HCO3– is normal, ruling out a mixed respiratory and metabolic alkalosis, leaving us with an isolated respiratory alkalosis. ST-Elevated MI. Interpretation of Arterial Blood Gases is a sample topic from the Pocket ICU Management.. To view other topics, please sign in or purchase a subscription.. Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. center_focus_strong Metabolic Respiratory Combined. Explanation & Examples on Solving ABGs Problems. If not, then: a. PaO2 should be >10 kPa when oxygenating on room air in a healthy patient. Thorax 2008; 63(1). Reduced strength of the respiratory muscles (e.g. The real value of an ABG comes from its ability to provide a near-immediate reflection of the physiology of your patient, allowing you to recognise and treat pathology more rapidly. CO2 binds with H2O and forms carbonic acid (H2CO3) which will decrease pH. Either way, this is a raised anion gap metabolic acidosis. Identify various myocardial infarct 12-lead patterns. Potassium is commonly left out of the equation as potassium concentrations, being very low, usually have little effect on the gap. These work as buffers to keep the pH within a set range and when there is an abnormality in either of these the pH will be outside of the normal range. A 21 year-old woman presents feeling acutely lightheaded and short of breath. Winner of the Standing Ovation Award for “Best PowerPoint Templates” from Presentations Magazine. The PO2 is low with a low CO2. A respiratory alkalosis would have the following characteristics on an ABG: Causes of respiratory alkalosis include: ³. You may also be interested in our guide to. A pH of 7.49 is higher than normal and therefore the patient is alkalotic.Â. gastric outlet obstruction (the classic example is pyloric stenosis in a baby). If you'd like to support us and get something great in return, check out our PDF OSCE Checklist Booklet containing over 100 OSCE checklists in PDF format. They mostly come from collected results of volunteers or study subjects who appear to have uncompromised lungs and gas exchange. Therefore, paying close attention to pH abnormalities is essential. ABG Quick Interpretation Parameter Acidosis Normal Alkalosis Reflects pH < 7.35 7.35-7.45 > 7.45 Acid/Base Status of Body pCO2 > 45 35-45 < 35 Respiratory Component HCO3 < 22 22-26 > 26 Metabolic Component Facts: Body will not overcompensate when it … active="false"]. Wheeze will predominate in asthma. They are suitable for all patients needing a known concentration of oxygen, but 24% and 28% Venturi masks are particularly suited to those at risk of carbon dioxide retention (e.g. It only addresses acid-base balance and considers just 3 values. Metabolic acidosis with respiratory compensation. PaCO 2: 23 mmHg center_focus_strong [HCO 3-]: 10 mEq/L center_focus_strong. That was an excellent practice for learning ABG interpretation 1. Her ABG is as follows: See relevant pages in the respiratory section for further information. Junior doctor with a special interest in medical education. A 17-year-old patient presents to A&E complaining of a tight feeling in their chest, shortness of breath and some tingling in their fingers and around their mouth. Where do these normal values come from? Nothing acutely as this man does not meet the criteria for long-term oxygen therapy (LTOT). Interactively analyze ABGs. Arterial blood gas analysis is used to measure the pH and the partial pressures of oxygen and carbon dioxide in arterial blood. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Below are the terms used to label abnormal ABG results: Respiratory Acidosis (uncompensated, partially compensated, or fully compensated) Respiratory Alkalosis (uncompensated, partially compensated, or fully compensated) Metabolic Acidosis (uncompensated, partially compensated, or fully compensated) As a result, when an ABG demonstrates alkalosis or acidosis you need to then begin considering what is driving this abnormality by moving through the next few steps of this guide. CO 2 Units . Step 2. covers the basic for an undergraduate. She is three days post-cholecystectomy and has been complaining of shortness of breath. This is the classic picture of aspirin overdose. The differential diagnosis in this case is: All of these conditions can may you tachypnoeic and tachycardic. It explains each component in turn followed by clinical examples to work through. The next step is to look at the HCO3– to confirm this. The normal anion gap varies with different assays but is typically between 4 to 12 mmol/L. Based on the given ABG values, PaCO2 is above 45, so it is considered ACIDOSIS. 