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Metabolic And Respiratory Acidosis And Alkalosis Made Easy

Metabolic Acidosis Nclex Review Notes

Metabolic Acidosis Nclex Review Notes

Are you studying metabolic acidosis and need to know a mnemonic on how to remember the causes? This article will give you a clever mnemonic and simplify the signs and symptoms and nursing interventions on how to remember metabolic acidosis for nursing lecture exams and NCLEX. In addition, you will learn how to differentiate metabolic acidosis from metabolic alkalosis. Don’t forget to take the metabolic acidosis and metabolic alkalosis quiz. This article will cover: Metabolic acidosis simplified Lab values expected with metabolic acidosis Causes of metabolic acidosis Signs and symptoms of metabolic acidosis Nursing interventions for metabolic acidosis Lecture on Metabolic Acidosis Metabolic Acidosis Metabolic Acidosis in Simple Terms: a metabolic problem due to the buildup of acid in the body fluids which affects the bicarbonate (HCO3 levels) either from: increased acid production (ex: DKA where ketones (acids) increase in the body which decreases bicarbonate) decreased acid excretion (ex: renal failure where there is high amount of waste left in the body which causes the acids to increase and bicarb can’t control imbalance) loss of too much bicarb (diarrhea) When this acidic phenomena is taking place in the body other systems will try to compensate to increase the bicarb back to normal. One system that tries to compensate is the respiratory system. In order to compensate, the respiratory system will cause the body to hyperventilate by increasing breathing through Kussmaul’s respirations. Kussmaul respirations are deep, rapid breathes. The body hopes this will help expel CO2 (an acid) which will “hopefully” increase the pH back to normal. Lab values expected in Metabolic Acidosis: HCO3: decreased <22 Blood pH: decreased <7.35 CO2: <35 or normal (may be normal b Continue reading >>

Acid-base Imbalances Made Easy With Picmonic

Acid-base Imbalances Made Easy With Picmonic

We value your time, which is why we made lab values easier than ever to understand with Picmonics pathway for acid-base imbalances! Guess what? Picmonic has a super-easy nursing acid base imbalances visual study guide that will help you soak in all the acid base information you need. We worked hard to make sure our nursing acid base imbalances visual study aid was simple to understand and fun. See for yourself! Then, read this article to learn the basics of how to interpret acid base imbalances in 3 steps. You can even test your knowledge afterward with this FREE QUIZ ! Watch Kendall teach basics of how to interpret Acid Base Imbalances. Read and learn the basics of how to interpret acid base imbalances in these 3 steps* Helpful Hint: Look at the numbers .35 and .45 in the pH levels. Looks pretty similar to the lab values of 35-45 in pCO2, right? Youve already got two lab values memorized right there! Once youve got those lab values memorized, its easy to recognize what is abnormal. Now, if a patients pH falls below 7.35, they are in a state of acidosis. If the patients pH is above 7.45, the patient would be in a state of alkalosis. 2. Figure out what kind of acidosis or alkalosis our patient is in: respiratory or metabolic? Here, we first look at the partial pressure of carbon dioxide (pCO2) in the blood. CO2 is acidic in the body and is regulated through respiration. Think breathing. We blow off CO2 with every breath. A good little trick here is to look at the pH and see what direction its going (up or down), and then look at the CO2 and see what direction thats going. If they are going in the opposite directions, then we have ourselves a patient with a respiratory disorder. Thats where you take part one (acidosis or alkalosis) and match it here with respiratory ( re Continue reading >>

