loss of [H+] or addition of [HCO3] 9. When would you consider respiratory acidosis? Respiratory acidosis: increase in pCO2 10. When would you consider respiratory alkalosis? Respiratory alkalosis : decrease in pCO2 11. What are the required lab values and historical information you need to assess acid base disorders? Recquired lab values/information Arterial blood gases: pH, PaCO2,calculated bicarb Electrolytes: Na, K, Cl, HCO3 BUN, Glucose, Creatinine Clinical history 12. What are anions? List the anions? Anions Chloride Bicarbonate(Total CO2) Proteins Organic acids Phosphates Sulfates 13. What are cations? List the cations? Cations Sodium Potassium Calcium Magnesium 14. What is anion gap? Anion gap (AG) Electrochemical balance: the total anions are the Continue reading >>

## Lab Test: Carbon Dioxide, Co2 (blood) Level

Lab Test: Carbon Dioxide, CO2 (Blood) Level Total carbon dioxide content (TCO2) measurement is the sumof the bicarbonate, carbonic acid, and dissolved carbon dioxide (CO2) inplasma, serum or whole blood. In the peripheral venous blood this is used toassist in evaluating the pH status of the patient and to assist in evaluationof electrolytes. Adults, plasma, at sea level: 21-30 mEq/L (21-30 mmol/L) Adults, capillary (heparin) plasma: 22-28 mEq/L (22-28 mmol/L) Adults, whole blood, arterial: 19-24 mEq/L (190-24 mmol/L) Adults, whole blood, venous: 22-26 mEq/L (22-26 mmol/L) Adults over 60 years, plasma or serum, venous: 23-31 mEq/L (23-31 mmol/L) Adults over 90 years, plasma or serum, venous: 20-29 mEq/L (20-29 mmol/L) Premature, 1 week, capillary (heparin) plasma: 14-27 mEq/L (14-27 mmol/L) Newborn, capillary (heprin) plasma: 13-22 mEq/L (13-22 mmol/L) Infant, capillary (heparin) plasma: 20-28 mEq/L (20-28 mmol/L) Child, capillary (heparin) plasma: 20-28 mEq/L (20-28 mmol/L) Suspected metabolic acidosis - the TCO2 concentration isreduced in both metabolic acidosis and respiratory alkalosis. A reduced blood pH measurement confirms thediagnosis of metabolic acidosis. Suspected metabolic alkalosis - the TCO2 concentration iselevated in both metabolic alkalosis and respiratory acidosis. Suspected respiratory acidosis - a reduced blood pHmeasurement confirms the diagnosis of respiratory acidosis. The serum CO2 test is usually included with other electrolyteassessments. It is important not toconfuse this test with Pco2. This CO2content measures H2CO3, dissolved CO2 and the bicarbonate ion (HC03) thatexists in the serum. Because the amountsof H2CO3 and dissolved CO2 in the blood are so small, CO2 content is anindirect measure of HCO3 anion. Levels of HCO3 are regulated by the Continue reading >>

## Metabolic Acidosis In Emergency Medicine Workup

Laboratory Studies Arterial blood gas analysis A low HCO3 level found on an automated sequential multiple analyzer (SMA) (eg, serum chemistries) is often the first clue to the presence of a metabolic acidosis; however, it cannot be the only consideration in the diagnosis of metabolic acidosis. A low HCO3 level can be caused by metabolic acidosis, a metabolic compensation of a respiratory alkalosis, or a laboratory error. The HCO3 level that is calculated by the arterial blood gas (ABG) machine, which uses the Henderson-Hasselbalch equation, represents a more accurate measure of the plasma HCO3 level than the SMA measurement. It is suggested that the HCO3 level that is determined from the ABG be used in the anion gap calculation instead of the HCO3 level found using the SMA. Measurement of pH and PCO2 by ABG in a patient with a low HCO3 level makes it possible to differentiate a metabolic compensation of a respiratory alkalosis from a primary metabolic acidosis. Measurement of PCO2 also makes it possible to judge the appropriateness of respiratory compensation of a metabolic acidosis, and to detect respiratory acidosis, which is signified by an elevated PCO2 level. Oxygenation does not affect the acid-base status of a patient and generally should not be part of the discussion unless severe hypoxia is leading to ischemia. In that case, measurement of PO2 can identify severe hypoxia as a precipitant of lactic acidosis. ABGs also measure base excess/base deficit (BE/BD), which is the best indicator of the degree of acidosis/alkalosis. BE/BD is measured by gauging the amount of acid or base that is required to titrate the patient's blood sample to a pH of 7.40, given a PCO2 level of 40 mm Hg at 37 degrees Celsius. BE/BD is a more accurate reflection of the body's state, and Continue reading >>

