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Mixed Respiratory And Metabolic Acidosis Abg

Uncompensated, Partially Compensated, Or Combined Abg Problems

Uncompensated, Partially Compensated, Or Combined Abg Problems

Arterial Blood Gas (ABG) analysis requires in-depth expertise. If the results are not understood right, or are wrongly interpreted, it can result in wrong diagnosis and end up in an inappropriate management of the patient. ABG analysis is carried out when the patient is dealing with the following conditions: • Breathing problems • Lung diseases (asthma, cystic fibrosis, COPD) • Heart failure • Kidney failure ABG reports help in answering the following questions: 1. Is there acidosis or alkalosis? 2. If acidosis is present, whether it is in an uncompensated state, partially compensated state, or in fully compensated state? 3. Whether acidosis is respiratory or metabolic? ABG reports provide the following descriptions: PaCO2 (partial pressure of dissolved CO2 in the blood) and PaO2 (partial pressure of dissolved O2 in the blood) describe the efficiency of exchange of gas in the alveolar level into the blood. Any change in these levels causes changes in the pH. HCO3 (bicarbonate in the blood) maintains the pH of the blood within normal range by compensatory mechanisms, which is either by retaining or increasing HCO3 excretion by the kidney. When PaCO2 increases, HCO3 decreases to compensate the pH. The following table summarizes the changes: ABG can be interpreted using the following analysis points: Finding acidosis or alkalosis: • If pH is more it is acidosis, if pH is less it is alkalosis. Finding compensated, partially compensated, or uncompensated ABG problems: • When PaCO2 is high, but pH is normal instead of being acidic, and if HCO3 levels are also increased, then it means that the compensatory mechanism has retained more HCO3 to maintain the pH. • When PaCO2 and HCO3 values are high but pH is acidic, then it indicates partial compensation. It means t Continue reading >>

Acid-base Disorders - Endocrine And Metabolic Disorders - Merck Manuals Professional Edition

Acid-base Disorders - 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 Vincents Ascension Health, Birmingham Acid-base disorders are pathologic changes in carbon dioxide partial pressure (Pco2) or serum bicarbonate (HCO3) that typically produce abnormal arterial pH values. Acidosis refers to physiologic processes that cause acid accumulation or alkali loss. Alkalosis refers to physiologic processes that cause alkali accumulation or acid loss. Actual changes in pH depend on the degree of physiologic compensation and whether multiple processes are present. Primary acid-base disturbances are defined as metabolic or respiratory based on clinical context and whether the primary change in pH is due to an alteration in serum HCO3 or in Pco2. Metabolic acidosis is serum HCO3< 24 mEq/L. Causes are Metabolic alkalosis is serum HCO3> 24 mEq/L. Causes are Respiratory acidosis is Pco2> 40 mm Hg (hypercapnia). Cause is Decrease in minute ventilation (hypoventilation) Respiratory alkalosis is Pco2< 40 mm Hg (hypocapnia). Cause is Increase in minute ventilation (hyperventilation) Compensatory mechanisms begin to correct the pH (see Table: Primary Changes and Compensations in Simple Acid-Base Disorders ) whenever an acid-base disorder is present. Compensation cannot return pH completely to normal and never overshoots. A simple acid-base disorder is a single acid-base disturbance with its accompanying compensatory response. Mixed acid-base disorders comprise 2 primary disturbances. Compensatory mechanisms for acid-base disturbances cannot return pH completely to normal and never overshoot. Primary Changes and Compensations in Simple Acid-Base Disorders 1.2 mm Hg decrease in Pco2 for every 1 mmol/L decrease in HC Continue reading >>

Arterial Blood Gases - Indications And Interpretation

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 patient - it is painful. If there is time then local anaesthesia can be used. ABG syringes usually come prepacked and are heparinised. Some contain a vacuum and thus the plunger does not always need to be pulled. (Check with your department as to which they use). The wrist is extended - a pillow under the hand may improve comfort. Palpate the artery and hold fingers firmly over the pulsation. Then introduce the needle at a 45 angle slowly with the bevel facing upwards, aiming for the point of maximum pulsation. Once you hit the artery, try to obtain at least a 1 ml sample. Once you have taken your s Continue reading >>