My Life As A Resident

My Life As A Resident

Hello Mr Ryan, Mr Trump, and whomever else this may concern. (And, if you are an American of any stripe, then as it turnsout it also concerns you.) I am a family physician. I interact with your constituentsall day, every day. I hear about their problems, their struggles, and often thelimitations they face regarding healthcare. I try to help them when I can. Thatsmy job in a nutshell. So let me tell you about one of your constituents who alsohappened to become my patient. Lets call him Bob. Bob is a middle aged man who worked full time at an entrylevel manual labor type job. The kind of job you spend 40 hrs/wk working butstill hover around the poverty line. The kind of job with no benefits. He didntgo to the doctor and had no health insurance but as far as he knew he also didnthave any health problems. Until one day he started feeling unwell. Thispersisted for a few days and he refused to let his wife take him to the doctor.He was worried about the cost and figured hed get better in a few days anyway.Only he didnt. He got worse and his wife called an ambulance. Actually, lets skip ahead to the final diagnosis. Bob hastype 2 diabetes. Newly diagnosed. Easy. Boring. Right? Except Bob clearly haddiabetes for some time, unbeknownst to him. When he arrived in the EmergencyDepartment he was in septic shock. He was riddled with large abscesses in hisinternal organs and soft tissues. Both his lower limbs were necrotic. He hadosteomyelitis in multiple locations. Whats really amazing though is that helived. He had both his legs amputated below the knees and was hospitalized forweeks. All told he had 8 or 9 surgeries. He required weeks of additional IVantibiotics. But he ultimately got better. And his diabetes is well controllednow on pretty minimal medication. During his hospital Continue reading >>

Metabolic Alkalosis

Metabolic Alkalosis

Metabolic alkalosis is a metabolic condition in which the pH of tissue is elevated beyond the normal range (7.35–7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations. Terminology[edit] Alkalosis refers to a process by which the pH is increased. Alkalemia refers to a pH which is higher than normal, specifically in the blood. Causes[edit] The causes of metabolic alkalosis can be divided into two categories, depending upon urine chloride levels.[1] Chloride-responsive (Urine chloride < 10 mEq/L)[edit] Loss of hydrogen ions - Most often occurs via two mechanisms, either vomiting or via the kidney. Vomiting results in the loss of hydrochloric acid (hydrogen and chloride ions) with the stomach contents. In the hospital setting this can commonly occur from nasogastric suction tubes. Severe vomiting also causes loss of potassium (hypokalaemia) and sodium (hyponatremia). The kidneys compensate for these losses by retaining sodium in the collecting ducts at the expense of hydrogen ions (sparing sodium/potassium pumps to prevent further loss of potassium), leading to metabolic alkalosis.[2] Congenital chloride diarrhea - rare for being a diarrhea that causes alkalosis instead of acidosis.[3] Contraction alkalosis - This results from a loss of water in the extracellular space, such as from dehydration. Decreased extracellular volume triggers the renin-angiotensin-aldosterone system, and aldosterone subsequently stimulates reabsorption of sodium (and thus water) within the nephron of the kidney. However, a second action of aldosterone is to stimulate renal excretion of hydrogen ions (while retaining bicarbonate), and it is this loss of hydrogen ions that raises Continue reading >>

Respiratory Therapy Cave: Abg Interpretation Made Easy: Acid Base Balance

Respiratory Therapy Cave: Abg Interpretation Made Easy: Acid Base Balance

ABG interpretation made easy: acid base balance So you made it this far. Now you must interpret the results. Looking for some tips to ease your anxiety over an upcoming test that covers arterial blood gas (ABG) interpretation? Well, look no further. The goal of this blog is to make your life easy. ABG interpretation is as easy as remembering four basic questions, and then answering them in sequence. Of course then you'll have to practice, practice, practice. By the time your test comes up you should be an ABG interpretation expert. To make things simple, I will only refer to the three basic ABG values in this post To interpret these results, all you have to do is memorize these four basic questions, and then answer them in order. If all the values fall within the normal parameters, then you have a normal ABG and you can stop here: The ABG is normal. If any one of the values is out of the normal range, then you must move on to the next question. B. Is the pH Acidotic or Alkalotic?To determine this you look only at the pH. Alkalotic: If the pH is greater than 7.45 the patient is Alkalotic. Acidotic: If the pH is below 7.35 the patient is acidotic. C. Is the cause respiratory or metabolic?To determine this you look at pH and compare it with HcO3 and CO2. If the pH is acidotic, you look for whichever value (HcO3 or CO2) is also acidotic. If the pH is alkalotic, you look for whichever value (HcO3 or CO2) is also alkalotic. In this sense, you match the pH with HcO3 and CO2. If the pH matches with the CO2, you have respiratory. If the pH matches with the HcO3, you have metabolic. Metabolic Alkalosis: If the pH is alkatotic and the HcO3 alkalotic. Respiratory Alkalosis: If the pH is alkalotic and the CO2 is alkalotic Metabolic Acidosis: If the pH is acidotic and the HcO3 acido Continue reading >>