## Base Excess

In physiology, base excess and base deficit refer to an excess or deficit, respectively, in the amount of base present in the blood. The value is usually reported as a concentration in units of mEq/L, with positive numbers indicating an excess of base and negative a deficit. A typical reference range for base excess is −2 to +2 mEq/L.[1] Comparison of the base excess with the reference range assists in determining whether an acid/base disturbance is caused by a respiratory, metabolic, or mixed metabolic/respiratory problem. While carbon dioxide defines the respiratory component of acid-base balance, base excess defines the metabolic component. Accordingly, measurement of base excess is defined, under a standardized pressure of carbon dioxide, by titrating back to a standardized blood pH of 7.40. The predominant base contributing to base excess is bicarbonate. Thus, a deviation of serum bicarbonate from the reference range is ordinarily mirrored by a deviation in base excess. However, base excess is a more comprehensive measurement, encompassing all metabolic contributions. Definition Pathophysiology sample values BMP/ELECTROLYTES: Na+ = 140 Cl− = 100 BUN = 20 / Glu = 150 K+ = 4 CO2 = 22 PCr = 1.0 \ ARTERIAL BLOOD GAS: HCO3− = 24 paCO2 = 40 paO2 = 95 pH = 7.40 ALVEOLAR GAS: pACO2 = 36 pAO2 = 105 A-a g = 10 OTHER: Ca = 9.5 Mg2+ = 2.0 PO4 = 1 CK = 55 BE = −0.36 AG = 16 SERUM OSMOLARITY/RENAL: PMO = 300 PCO = 295 POG = 5 BUN:Cr = 20 URINALYSIS: UNa+ = 80 UCl− = 100 UAG = 5 FENa = 0.95 UK+ = 25 USG = 1.01 UCr = 60 UO = 800 PROTEIN/GI/LIVER FUNCTION TESTS: LDH = 100 TP = 7.6 AST = 25 TBIL = 0.7 ALP = 71 Alb = 4.0 ALT = 40 BC = 0.5 AST/ALT = 0.6 BU = 0.2 AF alb = 3.0 SAAG = 1.0 SOG = 60 CSF: CSF alb = 30 CSF glu = 60 CSF/S alb = 7.5 CSF/S glu = 0.4 Base excess Continue reading >>

## Metabolic Acidosis

Metabolic acidosis is a condition that occurs when the body produces excessive quantities of acid or when the kidneys are not removing enough acid from the body. If unchecked, metabolic acidosis leads to acidemia, i.e., blood pH is low (less than 7.35) due to increased production of hydrogen ions by the body or the inability of the body to form bicarbonate (HCO3−) in the kidney. Its causes are diverse, and its consequences can be serious, including coma and death. Together with respiratory acidosis, it is one of the two general causes of acidemia. Terminology : Acidosis refers to a process that causes a low pH in blood and tissues. Acidemia refers specifically to a low pH in the blood. In most cases, acidosis occurs first for reasons explained below. Free hydrogen ions then diffuse into the blood, lowering the pH. Arterial blood gas analysis detects acidemia (pH lower than 7.35). When acidemia is present, acidosis is presumed. Signs and symptoms Symptoms are not specific, and diagnosis can be difficult unless the patient presents with clear indications for arterial blood gas sampling. Symptoms may include chest pain, palpitations, headache, altered mental status such as severe anxiety due to hypoxia, decreased visual acuity, nausea, vomiting, abdominal pain, altered appetite and weight gain, muscle weakness, bone pain, and joint pain. Those in metabolic acidosis may exhibit deep, rapid breathing called Kussmaul respirations which is classically associated with diabetic ketoacidosis. Rapid deep breaths increase the amount of carbon dioxide exhaled, thus lowering the serum carbon dioxide levels, resulting in some degree of compensation. Overcompensation via respiratory alkalosis to form an alkalemia does not occur. Extreme acidemia leads to neurological and cardia Continue reading >>

