Слайд 2It’s not magic understanding ABG’s, it just takes a little practice!
![It’s not magic understanding ABG’s, it just takes a little practice!](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-1.jpg)
Слайд 3Acid-base imbalances
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
![Acid-base imbalances Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-2.jpg)
Слайд 4Metabolic
• METABOLIC ACIDOSIS: Decrease the
HCO3 - --> the pH goes down.
• Compensation: Respiratory Alkalosis
![Metabolic • METABOLIC ACIDOSIS: Decrease the HCO3 - --> the pH goes](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-3.jpg)
(hyperventilation) will bring the pH back near normal.
• Causes: Diarrhea, DKA, LA, renal failure.
• METABOLIC ALKALOSIS: Increase the
HCO3 - --> the pH goes up.
• Compensation: Respiratory Acidosis (hypoventilation) can help to bring the pH+
Слайд 5Respiratory
RESPIRATORY ACIDOSIS: Increase the PCO2---> the pH goes down. Hypoventilation. Compensation: Metabolic
![Respiratory RESPIRATORY ACIDOSIS: Increase the PCO2---> the pH goes down. Hypoventilation. Compensation:](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-4.jpg)
Alkalosis can help bring the pH back near normal.
Causes: pneumonia, Bronchitis, Asthma
RESPIRATORY ALKALOSIS:Decrease the PCO2-> the pH goes up. Hyperventilation.
Compensation: Metabolic Acidosis can
help bring the pH back near normal.
Слайд 6METABOLIC ALKALOSIS
CAUSES:
• Vomiting: Lose enough stomach acid to produce alkalosis.
• Diuretics: Loop diuretics and
![METABOLIC ALKALOSIS CAUSES: • Vomiting: Lose enough stomach acid to produce alkalosis.](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-5.jpg)
thiazides can lead to hypokalemia ------> secondary metabolic alkalosis.
• Antacids overuse
Слайд 7RESPIRATORY ACIDOSIS:
causes:
CNS DEPRESSION
DRUGS:Opiates,sedatives,anaesthetics
OBESITY HYPOVENTILATION SYNDROME
STROKE
NEUROMUSCULAR DISORDERS:
NEUROLOGIC: POLIO,GBS,TETANUS,BOTULISM
MUSCULAR DYSTROPHY
AIRWAY OBSTRUCTION
ACUTE
![RESPIRATORY ACIDOSIS: causes: CNS DEPRESSION DRUGS:Opiates,sedatives,anaesthetics OBESITY HYPOVENTILATION SYNDROME STROKE NEUROMUSCULAR DISORDERS:](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-6.jpg)
ASPIRATION, LARYNGOSPASM
CHEST WALL RESTRICTION
PLEURAL: Effusions, empyema,pneumothorax,fibrothorax
CHEST WALL: Kyphoscoliosis, scleroderma,ankylosing spondylitis,obesity
SEVERE PULMONARY RESTRICTIVE DISORDERS
PULMONARY FIBROSIS
PARENCHYMAL INFILTRATION:
Pneumonia, edema
Слайд 8RESPIRATORY ALKALOSIS
Causes:
High altitude.
Neuromuscular disease
Respiratory center depression
Inadequate mechanical ventilation
Sepsis
Burns
![RESPIRATORY ALKALOSIS Causes: High altitude. Neuromuscular disease Respiratory center depression Inadequate mechanical ventilation Sepsis Burns](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-7.jpg)
Слайд 9Metabolic acidosis
Metabolic acidosis: Is caused by a decrease in HCO3- concentration in blood.
Causes:
Increased production
![Metabolic acidosis Metabolic acidosis: Is caused by a decrease in HCO3- concentration](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-8.jpg)
of acids: LA, kA, Salicylate poisoning.
Loss of HCO3-: Diarrhea and kidneys RTA.
Blood profile: pH decreased
[HCO3-] decreased, PCO2 decreased
Слайд 10Compensation of Metabolic acidosis:
Respiratory compensation: decrease in pH stimulates respiratory center causing hyperventilation which
![Compensation of Metabolic acidosis: Respiratory compensation: decrease in pH stimulates respiratory center](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-9.jpg)
produces decrease in PCO2.
Renal Compensation: excess H+ is excreted as titratable acid and NH4+.
Treatment: lactate containing solution which converts HCO3- ion the liver.