Acid-base Tutorial - Interpretation

Acid-base Tutorial - Interpretation

by "Grog" (Alan W. Grogono), Professor Emeritus, Tulane University Department of Anesthesiology What is a moderate interpretation of the text? Halfway between what it really means and what you would like it to mean? - Antonin Scalia. This page describes the interpretation of the acid-base component of blood gas results. Designing the interactive acid-base diagram necessitated the development of a logical approach. This page converts the logic back into a human process. Constraints of Not Knowing Patient Details: In a Perfect World complete information about a patient is available before acid-base values are analyzed. What follows is a logical framework for looking at acid-base values with no patient. Reports may say that the results are "typical of" or "characteristic of" a single clinical problem. However, identical results can also be obtained from a complex combination of clinical problems. Step 1: Is the pH normal, acid, or alkaline critical because it governs all the subsequent thinking. In acute problems the change is usually acidic - a low pH - e.g., 7.2 or 7.1. This is because failure, either respiratory or metabolic, results in the accumulation of acids. The following paragraphs assume the result is acid. However, also look at the Table of Details which follows the paragraphs below. Step 2: If the respiratory change is also acid (raised PCO2), then the cause is respiratory, unless the metabolic component is also acidic in which case both are contributing to the acidic pH. If the PCO2 is not like the pH, i.e., the PCO2 is low (alkaline), then the primary problem must be metabolic and the low PCO2 is compensating for the metabolic acidosis. Standard Base Excess - the Metabolic Component: Step 3: If the Standard Base Excess (SBE) is acidic (a negative SBE), then Continue reading >>

A Primer On Arterial Blood Gas Analysis By Andrew M. Luks, Md(cont.)

A Primer On Arterial Blood Gas Analysis By Andrew M. Luks, Md(cont.)

Step 4: Identify the compensatory process (if one is present) In general, the primary process is followed by a compensatory process, as the body attempts to bring the pH back towards the normal range. If the patient has a primary respiratory acidosis (high PCO2 ) leading to acidemia: the compensatory process is a metabolic alkalosis (rise in the serum bicarbonate). If the patient has a primary respiratory alkalosis (low PCO2 ) leading to alkalemia: the compensatory process is a metabolic acidosis (decrease in the serum bicarbonate) If the patient has a primary metabolic acidosis (low bicarbonate) leading acidemia, the compensatory process is a respiratory alkalosis (low PCO2 ). If the patient has a primary metabolic alkalosis (high bicarbonate) leading to alkalemia, the compensatory process is a respiratory acidosis (high PCO2 ) The compensatory processes are summarized in Figure 2. (opens in a new window) Important Points Regarding Compensatory Processes There are several important points to be aware of regarding these compensatory processes: The body never overcompensates for the primary process. For example, if the patient develops acidemia due to a respiratory acidosis and then subsequently develops a compensatory metabolic alkalosis (a good example of this is the COPD patient with chronic carbon dioxide retention), the pH will move back towards the normal value of 7.4 but will not go to the alkalemic side of normal This might result in a pH of 7.36, for example but should not result in a pH such as 7.44 or another value on the alkalemic side of normal. If the pH appears to "over-compensate" then an additional process is at work and you will have to try and identify it. This can happen with mixed acid-base disorders, which are described further below. The pace of co Continue reading >>