## Abg (arterial Blood Gas)

These measurements are often used to evaluate oxygenation of the tissues and pulmonary function. pH is a measurement of the acidity of the blood, reflecting the number of hydrogen ions present. Lower numbers mean more acidity; higher numbers mean more alkalinity. pH is elevated (more alkaline, higher pH) with: pH is decreased (more acid, lower pH) with: More severe degrees of congestive heart failure pCO2 (partial pressure of carbon dioxide) reflects the the amount of carbon dioxide gas dissolved in the blood. Indirectly, the pCO2 reflects the exchange of this gas through the lungs to the outside air. Two factors each have a significant impact on the pCO2. The first is how rapidly and deeply the individual is breathing: Someone who is hyperventilating will "blow off" more CO2, leading to lower pCO2 levels Someone who is holding their breath will retain CO2, leading to increased pCO2 levels The second is the lungs capacity for freely exchanging CO2 across the alveolar membrane: With pulmonary edema, there is an extra layer of fluid in the alveoli that interferes with the lungs' ability to get rid of CO2. This leads to a rise in pCO2. With an acute asthmatic attack, even though the alveoli are functioning normally, there may be enough upper and middle airway obstruction to block alveolar ventilation, leading to CO2 retention. Pulmonary embolism (This leads to hyperventilation, a more important consideration than the embolized/infarcted areas of the lung that do not function properly. In cases of massive pulmonary embolism, the infarcted or non-functioning areas of the lung assume greater significance and the pCO2 may increase.) PO2 (partial pressure of oxygen) reflects the amount of oxygen gas dissolved in the blood. It primarily measures the effectiveness of the lungs i Continue reading >>

## Metabolic Acidosis - Endocrine And Metabolic Disorders - Merck Manuals Professional Edition

(Video) Overview of Acid-Base Maps and Compensatory Mechanisms By James L. Lewis, III, MD, Attending Physician, Brookwood Baptist Health and Saint Vincent’s Ascension Health, Birmingham Metabolic acidosis is primary reduction in bicarbonate (HCO3−), typically with compensatory reduction in carbon dioxide partial pressure (Pco2); pH may be markedly low or slightly subnormal. Metabolic acidoses are categorized as high or normal anion gap based on the presence or absence of unmeasured anions in serum. Causes include accumulation of ketones and lactic acid, renal failure, and drug or toxin ingestion (high anion gap) and GI or renal HCO3− loss (normal anion gap). Symptoms and signs in severe cases include nausea and vomiting, lethargy, and hyperpnea. Diagnosis is clinical and with ABG and serum electrolyte measurement. The cause is treated; IV sodium bicarbonate may be indicated when pH is very low. Metabolic acidosis is acid accumulation due to Increased acid production or acid ingestion Acidemia (arterial pH < 7.35) results when acid load overwhelms respiratory compensation. Causes are classified by their effect on the anion gap (see The Anion Gap and see Table: Causes of Metabolic Acidosis ). Lactic acidosis (due to physiologic processes) Lactic acidosis (due to exogenous toxins) Toluene (initially high gap; subsequent excretion of metabolites normalizes gap) HIV nucleoside reverse transcriptase inhibitors Biguanides (rare except with acute kidney injury) Normal anion gap (hyperchloremic acidosis) Renal tubular acidosis, types 1, 2, and 4 The most common causes of a high anion gap metabolic acidosis are Ketoacidosis is a common complication of type 1 diabetes mellitus (see diabetic ketoacidosis ), but it also occurs with chronic alcoholism (see alcoholic ketoacidos Continue reading >>