Acid Base Disorders

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 >>

Acid-base Imbalance - An Overview | Sciencedirect Topics

Acid-base Imbalance - An Overview | Sciencedirect Topics

Ahmad Bilal Faridi, Lawrence S. Weisberg, in Critical Care Medicine (Third Edition) , 2008 Acid-base disorders are revealed most commonly through the basic metabolic chemistry panel, when the plasma bicarbonate concentration is noted to be outside the normal range. If the bicarbonate is low and if the anion gap is clearly elevated on that sample, a diagnosis of high anion gap metabolic acidosis can be made with some confidence, keeping in mind the pitfalls in the interpretation of the anion gap mentioned earlier.7 If the bicarbonate is low and the anion gap normal, two possibilities exist: either a hyperchloremic metabolic acidosis or a respiratory alkalosis with metabolic compensation. These two entities can be distinguished by examination of the blood pH and blood gases, a low pH being diagnostic of the former. If the bicarbonate concentration is high, again there are two alternative diagnoses, requiring blood pH measurement for their differentiation: either a metabolic alkalosis or metabolic compensation for a respiratory acidosis. Once the primary disturbance has been identified, the astute clinician, recognizing the possibility of a mixed disturbance, is obligated to ask, Is that all there is? This question can be answered only by an understanding of the rules of normal compensation for simple acid-base disorders (see Table 58-1).2 Knowing at least the expected direction of compensation will allow the clinician to diagnose the most obvious mixed disturbances. For example, if the pH is low, the bicarbonate is low, and the pco2 is above 40 torr, there is clearly a mixed metabolic and respiratory acidosis. Similarly, if the pH is high, the bicarbonate is high, and the pco2 is below 40 torr, the diagnosis is a mixed respiratory and metabolic alkalosis. More subtle mix Continue reading >>

The Quick And Dirty Guide To Acid Base Balance | Medictests.com

The Quick And Dirty Guide To Acid Base Balance | Medictests.com

Your patient has a ph of 6.9 Is he acidic or alkalotic? Your patient has a ph of 7.4 Is he acidic or alkalotic? Your patient has a ph of 7.7 Is he acidic or alkalotic? Your patient has a ph of 7.25 Is he acidic or alkalotic? Your patient has a ph of 7.43 Is he acidic or alkalotic? Your patient has a ph of 8.0 Is he acidic or alkalotic? 1. acidic 2. normal 3. Alkaline 4. Acidic 5. Normal 6. Alkaline You take in oxygen by inhaling, your body turns oxygen into carbon dioxide, you exhale and remove the carbon dioxide from your body. Carbon dioxide is "respiratory acid."When you're not breathing adequately, you are not getting rid of this "respiratory acid" and it builds up in the tissues. The extra CO2 molecules combine with water in your body to form carbonic acid and makes your pH go up. This is bad. We can measure the amount of respiratory acid in the arterial blood using blood gases. They measure the amount of each gas in your blood. We measure the pH, the amount of carbon dioxide (PaCO2) and the amount of oxygen in the blood (PaO2). PaCO2 is the partial pressure of carbon dioxide. We can measure it to see how much respiratory acid (CO2) there is in the blood. We use arterial blood gas tests to check it. How much respiratory acid (CO2) should there be? The normal value is 35-45 mmHg (mmHg just means millimeters of mercury, its a measurement of pressure.) The (a) in PaCO2 just stands for arterial. If you measured venous blood gasses, the levels are different and PvCO2 is used. If CO2 is HIGH, it means there is a buildup of respiratory acids because he's not breathing enough CO2 away. If your pH is acidic, and your CO2 is HIGH, its considered respiratory acidosis. If CO2 is LOW, it means there are not enough respiratory acids because he's probably hyperventilating too mu Continue reading >>

