Arterial Blood Gases Flashcards

1
Q

Normal human pH is _____

A

7.35 - 7.45

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2
Q

Think of CO2 as the Respiratory _____

A

Acid

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3
Q

T/F H+ ions are a normal product of normal cellular metabolism.

A

T

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4
Q

There are several buffering systems utilized in the body to
manage the pH, the main one being the _____

A

Carbonic Acid- Bicarbonate System

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5
Q

Think of HCO3- as the Metabolic ____

A

Base

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6
Q

The ____ are the Metabolic System that controls the HCO3- level

A

kidneys

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7
Q

The respiratory system manages
the pH by _____

A

increasing or
decreasing the respiratory rate
and inspiration depth.

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8
Q

The kidneys manage the pH by _____

A

retaining HCO3 or by eliminating H+ in urine.

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9
Q

Metabolic Acidosis

A

○ Results from decreased HCO3- or increased Acid retention.
■ Causes an increased H+ concentration, decreasing the pH

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10
Q

Clinical causes of metabolic acidity:

A

■ Failure of the kidneys to successfully excrete extracellular acids
(due to renal diseases, whether acute or chronic).
■ Formation of excess metabolic acids in the body (such as diabetic
ketoacidosis, lactic acidosis, etc.).
■ Loss of base from body fluids (such as severe diarrhea, which
results in loss of large amounts of bicarbonate in the feces)

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11
Q

Treatment of metabolic acidosis

A

centers on treating the underlying condition.
■ In more severe cases, treatment with alkali therapy (ie. NaHCO3)
may be indicated to raise and maintain pH to > 7.2

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12
Q

Metabolic Alkalosis

A

○ Results from increased HCO3- concentration or loss of excess H+.
■ Causes a decreased H+ concentration, increasing the pH

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13
Q

Clinical causes of metabolic alkalosis:

A

■ Increased ingestion of alkaline drugs, such as Tums (NaHCO3).
■ Thiazide and Loop Diuretics medications.
■ Excessive vomiting can result in loss of large amounts of acid from
the gastric hydrochloric acid (HCl).
■ Excessive Aldosterone secretion results in increased renal Na+
reabsorption, which also causes increased urinary excretion of H+

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14
Q

Treatment of metabolic aklalosis

A

focuses on the treating/correcting the underlying condition.
■ May also involve correcting electrolyte imbalances that are present.

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15
Q

Respiratory Acidosis:

A

○ Results from decreased ventilation and increased PCO2.
■ Causes increased H2CO3 and H+, resulting in decreased pH

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16
Q

Clinical causes of Hypoventilation (Respiratory acidosis)

A

■ Damage to respiratory center in the medulla oblongata.
■ Obstructive lung conditions, such as COPD, chest trauma, etc
■ Factors that interfere with pulmonary gas exchange, such as
pneumonia, pulmonary embolism, cardiac arrest, etc
■ Other causes of hypoventilation, such as narcotic overdose

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17
Q

Treatment of respiratory acidosis:

A

Treat underlying condition and consider hyperventilation.
■ Often requires admission to the ICU; hyperventilation is often done
with BIPAPs or endotracheal intubation.

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18
Q

Respiratory Alkalosis:

A

○ Results from increased ventilation and decreased PCO2.
■ Causes decreased H2CO3 and H+, resulting in increased pH

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19
Q

Clinical causes of Hyperventilation (respiratory alkalosis)

A

■ Situations such as anxiety, panic attacks, fever,
some head injuries, COPD, asthma, pneumonia,
pulmonary fibrosis, etc.
■ Can be iatrogenic hyperventilation

20
Q

Treatment of respiratory alkalosis

A

Focused the underlying condition.
■ Respiratory alkalosis itself is rarely life
threatening and emergent treatment is usually not indicated

21
Q

Arterial Blood Gases

A

An Arterial Blood Gas, or ABG, is a diagnostic assessment
that can be used to evaluate a patient’s Acid-Base status, and diagnose Hypoxia

22
Q

ABGs can diagnose _____

A

hypoxia

23
Q

ABG process

A

● The procedure involves a needle being placed in a peripheral
artery to obtain a sample of arterial blood.
● An ABG provides the clinician with…
○ Arterial pH
○ Arterial PCO2
○ Arterial PO2
○ Percentage of O2 Saturation
○ Bicarbonate (HCO3-)

24
Q

Patients who typically require an arterial blood gas measurement are those who are

A

○ In respiratory failure.
○ Critically ill or rapidly deteriorating.
■ Examples: Sepsis, multi organ failure, DIC, etc.
○ In a state of uncontrolled DM (and concern for DKA).
○ Suspected of taking an overdose of dangerous toxin

25
Q

ABG collection is not significantly invasive but does have a
few potential complications:

A

○ Ex: Arterial thrombosis or occlusion, and Bleeding.
○ See Arterial Sampling slide set for more details

26
Q

6 steps to ABG interpretation:

A
  1. pH - Is there Acidosis or Alkalosis?
  2. Is the CO2 normal?
  3. Is the HCO3 normal?
  4. Match the CO2 or the HCO3 with the pH (on the grid).
  5. Does CO2 or HCO3 go the opposite direction of the pH?
  6. Are the PO2 and O2 Saturation normal?
27
Q

If ph is WNL, what do you label it as?