Acid-base Disturbance: A Comprehensive Flowchart-based Diagnostic Approach

Acid-base Disturbance: A Comprehensive Flowchart-based Diagnostic Approach

Received October 10, 2014; Accepted Date: February 28, 2015; Published Date: March 04, 2015 Citation: Ali AA, Abdullah AM, Jaber AS (2015) Acid-Base Disturbance: A Comprehensive Flowchart-based Diagnostic Approach. Emerg Med (Los Angel) 5:245. doi:10.4172/2165-7548.1000245 Copyright: 2015 Ali AA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Approaching acid-base disturbances is considered a medical problem among healthcare practitioners. Practicewise, system-based approach should be used to simplify the diagnosis and facilitate management. Flowcharts are considered education tools that can organize thoughts and standardize care. Using a flowchart approach make the practitioners solve any complex acid-base disturbance and facilitate the teaching of such topic. Acid-base; Metabolic; Respiratory; Acidosis; Alkalosis; Anion gap; Osmol gap; Flowchart The acid-base homeostasis is carefully balanced through a delicate series of interactions which involve organs such as the lungs and kidneys, as well as a complex system of buffers. Optimal body function and metabolic systems are kept in check by maintaining a normal pH (7.35-7.45) of arterial blood. Values less then <7.35 are termed acidemia, whereas values more than >7.45 are referred to as alkalemia. Any disorder that lowers the pH to <7.35 is called acidosis, while a disorder that increases the pH >7.45 is called alkalosis [ 1 - 3 ]. The Henderson-Hasselbalch equation describes the Regulation of the systemic pH by means of metabolic and respiratory components [ 4 ]: The equation demonstrates that the pH is determined by bicarbona Continue reading >>

Abg: Respiratory Acidosis/metabolic Alkalosis

Abg: Respiratory Acidosis/metabolic Alkalosis

Home / ABA Keyword Categories / A / ABG: Respiratory acidosis/metabolic alkalosis ABG: Respiratory acidosis/metabolic alkalosis A combined respiratory acidosis / metabolic alkalosis will result in elevated PaCO2 and serum bicarbonate. Which process is the primary disorder (e.g. primary respiratory acidosis with metabolic compensation versus primary metabolic alkalosis with respiratory compensation) is dependent on the pH in an acidotic patient, the acidosis is primary (and the alkalosis is compensatory) and vice versa. Compensation behaves in accordance with the following rules: Metabolic Acidosis: As bicarbonate goes from 10 to 5, pCO2 will bottom out at 15. pCO2 = 1.5 x [HCO3-] + 8 (or pCO2 = 1.25 x [HCO3-]) Metabolic Alkalosis: compensation here is less because CO2 is driving force for respiration. pCO2 = 0.7 x [HCO3-] + 21 (or pCO2 = 0.75 x [HCO3-]) Acutely: [HCO3-] = 0.1 x pCO2 or pH = 0.008 x pCO2 Chronically: [HCO3-] = 0.4 x pCO2 or pH = 0.003 x pCO2 Respiratory Alkalosis: Metabolic compensation will automatically be retention of chloride (i.e., hyperchloremic, usually referred to as loss of bicarb although it is the strong ion difference that matters). If you have an anion gap, then youve automatically got a little bit of an acidosis on top of the compensation (because the compensation should be a NON-gap acidotic process. Acutely: [HCO3-] = 0.2 x pCO2 (or pH = 0.008 x pCO2) Chronically: [HCO3-] = 0.4 x pCO2 (or pH = 0.017 x pCO2) Continue reading >>