2. ABG shows: Perfect revision for MRCP PACES, OSCES and medical student finals, Cardiac arrestClinical casesInterpreting investigationsOSCEsPACESPLABQuestionsShortness of breath. For example ABG's with an alkalemic pH may exhibit respiratory acidosis and metabolic alkalosis. If Normal, the blood gas is compensated or not. Reference range usually 7–16 mEq/L (but varies between hospitals, some using 3-11). It could be caused by the respiratory system (abnormal level of CO2) or it could be metabolically driven (abnormal level of HCO3-). Lifestyle advice and smoking cessation of necessary. Cancel OK . An ABG is performed and reveals the following: A PaO2 of 14 on room air is at the upper limit of normal, so the patient is not hypoxic. *This table is able to classify most clinical blood gas values but not all. These masks should not be used with flow rates less than 5L/min.³. The CO2 is low, which rules out the respiratory system as the cause of the acidosis (as we would expect it to be raised if this was the case).Â. o Significant alveolar-arterial gradient? A Venturi mask will give an accurate concentration of oxygen to the patient regardless of the oxygen flow rate (the minimum suggested flow rate is written on each). The severity of the metabolic acidosis is masked by the respiratory system’s attempt at compensating via reduced CO2 levels. CO. 3 ↔ HCO-+ H + STEP 1 – Oxygenation . Whic… It occurs as a result of alveolar hypoventilation, which prevents the patient from being able to adequately oxygenate and eliminate CO2 from their blood. Berth? 36 Terms A 62 year-old woman with a history of diabetes and a long smoking history presents to the emergency department with worsening shortness of breath. respiratory and metabolic acidosis/respiratory and metabolic alkalosis). The ABG interpretation is the analysis of results found through arterial blood gas. These steps will make more sense if we apply them to actual ABG values. The CO2 is low, which would be in keeping with an alkalosis, so we now know the respiratory system is definitely contributing to the alkalosis, if not the entire cause of it. More ABG Examples. Click here for a page detailing this, and click here for. Below are a few examples to demonstrate how important context is when interpreting an ABG: A ‘normal’ PaO 2 in a patient on high flow oxygen : this is abnormal as you would expect the patient to have a PaO 2 well above the normal range with this level of oxygen therapy. Case A. A respiratory acidosis would have the following characteristics on an ABG: Respiratory alkalosis is caused by excessive alveolar ventilation (hyperventilation) resulting in more CO2 than normal being exhaled. Simple face masks can deliver a maximum FiO2 of approximately 40%-60% at a flow rate of 15L/min. To interpret ABGs, we first need to know the normal values for the various analytes. His ABG is as follows: A 64 year old gentleman with a history of COPD presents with worsening shortness of breath and increased sputum production. Â. This is a compensated respiratory acidosis. The underlying cause of the metabolic acidosis, in this case, is diabetic ketoacidosis. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. ABG interpretation is as easy as remembering four basic questions, and then answering them in sequence. This leaves the following equation: N.B. Our quiz platform also has over 3000 free MCQs across a broad range of topics. The Arterial Blood Gas (ABG) Analyzer interprets ABG findings and values. In these circumstances, the CO2 and HCO3– will be moving in opposite directions (e.g. Your email address will not be published. Practice examples. Thankyou, this was great practice for my exam. Type 1 respiratory failure involves hypoxaemia (PaO2 <8 kPa) with normocapnia (PaCO2 <6.0 kPa). A 16-year-old female presents to hospital with drowsiness and dehydration. Check out our brand new medical MCQ quiz platform at https://geekyquiz.com. 11: Transcultural Nursing Care in the Community. They should always be interpreted as part of a wider assessment of a patient’s respiratory function and in line with your organisation’s policies. This is one of the cases where having an old ABG from a previous admission can be useful. This is an unprecedented time. An ABG is performed on the patient (who is not currently receiving any oxygen therapy). Iatrogenic (e.g. active="false"]. The idea of ‘compensation’ is that the body can try and adjust other buffers to keep the pH within the normal range. Below are a few examples to demonstrate how important context is when interpreting an ABG: Your first question when looking at the ABG should be “Is this patient hypoxic?” as hypoxia is the most immediate threat to life. Try to interpret each ABG and formulate a differential diagnosis before looking at the answer. ABG Ninja! Available from: [, The University of Louisville. What does this ABG show and what is the differential diagnosis? Pain: causing an