A

f it is within normal limits, label what side of 7.4 it falls on.
○ Normal acidic or normal alkalotic

28
Q

The normal pCO2 level is _____

A

35 - 45 mmHg

29
Q

The normal HCO3 level is _____

A

22 - 26 mEq/L

30
Q

How do you Match the CO2 or the HCO3 with the pH (on the grid)?

A

● Matching the variable to the pH helps you determine which
Acid-Base disorder you are looking at.
● Which variable is also acidic (or alkalotic)?

31
Q

For example:
○ If we have an acidic pH, and the CO2 also falls in the
acidic category, then we know we have a ______

A

Respiratory Acidosis (because CO2 is the respiratory factor and
because of the pH)

32
Q

C02 Range/levels

A

● The normal pCO2 level is 35 - 45 mmHg
● Greater than 45 is considered Acidic.
● Less than 35 is considered Alkalotic.

33
Q

HCO3 Range/levels

A

● The normal HCO3 level is 22 - 26 mEq/L
● Greater than 26 is considered Alkalotic.
● Less than 22 is considered Acidic

34
Q

This step helps you determine if the body is compensating for
the Acid-Base disturbance

A

Deciding - Does the CO2 or HCO3 go the opposite direction of the pH?

35
Q

pH level tells you level of _____

A

compensation

36
Q

The normal range for PO2 is ____ and the normal range for
O2Sat is _____

A

80 - 100 mmHg; 95 - 100%

37
Q

Anion Gap

A

● The anion gap is an important lab calculation that can help to
narrow the differential diagnosis when a patient presents
with a Metabolic Acidosis.
● The anion gap is the difference between primary measured
cations (sodium and potassium) and the primary measured
anions (chloride and bicarbonate) in serum

38
Q

The “gap” that normally exists between the measured cations `and anions accounts for various negatively charged plasma substances, including:

A

○ Albumin
○ Phosphate (PO4)
○ Sulfate (SO4)
○ Organic compounds (like lactic acid and others)

39
Q

Why is it important to always calculate the anion gap?

A

It’s important to always calculate the anion gap as it is possible to have an abnormal anion gap even when the ion concentrations in the serum are normal

40
Q

Anion Gap normal range

A

6-12 mEq

41
Q

If the anion gap is high (greater than 12 mEq) in met. acidosis, this
may suggest that one of the following is the underlying condition:

A

○ Increased levels of another Metabolic Anion-
■ Diabetic Ketoacidosis
■ Alcoholic Ketoacidosis
■ Lactic Acidosis
■ Advanced Chronic Kidney Disease
■ Starvation (results in ketosis)
○ Presence of Drug or Chemical Anion-
■ Salicylate intoxication (Aspirin, etc.)
■ Methanol (a simple alcohol)
■ Propylene (vaping) or Ethylene Glycol (antifreeze, coolant)

42
Q

A common mnemonic used to remember the causes of High
Anion Gap Metabolic Acidosis is MUDPILES

A

○ M- Methanol
○ U- Uremia (chronic kidney failure)
○ D- Diabetic Ketoacidosis
○ P- Propylene Glycol
○ I- Infection, iron, isoniazid (very rare)
○ L- Lactic Acidosis
○ E- Ethylene Glycol
○ S- Salicylates

43
Q

If the anion gap is normal (between 6 and 12 mEq) in a patient with metabolic acidosis, this may suggest that one of the following is the underlying condition:

A

○ Loss of bicarbonate-
■ Diarrhea
■ Recovery from Diabetic Ketoacidosis
■ Ileostomy Fluid Loss
■ Carbonic anhydrase inhibitors, like Topiramate
○ Chloride retention-
■ Renal Tubular Acidosis

44
Q

Although not usually associated with metabolic acidosis, a
decreased anion gap can occur because of ____

A

a reduction in
unmeasured anions or an increase in unmeasured cations in
various non-acid-base disorders

45
Q

If the anion gap is decreased (less than 6 mEq), this may suggest that one of the following is the underlying condition:

A

○ Hypoalbuminemia (decreased unmeasured anion)
○ Plasma Cell Dyscrasia
■ Monoclonal Protein
○ Bromide Intoxication

46
Q
A