Chapter 8. Blood Gases And Acidbase Disorders

Chapter 8. Blood Gases And Acidbase Disorders

Chapter 8. Blood Gases and AcidBase Disorders Chapter 8. Blood Gases and AcidBase Disorders. In: Gomella LG, Haist SA. Gomella L.G., Haist S.A. Eds. Leonard G. Gomella, and Steven A. Haist.eds. Clinician's Pocket Reference: The Scut Monkey, 11e New York, NY: McGraw-Hill; 2007. Accessed April 29, 2018. . "Chapter 8. Blood Gases and AcidBase Disorders." Clinician's Pocket Reference: The Scut Monkey, 11e Gomella LG, Haist SA. Gomella L.G., Haist S.A. Eds. Leonard G. Gomella, and Steven A. Haist. New York, NY: McGraw-Hill, 2007, Blood gases provide information concerning the oxygenation, ventilatory, and acid-base status of the patient. Blood gas results are usually given as pH, P 2, [HCO3], base excess or deficit (base difference), and O2 saturation. This test gives information on acidbase homeostasis (pH, P 2, [HCO3], and base difference) and on blood oxygenation (P 2, O2 saturation). Arterial blood gases (ABG) are most commonly measured; venous, mixed venous, and capillary blood gases are measured less frequently. Indications for blood gas determinations are as follows (Respir Care 2001;46:498505): 2), and oxygenation and O2-carrying capacity (Pa To quantitate the response to therapeutic intervention (eg, supplemental O2 administration, mechanical ventilation) or diagnostic evaluation (eg, exercise desaturation) Monitoring the severity and progression of documented disease processes (eg, COPD) Normal values for blood gas analysis are given in Table 81 , and capillary blood gases are discussed in a following section. Mixed venous blood gases are reviewed in Chapter 20 . The bicarbonate concentration ([HCO3]) from the blood gas is a calculated value and should not be used in interpretation of blood gases; the [HCO3] from a concurrent chemistry panel should be used. Note: Continue reading >>

More Abg Examples - Resus

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 primary cause? Given the low HCO3 and the not so high pCO2 it isMETABOLIC ACIDOSIS. Expected pCO2 is [(1.5xHCO3) +8]+2 i.e.., [(~30) + 8]+2 = 38-39 sothere is adequate compensation Na -(Cl + HCO3) = 108-(72 + 19) = 17 so raised anion gap metabolic acidosis. (reference is 8-16) Is there any other process going on? Look at the delta gap. change in AG/change in HCO3 = 17-12(use 12 as the expected AG)/24-19(24 is the expected HCO3) = 5/5 = 1 so this is a pure anion gap metabolic acidosis. ( Given what I say below, I might have also expected a normal anion gap metabolic acidosis) The Na is very low an Continue reading >>

Recognizing Mixed Acid Base Disturbances - Acvim 2008 - Vin

Recognizing Mixed Acid Base Disturbances - Acvim 2008 - Vin

A proper understanding of the terms acidosis, alkalosis, acidemia, and alkalemia is necessary to differentiate simple from mixed acid base disorders.1 Acidosis and alkalosis refer to the pathophysiologic processes that cause net accumulation of acid or alkali in the body, whereas acidemia and alkalemia refer specifically to the pH of extracellular fluid. In acidemia, the extracellular fluid pH is less than normal and the [H+] is higher than normal. In alkalemia, the extracellular fluid pH is higher than normal and the [H+] is lower than normal. Due to the effectiveness of compensatory mechanisms, animals can have acidosis or alkalosis but not acidemia or alkalemia. For example, a dog with chronic respiratory alkalosis may have a blood pH that is within the normal range. Such a patient has alkalosis, but does not have alkalemia. The primary acid base disorders are divided into metabolic and respiratory disturbances: metabolic acidosis, metabolic alkalosis, respiratory acidosis, and respiratory alkalosis. The Henderson-Hasselbach equation in its clinically relevant form emphasizes the relationship between the metabolic and respiratory systems in determining extracellular fluid pH: Traditionally, the kidneys have been considered responsible for regulation of the metabolic component (blood bicarbonate concentration, [HCO3-]) and the lungs for regulation of the respiratory component (partial pressure of CO2, [pCO2]). In this form, the Henderson-Hasselbach equation makes it clear that the pH of extracellular fluid is determined by the ratio of the bicarbonate concentration and pCO2. Each primary (metabolic or respiratory) acid base disturbance is accompanied by a secondary (opposing) response in the other system (respiratory or metabolic). Blood pH is returned nearly, but no Continue reading >>