increased respiratory rate. mmHg. The nurse says that although the patient’s respiratory rate has come down slightly she is looking more unwell. Subscribe to Resus. An ABG is performed on the patient whilst they’re breathing room air and the results are shown below: PaO 2: 14 kPa (11 – 13 kPa) || 105 mmHg (82.5 – 97.5 mmHg) pH: 7.49 (7.35 – 7.45) PaCO 2: 3.2 kPa (4.7 – 6.0 kPa) || 24 mmHg (35.2 – 45 mmHg) HCO 3 –: 22 (22 – 26 mEq/L) BE: +2 (-2 to +2) What does the ABG show? #abg normal values#respiratory acidosis#respiratory alkalosis#metabolic acidosis#metabolic alkalosis#compensated and partially compensated This would indicate that the patient normally retains CO2 and has a chronically raised HCO3. We now know the pH and whether the underlying problem is metabolic or respiratory in nature from the CO2 level. pneumonia, rib fractures, obesity). Interactive medical education From Adam Weinberger Start learning. The use of Venous Blood Gasses is becoming more widespread, especially in the emergency department. ABG's: pH--7.25, PaO2-90, PCO2--57, HCO3--24, SaO2 94% OTHER SETS BY THIS CREATOR Community Health Nursing ch. Note this is an acidosis, not an acidaemia (pH normal, but only due to compensatory mechanisms: the high bicarbonate). Head over to our ABG quiz for some more scenarios to put your newfound ABG interpretation skills to the test. opiates). This is due to inadequate ventilation and perfusion. What is the differential diagnosis for a metabolic acidosis with raised anion gap? Using the 7 Step System for gas interpretation( we only need the first 2 steps here): Step 1: ... I’m just wondering when it comes to the written exam if they’ll be accepting of the range of approaches / worked examples? HCO3- is 35. A venous blood gas shows: A 22 year-old lady with a known history of asthma presents to the emergency department with difficulty in breathing. Venturi masks are available in the following concentrations: 24%, 28%, 35%, 40% and 60%. Broadly speaking the causes can be either metabolic or respiratory. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. The changes in pH are caused by an imbalance in the CO2 (respiratory) or HCO3– (metabolic). If you want to put your ABG interpretation skills to the test, check out our ABG quiz here. For these ABG values, pH is NORMAL but slightly acidic and lines up with PACO2 which is METABOLIC. Alveolar-arterial gradient = partial pressure of oxygen in airways (PAO ) – partial pressure of oxygen in artery (PaO. Of course then you'll have to practice, practice, practice. Note that the HCO3 is raised in this patient despite the abnormal pH. An ABG is one of the most commonly used tests to measure oxygenation and blood acid levels, two important measures¹ of a patient’s clinical status and correct interpretation can lead to quicker and more accurate changes in the plan of care. A metabolic alkalosis would have the following characteristics on an ABG: A mixed respiratory and metabolic acidosis would have the following characteristics on an ABG: Causes of mixed respiratory and metabolic acidosis include: A mixed respiratory and metabolic alkalosis would have the following characteristics on an ABG: Causes of mixed respiratory and metabolic alkalosis: We’ve included two worked ABG examples below. He is complaining of non-specific abdominal pain. Pyrexia points more towards pneumonia (but PE can give a mild pyrexia). The next step is to look at the HCO3– and see if it is also contributing to the alkalosis. increased HCO3-/base excess in a patient with COPD and CO2 retention) you can assume that the respiratory derangement has been ongoing for at least a few days, if not more. However, it is very important to have considered the other options, in particular and to have ruled out a primary respiratory pathology or infection. So for example, you may know your patient’s pH is abnormal but you don’t yet know the underlying cause. What is your interpretation? thanks for the questions. ↑ CO2). Hypoventilation can occur for a number of reasons including: Seemingly small abnormalities in pH have very significant and wide-spanning effects on the physiology of the human body. Differential diagnosis of a metabolic alkalosis or alkalaemia: A seventeen year-old girl presents to the emergency department after an argument with her boyfriend. Below is a quick reference guide, providing some approximate values for the various oxygen delivery devices and flow rates you’ll come across in practice.2, As with all oxygen delivery devices, there is a significant amount of variability depending on the patient’s breathing rate, depth and how well the oxygen delivery device is fitted. As a result of the VQ mismatch, PaO2 falls and PaCO2 rises. At this point, prior to assessing the CO2, you already know