Слайд 17Metabolic Acidosis
pH 7.30
PaCO2 40
HCO3 15
![Metabolic Acidosis pH 7.30 PaCO2 40 HCO3 15](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-16.jpg)
Слайд 18Metabolic Alkalosis
pH 7.50
PCO2 40
HCO3 30
![Metabolic Alkalosis pH 7.50 PCO2 40 HCO3 30](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-17.jpg)
Слайд 19Respiratory Acidosis
pH 7.30
PaCO2 60
HCO3 26
![Respiratory Acidosis pH 7.30 PaCO2 60 HCO3 26](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-18.jpg)
Слайд 20Respiratory Alkalosis
pH 7.50
PaCO2 25
HCO3 23
![Respiratory Alkalosis pH 7.50 PaCO2 25 HCO3 23](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-19.jpg)
Слайд 21What are the compensations?
• Respiratory acidosis --metabolic alkalosis
• Respiratory alkalosis --metabolic acidosis
• In respiratory conditions,
![What are the compensations? • Respiratory acidosis --metabolic alkalosis • Respiratory alkalosis](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-20.jpg)
therefore, the kidneys will attempt to compensate and visa versa.
Слайд 22Buffers kick in within minutes.
Respiratory compensation is rapid and starts within minutes
![Buffers kick in within minutes. Respiratory compensation is rapid and starts within](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-21.jpg)
and complete within 24 hours. Kidney compensation takes hours and up to 5 days
Слайд 24Acid base disorder-worksheet
Practice ABG’s
![Acid base disorder-worksheet Practice ABG’s](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-23.jpg)
Слайд 25Answers:
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic acidosis 4.Compensated
Respiratory
acidosis
5. Metabolic alkalosis
6. Compensated Respiratory
![Answers: 1. Respiratory alkalosis 2. Respiratory acidosis 3. Metabolic acidosis 4.Compensated Respiratory](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-24.jpg)
acidosis
7. Compensated Metabolic
alkalosis
8. Metabolic acidosis
9. Respiratory acidosis
10. Metabolic alkalosis
Слайд 26STEPS OF ASSESSING ABG
STEP 1: Diagnose whether it is acidosis or alkalosis-
![STEPS OF ASSESSING ABG STEP 1: Diagnose whether it is acidosis or](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-25.jpg)
(pH will help)
STEP2:Diagnose whether compensated or non compensated
STEP 3: Diagnose whether it is metabolic or respiratory(Look at the value of bicarbonate and pCO2)
Слайд 27Work sheet
Diarrhea may lead to----------?
Acid loss due to vomiting and gastric
suction may
![Work sheet Diarrhea may lead to----------? Acid loss due to vomiting and](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-26.jpg)
lead to ______ alkalosis?
Overuse of _________may lead to metabolic alkalosis?
Слайд 28Problem#1
67 year female known diabetic for past 20years presented with sudden onset
![Problem#1 67 year female known diabetic for past 20years presented with sudden](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-27.jpg)
of severe chest pain and Shortness of breath.
ABG analysis showed:
pH 7.36
PCO2 33 mmHg
HCO3 18 mmol/L
Discuss the probable diagnosis.
Слайд 29Problem #2
A 30-year old man with DM presents with polyuria, polydipsia, fever, cough,
![Problem #2 A 30-year old man with DM presents with polyuria, polydipsia,](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-28.jpg)
and purulent sputum.
His ABG shows the following Na+140 / Cl- 104
K+7.0
pH: 6.95
pCO2 : 33
Hco3 : 7.0
Discuss the probable diagnosis.
Слайд 30Problem#3
45 year old male was admitted to the emergency room with complaints
![Problem#3 45 year old male was admitted to the emergency room with](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-29.jpg)
of mild vomiting, associated with disorientation and muscular weakness. His blood investigations showed the following
pH =7.20 Na -137meq/l
HCO3-=16mEq / L Cl-108meq/l
pCO2 = 34mm Hg K -5.8
Glucose=685mg/dl
urea49mg/dl
Слайд 31Problem #4
60 year male presents to the ED from a nursing home.
![Problem #4 60 year male presents to the ED from a nursing](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-30.jpg)
You have no history other than he has been breathing rapidly and is less responsive than usual.
Na+ 123 Cl- 99 HCO3 - 5
pH 7.31pCO2 10
Discuss the probable diagnosis.
Слайд 32Problem # 5
60year old man was admitted with severe abdominal pain, which started
![Problem # 5 60year old man was admitted with severe abdominal pain,](/_ipx/f_webp&q_80&fit_contain&s_1440x1080/imagesDir/jpg/949336/slide-31.jpg)
some 2 hours back.
Clinically he was in a state of shock with distended abdomen. Femoral pulses could not be palpable
His ABG shows the follows pH : 7.05
pCO2: 26.3 mmHg
HCO3: 7 mmol/L Discuss the probable diagnosis.