The Interpretation Of Arterial Blood Gases

The Interpretation Of Arterial Blood Gases

The interpretation of arterial blood gases The interpretation of arterial blood gases Aust Prescr 2010;33:124-91 Aug 2010DOI: 10.18773/austprescr.2010.059 Arterial blood gas analysis is used to measure the pH and the partial pressures of oxygen and carbon dioxide in arterial blood. The investigation is relatively easy to perform and yields information that can guide the management of acute and chronic illnesses.This information indicates a patient's acid-base balance, the effectiveness of their gas exchange and the state of their ventilatory control. Interpretation of an arterial blood gas result should not be done without considering the clinical findings.The results change as the body compensates for the underlying problem. Factors relating to sampling technique, specimen processing and environment may also influence the results. Arterial blood gas analysis is a common investigation in emergency departments and intensive care units for monitoring patients with acute respiratory failure. It also has some application in general practice, such as assessing the need for domiciliary oxygen therapy in patients with chronic obstructive pulmonary disease. An arterial blood gas result can help in the assessment of a patient's gas exchange, ventilatory control and acidbase balance. However, the investigation does not give a diagnosis and should not be used as a screening test. It is imperative that the results are considered in the context of the patient's symptoms. While non-invasive monitoring of pulmonary function, such as pulse oximetry, is simple, effective and increasingly widely used, pulse oximetry is no substitute for arterial blood gas analysis. Pulse oximetry is solely a measure of oxygen saturation and gives no indication about blood pH, carbon dioxide or bicarbona Continue reading >>

Types Of Disturbances

Types Of Disturbances

The different types of acid-base disturbances are differentiated based on: Origin: Respiratory or metabolic Primary or secondary (compensatory) Uncomplicated or mixed: A simple or uncomplicated disturbance is a single or primary acid-base disturbance with or without compensation. A mixed disturbance is more than one primary disturbance (not a primary with an expected compensatory response). Acid-base disturbances have profound effects on the body. Acidemia results in arrythmias, decreased cardiac output, depression, and bone demineralization. Alkalemia results in tetany and convulsions, weakness, polydipsia and polyuria. Thus, the body will immediately respond to changes in pH or H+, which must be kept within strict defined limits. As soon as there is a metabolic or respiratory acid-base disturbance, body buffers immediately soak up the proton (in acidosis) or release protons (alkalosis) to offset the changes in H+ (i.e. the body compensates for the changes in H+). This is very effective so minimal changes in pH occur if the body is keeping up or the acid-base abnormality is mild. However, once buffers are overwhelmed, the pH will change and kick in stronger responses. Remember that the goal of the body is to keep hydrogen (which dictates pH) within strict defined limits. The kidney and lungs are the main organs responsible for maintaining normal acid-base balance. The lungs compensate for a primary metabolic condition and will correct for a primary respiratory disturbance if the disease or condition causing the disturbance is resolved. The kidney is responsible for compensating for a primary respiratory disturbance or correcting for a primary metabolic disturbance. Thus, normal renal function is essential for the body to be able to adequately neutralize acid-base abnor Continue reading >>

Simple Method Of Acid Base Balance Interpretation

Simple Method Of Acid Base Balance Interpretation

A FOUR STEP METHOD FOR INTERPRETATION OF ABGS Usefulness This method is simple, easy and can be used for the majority of ABGs. It only addresses acid-base balance and considers just 3 values. pH, PaCO2 HCO3- Step 1. Use pH to determine Acidosis or Alkalosis. ph < 7.35 7.35-7.45 > 7.45 Acidosis Normal or Compensated Alkalosis Step 2. Use PaCO2 to determine respiratory effect. PaCO2 < 35 35 -45 > 45 Tends toward alkalosis Causes high pH Neutralizes low pH Normal or Compensated Tends toward acidosis Causes low pH Neutralizes high pH Step 3. Assume metabolic cause when respiratory is ruled out. You'll be right most of the time if you remember this simple table: High pH Low pH Alkalosis Acidosis High PaCO2 Low PaCO2 High PaCO2 Low PaCO2 Metabolic Respiratory Respiratory Metabolic If PaCO2 is abnormal and pH is normal, it indicates compensation. pH > 7.4 would be a compensated alkalosis. pH < 7.4 would be a compensated acidosis. These steps will make more sense if we apply them to actual ABG values. Click here to interpret some ABG values using these steps. You may want to refer back to these steps (click on "linked" steps or use "BACK" button on your browser) or print out this page for reference. Step 4. Use HC03 to verify metabolic effect Normal HCO3- is 22-26 Please note: Remember, the first three steps apply to the majority of cases, but do not take into account: the possibility of complete compensation, but those cases are usually less serious, and instances of combined respiratory and metabolic imbalance, but those cases are pretty rare. "Combined" disturbance means HCO3- alters the pH in the same direction as the PaCO2. High PaCO2 and low HCO3- (acidosis) or Low PaCO2 and high HCO3- (alkalosis). Continue reading >>