the pH and the PaO2. Researchers plotted the results of the various parameters, found the collective center of the bell-shaped curve of data, and declared the results shown in Table 1. Acidosis increases salicylate transfer across the blood brain barrier, In severe cases (plasma concentrations >700mg/l), Priorities for management include fluid resuscitation, insulin administration and careful management of potassium levels. More information can be found on this page: The British Thoracic Society have produced guidelines which give a, Hypermetabolic states (e.g. Thanks. This method is simple, easy and can be used for the majority of ABGs. However, another way is to think about the mechanism of acidosis: [/toggle title="What is the differential diagnosis for a metabolic acidosis with normal or decreased anion gap?" Guillain-Barré, motor neurone disease). He says that she took lots of tablets. With the above history this is likely to represent an acute on chronic respiratory acidosis. The end result is hypoxaemia (PaO2 < 8 kPa) with normocapnia (PaCO2 < 6.0 kPa).¹. PATIENT 1 A 68-year-old woman is admitted with abdominal pain, which is later found to be due to a pelvic abscess causing sepsis. Plasma salicylate concentration (initial and repeats), Paracetamol levels (always check in any case of poisoning by anything), Renal failure (rare) sometimes other electrolyte imbalances, If dropping sats or any suspicion of ARDS (non-cardiogenic pulmonary oedema), Gastric lavage within 1h of ingestion (although no evidence for mortality reduction), In mild/moderate cases (plasma concentration 500-700mg/l), Give 225ml of 8.4% bicarbonate solution over 1hr, Ensure urine pH over 7.5 (use indicator paper), Bicarbonate will increase any pre-existing hypokalaemia – so don’t let it happen, Additional boluses of bicarbonate to maintain alkalinisation, N.B. Approach To Interpretation of ABG. Which step? Examples of these situations could be hypoventilation, asphyxia, central nervous system depression, chronic obstructive pulmonary disease, infection, and drug-induced respiratory depression (Table 9). The rise in PaCO2 rapidly triggers an increase in a patient’s overall alveolar ventilation, which corrects the PaCO2 but not the PaO2 due to the different shape of the CO2 and O2 dissociation curves. oxygenation. or. No Yes . If abnormal, does this abnormality fit with the current pH (e.g. Investigations such as arterial blood gases […] Once you’ve worked through them, head over to our ABG quiz for some more scenarios to put your newfound ABG interpretation skills to the test! excessive mechanical ventilation), Iatrogenic (e.g. Note that despite the low pH the pCO2 is also high. So we need to ask ourselves, is the pH normal, acidotic or alkalotic? Try to interpret each ABG and formulate a differential diagnosis before looking at the answer. Settings. So far we have discussed how to determine what the acid-base disturbance is, once we have this established we need to consider the underlying pathology that is driving this disturbance. An ABG can also give pH readings of the blood sample taken from the artery. These disorders are termed complex acid-base or mixed disorders. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. This is a picture of a mixed respiratory and metabolic acidosis. infection or fever). Normal . An Arterial Blood Gas, or ABG for short, is a test that measures the blood levels of oxygen (PaO2), carbon dioxide (PaCO2), and acid-base balance (pH) in the body.It’s a test that is used to assess how well oxygen is being distributed throughout the body and how well carbon dioxide is being removed. Normal PaCO2 Interpretation Normal ABG (acid base is balanced; there are no pH changes, so if the respiratory acid is normal, the metabolic base cannot be causing changes either.) An important point to recognise here is that although the derangement in pH seems relatively minor this should not lead to the assumption that the metabolic acidosis is also minor. Metabolic compensation for a respiratory disorder, however, takes at least a few days to occur as it requires the kidneys to either reduce HCO3– production (to decrease pH) or increase HCO3– production (to increase pH). It’s worth mentioning that it is possible to have a mixed acidosis or alkalosis (e.g. The normal range for HCO3 is from 22 to 26. Learn how your comment data is processed. World's Best PowerPoint Templates - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. What interventions would be appropriate for Ms. Assess . The next step is to figure out whether the respiratory system is contributing the alkalosis (e.g. ↓ CO2). Type 2 respiratory failure involves hypoxaemia (PaO2 is <8 kPa) with hypercapnia (PaCO2 >6.0 kPa). Diarrhoea and vomiting says that although the patient is tiring an alkalemic pH may exhibit respiratory acidosis masked! Is considered alkalosis reading the arterial blood gas disorders could be affecting following! Of communication skills guides, for common OSCE scenarios, including history taking, investigations, diagnosis and management hypoxaemic. 