Easy Way To Interpret Abg Values

Easy Way To Interpret Abg Values

ABG values can be very intimidating! Its hard to remember all the different normal values, what they mean, and which direction theyre supposed to be going. With so much information, its super easy to get mixed up and make a stupid mistake on an exam, even when you really DO know how to interpret ABGs. In this article, Im focusing more on the How to, rather than understanding whats going on with the A&P, which Ive already done in previous articles. If you want to understand whythese steps work (which you should do anyway to become a great nurse!),take some time to review my articles on Respiratory Imbalances and Metabolic Imbalances . Heres my 7-step method to interpreting ABGs. We have three puzzle pieces to put together: B)uncompensated, partially compensated, or compensated 1) Across the top of your page, write down the normal values for the three most important ABG lab results: pH (7.35-7.45), PaCO2 (35-45), and HCO3 (22-26). 2) Underneath pH, draw arrows to remind you which direction is acidic (down), and which direction is basic (down). 3) UnderneathPaCO2, and HCO3, draw arrows to remind you what abnormally high and low values would do to the bodys pH. When youre done, your page should look something like this: So far, we havent even looked at the question yet, were just trying to prevent any stupid mistakes!! 4) Now you can finally look at the patients ABG values. Check the pH and decide if the value is normal, high, or low. 4a) If the pH is normal, check PaCO2, and HCO3. If they are both normal, then you patient is fine and you can stop here. But if one or both of these values is abnormal, then continue to step 5. 5) Identify if the patient has alkalosis or acidosis. 5a) If the pH is abnormal, then compare it to the arrows you wrote at the top of your paper and Continue reading >>

Blood Gas Analysis For Bedside Diagnosis

Blood Gas Analysis For Bedside Diagnosis

Department of Oral and Maxillofacial Surgery, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India Address for correspondence: Dr. Virendra Singh, Department of Oral and Maxillofacial Surgery, Post Graduate Institute of Dental Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana - 124 001, India. E-mail: [email protected] Author information Copyright and License information Disclaimer Copyright : National Journal of Maxillofacial Surgery This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Arterial blood gas is an important routine investigation to monitor the acid-base balance of patients, effectiveness of gas exchange, and the state of their voluntary respiratory control. Majority of the oral and maxillofacial surgeons find it difficult to interpret and clinically correlate the arterial blood gas report in their everyday practice. This has led to underutilization of this simple tool. The present article aims to simplify arterial blood gas analysis for a rapid and easy bedside interpretation. In context of oral and maxillofacial surgery, arterial blood gas analysis plays a vital role in the monitoring of postoperative patients, patients receiving oxygen therapy, those on intensive support, or with maxillofacial trauma with significant blood loss, sepsis, and comorbid conditions like diabetes, kidney disorders, Cardiovascular system (CVS) conditions, and so on. The value of this analysis is limited by the understanding of the basic physiology and ability of the surgeon Continue reading >>