Blood Gas Interpretation

Blood Gas Interpretation

The body normally controls the pH of blood within a tight range. One must always remember that pH is a logarithmic scale and so a change from 8 to 7 is a ten-fold increase in H+ concentration. A normal intracellular pH is required for the functioning of many enzyme systems. When blood becomes profoundly acidotic (pH<7) then cellular function becomes impossible and death ensues. There are a lot of texts available describing the causes of the respiratory and metabolic acidosis and alkalosis. However the best way to learn how to interpret blood gases is to practice. Normal Blood gas. The only abnormal result here is the pO2, however this is a venous gas and so the pO2 should be low. This is therefore a normal blood gas. It is important to rule out a diabetic ketoacidosis in children with diabetes who are unwell with high blood sugars. The learning point here is that blood gas analysis doesn’t just have to be performed on arterial blood. A lot can be established from venous or capillary samples. Respiratory Acidosis – Respiratory failure (bronchiolitis). This baby has bronchiolitis. There is a respiratory acidosis. Notice the high oxygen secondary to aggressive oxygen therapy. Treatment of bronchiolitis is supportive, ie oxygen and fluids. Respiratory Acidosis – respiratory failure secondary to acute exacerbation of asthma This is a respiratory acidosis. This boy is in respiratory failure secondary to an acute exacerbation of his asthma. A “silent chest” where you can only just hear breath sounds is a very serious clinical sign. This boy will need aggressive treatment and likely intubation and transfer to PICU. Respiratory Acidosis with metabolic compensation– Respiratory failure (pneumonia) This boy has pneumonia associated with respiratory failure. There is a Continue reading >>

Mixed Acid-base Disorders.

Mixed Acid-base Disorders.

1. Vet Clin North Am Small Anim Pract. 1989 Mar;19(2):307-26. (1)Department of Small Animal Clinical Sciences, University of Minnesota College of Veterinary Medicine, St. Paul. Mixed acid-base disturbances are combinations of two or more primary acid-basedisturbances. Mixed acid-base disturbances may be suspected on the basis offindings obtained from the medical history, physical examination, serumelectrolytes and chemistries, and anion gap. The history, physical examination,and serum biochemical profile may reveal disease processes commonly associatedwith acid-base disturbances. Changes in serum total CO2, serum potassium andchloride concentrations, or increased anion gap may provide clues to theexistence of acid-base disorders. Blood gas analysis is usually required toconfirm mixed acid-base disorders. To identify mixed acid-base disorders, bloodgas analysis is used to identify primary acid-base disturbance and determine ifan appropriate compensatory response has developed. Inappropriate compensatoryresponses (inadequate or excessive) are evidence of a mixed respiratory andmetabolic disorder. The anion gap is also of value in detecting mixed acid-basedisturbances. In high anion gap metabolic acidosis, the change in the anion gapshould approximate the change in serum bicarbonate. Absence of this relationship should prompt consideration of a mixed metabolic acid-base disorder. Finding anelevated anion gap, regardless of serum bicarbonate concentration, suggestsmetabolic acidosis. In some instances, elevated anion gap is the only evidence ofmetabolic acidosis. In patients with hyperchloremic metabolic acidosis, increasesin the serum chloride concentration should approximate the reduction in the serumbicarbonate concentration. Significant alterations from this relationsh Continue reading >>

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