## Acid Base Disorders

Arterial blood gas analysis is used to determine the adequacy of oxygenation and ventilation, assess respiratory function and determine the acid–base balance. These data provide information regarding potential primary and compensatory processes that affect the body’s acid–base buffering system. Interpret the ABGs in a stepwise manner: Determine the adequacy of oxygenation (PaO2) Normal range: 80–100 mmHg (10.6–13.3 kPa) Determine pH status Normal pH range: 7.35–7.45 (H+ 35–45 nmol/L) pH <7.35: Acidosis is an abnormal process that increases the serum hydrogen ion concentration, lowers the pH and results in acidaemia. pH >7.45: Alkalosis is an abnormal process that decreases the hydrogen ion concentration and results in alkalaemia. Determine the respiratory component (PaCO2) Primary respiratory acidosis (hypoventilation) if pH <7.35 and HCO3– normal. Normal range: PaCO2 35–45 mmHg (4.7–6.0 kPa) PaCO2 >45 mmHg (> 6.0 kPa): Respiratory compensation for metabolic alkalosis if pH >7.45 and HCO3– (increased). PaCO2 <35 mmHg (4.7 kPa): Primary respiratory alkalosis (hyperventilation) if pH >7.45 and HCO3– normal. Respiratory compensation for metabolic acidosis if pH <7.35 and HCO3– (decreased). Determine the metabolic component (HCO3–) Normal HCO3– range 22–26 mmol/L HCO3 <22 mmol/L: Primary metabolic acidosis if pH <7.35. Renal compensation for respiratory alkalosis if pH >7.45. HCO3 >26 mmol/L: Primary metabolic alkalosis if pH >7.45. Renal compensation for respiratory acidosis if pH <7.35. Additional definitions Osmolar Gap Use: Screening test for detecting abnormal low MW solutes (e.g. ethanol, methanol & ethylene glycol [Reference]) An elevated osmolar gap (>10) provides indirect evidence for the presence of an abnormal solute which is prese Continue reading >>

## 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 solution. It is inversely proportional to the concentration of hydrogen ions. When a solution becomes more acidic the concentration of hydrogen ions increases and the pH falls. Normally the bodys pH is closely controlled at between 7.35 7.45. This is achieved through buffering and excretion of acids. Buffers include plasma proteins and bicarbonate (extracellular) and proteins, phosphate and haemoglobin (intracellularly). Hydrogen ions are excreted via the kidney and carbon dioxide is excreted via the lungs. Changes in ventilation are the primary way in which the concentration of H+ ions is regul Continue reading >>

## Blood Gases | Medical Tests | Ucsf Benioff Children's Hospital

Usually, blood is taken from an artery. The blood may be collected from the radial artery in the wrist, the femoral artery in the groin, or the brachial artery in the arm. The health care provider may test circulation to the hand before taking a sample of blood from the wrist area. The health care provider will insert a small needle through the skin into the artery. You can choose to have numbing medicine (anesthesia) applied to the site before the test begins. In some cases, blood from a vein may be used. After the blood is taken, pressure is applied to the site for a few minutes to stop the bleeding. The health care provider will watch the site for signs of bleeding or circulation problems. The sample must be quickly sent to a laboratory for analysis to ensure accurate results. There is no special preparation. If you are on oxygen therapy, the oxygen concentration must remain constant for 20 minutes before the test. You may feel brief cramping or throbbing at the puncture site. The test is used to evaluate respiratory diseases and conditions that affect the lungs. It helps determine the effectiveness of oxygen therapy. The test also provides information about the body's acid/base balance, which can reveal important clues about lung and kidney function and the body's general metabolic state. Partial pressure of oxygen (PaO2) - 75 - 100 mmHg Partial pressure of carbon dioxide (PaCO2) - 38 - 42 mmHg Note: mEq/L = milliequivalents per liter; mmHg = millimeters of mercury At altitudes of 3,000 feet and above, the oxygen values are lower. Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results. The examples above show the common measurements for results for these tests. Some laboratories Continue reading >>