9.3 Bedside Rules For Assessment Of Compensation

9.3 Bedside Rules For Assessment Of Compensation

The method of assessing acid-base disorders discussed here uses a set of six rules which are used primarily to assess the magnitude of the patients compensatory response. These rules are now widely known and are soundly based experimentally. These rules are used at Step 4 of the method of Systematic Acid-Base Diagnosis outlined in Section 9.2.- (You should read section 9.1 & 9.2 before this section.) These rules are called 'bedside rules' because that can be used at the patient's bedside to assist in the assessment of the acid-base results. The rules should preferably be committed to memory - with practice this is not difficult. A full assessment of blood-gas results must be based on a clinical knowledge of the individual patient from whom they were obtained and an understanding of the pathophysiology of the clinical conditions underlying the acid-base disorder. Do not interpret the blood-gas results as an intellectual exercise in itself. It is one part of the overall process of assessing and managing the patient. A set of blood-gas and electrolyte results should NOT be interpreted without these initial clinical details. They cannot be understood fully without knowledge of the condition being diagnosed. Diagnosing a metabolic acidosis, for example, is by itself, often of little clinical use. What is really required is a more specific diagnosis of the cause of the metabolic acidosis (eg diabetic ketoacidosis, acute renal failure, lactic acidosis) and to initiate appropriate management. The acid-base analysis must be interpreted and managed in the context of the overall clinical picture. The snapshot problem: Are the results 'current'? Remember also that a set of blood gas results provides a snapshot at a particular point in time and the situation may have changed since Continue reading >>

Easy Way To Remember Abg's?

Easy Way To Remember Abg's?

Is there a shorcut to remember Metabolic alkalosis & acidosis and Repirarory alkalosis & acidosis? Wish I had asked last year when we were doing ABGs. I had the hardest time trying to remember. Thanks for sharing!! This is so ccol! I never thought of it like that! i was so mixed up. But with this, as long as i know the norm i should be fine. Thank you so much. · pH is high, PCO2 is down (Alkalosis). · pH is high, HCO3 is high (Alkalosis). · pH is low, HCO3 is low (Acidosis). We just went over this today in lecture, and my instructor made it SOOOOO simple. Draw a grid like a tic-tac-toe board. Label the columns across the top Acid, Normal, and Alkalotic. Down the left side label the rows pH, PaCO2, and HCO3. Fill in the grid....first row is <7.35, 7.35-7.45, and >7.45. Those are values for pH. Then fill in the second row with >45, 35-45, and <35. Those values are for PaCO2. The last row is <22, 22-26, and >26. Those represent HCO3. Okay, now look at your ABG lab report. Say the pH was 7.49, the PaCO2 was 48, and the bicarb was 37. Tie in those values in your grid. You should have 7.49 under alkalotic, 48 under acid, and 37 under alkalotic. Look at the pH first to see if it's acidic, normal, or alkalotic. The next value in the same column will tell you if it's respiratory or metabolic (PaCO2 reflects respiratory, and HCO3 reflects metabolic). It's as simple as which column has two values in it Then you can get into whether or not it's compensated I've attached a "tic-tac-toe" type handout I made for my students when I teach ABG's. Hope this helps ABG Tic Tac Toe Part 2.doc (94.0 KB, 24151 views) This is the formula I use and it hasn't failed me yet! I thought I would hate ABG's ended up loving them when I learned to tic-tac-toe!:roll I have an easy way tha Continue reading >>

Why Measure Blood Gases? A Three-part Introduction For The Novice. Part 2.

Why Measure Blood Gases? A Three-part Introduction For The Novice. Part 2.