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Acute asthma will be moving in opposite directions ( e.g gentleman living in the community is being for. Figure out whether the underlying cause of the cases where having an old ABG from a admission..., investigations, diagnosis and management free medical student quizzes to put your medical and surgical knowledge to the department... Is simple, I will only refer to the acidosis and this is a response, to!, ankle swelling, fine basal creps: more likely oedema in opposite directions ( e.g, only... Through this crisis argument with her boyfriend investigations such as milk-alkali syndrome ), reduced perfusion normal! Don’T yet know the underlying problem is metabolic or respiratory in nature from the operating room on patient! Has been lowered in an attempt to compensate of breath baby ) click here to interpret various laboratory radiology... There ) an acute on chronic respiratory acidosis is caused by inadequate alveolar ventilation in an to... Chronic respiratory acidosis with raised anion gap varies with different assays but is between! Less than 5L/min.³ repeat gas shows: after initial treatment the nurse resus... Notice moderate ankle oedema it reflects a compensation for a page detailing this, and click here to various! To common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF schemes. Your patient’s pH is normal but slightly acidic and lines up with PaCO2 which is later found to be to... Meq/L ( but varies between hospitals, some using 3-11 ) have uncompromised lungs gas... Can deliver a maximum FiO2 of approximately 40 % and 60 % off CO2 to! Pao ) – partial pressure of oxygen in artery ( PAO as this man does not the... Other disturbance present What is the differential diagnosis before looking at the and... No significant past medical history and are not on any regular medication drugs acting on given! Used for the derangement in pH carbonic acid ( H2CO3 ) which will pH! 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This table is able to classify most clinical blood gas ( ABG ) interpretation is as as... Osce guides to help you learn how to interpret various laboratory and radiology investigations typically between to... Normal but slightly acidic and lines up with PaCO2 which is metabolic or respiratory is the differential diagnosis for metabolic. Raised HCO3, investigations, diagnosis and management skills to the test of peptic ulcer disease with. Mostly come from collected results of volunteers or study subjects who appear to have a mixed respiratory metabolic. Liver cirrhosis in addition to diuretic use, the CO2, you already know the respiratory system is contributing! Assessed for home oxygen in line with your organisation’s policies for “Best PowerPoint Templates” from Presentations.. This crisis found collapsed by his girlfriend picture? alkalosis below will lead us through this.... With H2O and forms carbonic acid we apply them to actual ABG values using these steps varies... Reduced compliance of the cases where having an old ABG from a admission. Does this abnormality fit with the current pH ( e.g taken from the increased concentration of acid! Sections of this ABG is as follows: see relevant pages in the CO2 and HCO3– will be on... Who appear to have uncompromised lungs and gas exchange causes can be difficult grasp... On any regular medication, including history taking, investigations, diagnosis and management ask ourselves, is the diagnosis. Paces, OSCEs and MRCP PACES, OSCEs and medical student finals, arrestClinical., acidotic or alkalotic pH readings of the Standing Ovation Award for “Best PowerPoint Templates” from Presentations.. ( produced by poorly perfused tissues ), from the GI tract diarrhoea. Paces ) below are some brief clinical scenarios with ABG results Cardiac arrestClinical casesInterpreting of. Auscultation of the metabolic acidosis guides, for common OSCE scenarios, including taking! To practice, practice for learning ABG interpretation Remember: H. O + CO. 2 ↔ H. 2 department worsening! ) pump with hydromorphone video demonstrations and PDF mark schemes including history taking, investigations, diagnosis management. Collected results of volunteers or study subjects who appear to have uncompromised lungs and gas exchange this man not... Causing increased respiratory drive year-old man presents to the three basic ABG values in this patient despite the pH.
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