Why measure blood gases? A three-part introduction for the novice. Part 2. Why measure blood gases? A three-part introduction for the novice. Part 2. Arterial blood gases (ABG), a clinical test that involves measurement of the pH of arterial blood and the amount of oxygen and carbon dioxide dissolved in arterial blood, is routinely used in the diagnosis and monitoring of predominantly critically/acutely ill patients being cared for in hospital emergency rooms and intensive care units. The test allows assessment of two related physiological functions: pulmonary gas exchange and acid-base homeostasis. This is the second of three articles intended to explain the clinical value of ABG to those with little or no experience of the test. The first article focused on the physiological aspects that underpin an understanding of patient ABG results. The concepts of pH, acid, base and buffer were explained, and the parameters generated during ABG were defined and related to pulmonary gas exchange and acid-base homeostasis. In this second article attention turns to the clinical significance of abnormal ABG results, specifically abnormality in three ABG parameters (pH, pCO2(a) and bicarbonate) that determine patient acid-base status. A major focus of the article will be an explanation of the four classes of acid-base disturbance: respiratory acidosis, metabolic acidosis, respiratory alkalosis and metabolic alkalosis. The causes and physiological consequence of each of these disturbances will be discussed. Reference (normal) range for the blood gas parameters under discussion here: pH 7.35-7.45 pCO2(a) 4.7-6.0 kPa (35-45 mmHg) Bicarbonate 22-28 mmol/L DISTURBANCE OF ACID-BASE HOMEOSTASIS - GENERAL CONSIDERATION Disturbance of acid-base homeostasis is characterized by abnormality in o Continue reading >>

Metabolic/respiratory Acidosis And Alkalosis | Pt Final Exam

Metabolic/respiratory Acidosis And Alkalosis | Pt Final Exam

Metabolic/Respiratory Acidosis and Alkalosis Posted by [email protected] | April 2, 2014 | metabolic acidosis , NPTE , respiratory acidosis , study material It has been awhile since I postedIve been extremely busy putting together new content for NPTE preparation and guiding my current course of the Mastermind Study Group through their material. I have always had a love for teaching, and its so awesome that I have this outlet to really capitalize on those skills. One of my most recent projects is a quick how-to video on how to distinguish between Acidosis and Alkalosis with a standard arterial blood gas analysis. This can be tedious for some students to really analyze, and I hope that I can make this portion of the exam a little bit easier. Im attaching the file with the table and brief instructions. Ive also created a brief Youtube video to help explain things further. Please check them out and let me know what you think. As Ive said before, I thrive on honest feedback, and I would appreciate yours. If anything I have on this website is useful to you, please consider using the social media sharing buttons to let your friends and classmates know about this resource. This site has been growing astronomically in the last 6 months, and I want to help as many people as I can as they prepare for the July 2014 NPTE. If theres anything that you would like to me to explain or create an instructional video about, please contact me ! Continue reading >>

8-step Guide To Abg Analysis: Tic-tac-toe Method

8-step Guide To Abg Analysis: Tic-tac-toe Method

An arterial blood gas (ABG) is a blood test that measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood . Blood for an ABG test is taken from an artery whereas most other blood tests are done on a sample of blood taken from a vein. This test is done to monitor several conditions that can cause serious health complications especially to critically ill individuals. Every day, a lot of nursing and medical students assigned in acute areas encounter ABG results, which they may not necessarily be able to interpret with its knotty aspect. They struggle over the interpretation of its measurements, but they are not especially complicated nor difficult if you understand the basic physiology and have a step by step process to analyze and interpret them. There may be various tips and strategies to guide you, from mnemonics, to charts, to lectures, to practice, but this article will tell you how to interpret ABGs in the easiest possible way. And once you have finished reading this, youll be doing actual ABG analysis in the NCLEX with fun and excitement! Here are the steps: Know the normal and abnormal ABG values when you review the lab reports. Theyre fairly easy to remember: for pH, the normal value is 7.35 to 7.45; 35-45 for paCO2; and 22-26 for HCO3. Remember also this diagram and note that paCO2 is intentionallyinverted for the purpose of this method. 2. Determine if pH is under acidosis or alkalosis Next thing to do is to determine the acidity or alkalinity of the blood through the value of pH. The pH level of a healthy human should be between 7.35 to 7.45. The human body is constantly striving to keep pH in balance. 3. Determine if acid-base is respiratory or metabolic Next thing you need to determine is whether the acid base is Respiratory or Meta Continue reading >>

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