最新ABG analysis & Acid-Base Disorders - Home Page :动脉血气分析&酸碱失调-首页-PPT文档.ppt
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1、Outline,Discuss simple steps in analyzing ABGs Calculate the anion gap Calculate the delta gap Differentials for specific acid-base disorders,Steps for ABG analysis,What is the pH? Acidemia or Alkalemia? What is the primary disorder present? Is there appropriate compensation? Is the compensation acu
2、te or chronic? Is there an anion gap? If there is a AG check the delta gap? What is the differential for the clinical processes?,Normal Values,Step 1:,Look at the pH: is the blood acidemic or alkalemic? EXAMPLE : 65yo M with CKD presenting with nausea, diarrhea and acute respiratory distress ABG :AB
3、G 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5.1 ACIDMEIA OR ALKALEMIA ?,EXAMPLE ONE,ABG 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5.1 Answer PH = 7.23 , HCO3 7 Acidemia,Step 2: What is the primary disorder?,EXAMPLE,ABG 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3
4、 7/BUN 119/ Cr 5. PH is low , CO2 is Low PH and PCO2 are going in same directions then its most likely primary metabolic will check to see if there is a mixed disoder.,Step 3-4: Is there appropriate compensation? Is it chronic or acute?,Respiratory Acidosis Acute: for every 10 increase in pCO2 - HCO
5、3 increases by 1 and there is a decrease of 0.08 in pH MEMORIZE Chronic: for every 10 increase in pCO2 - HCO3 increases by 4 and there is a decrease of 0.03 in pH Respiratory Alkalosis Acute: for every 10 decrease in pCO2 - HCO3 decreases by 2 and there is a increase of 0.08 in PH MEMORIZE Chronic:
6、for every 10 decrease in pCO2 - HCO3 decreases by 5 and there is a increase of 0.03 in PH,Step 3-4: Is there appropriate compensation? Is it acute or chronic ?,Metabolic Acidosis Winters formula: pCO2 = 1.5HCO3 + 8 2 MEMORIZE If serum pCO2 expected pCO2 - additional respiratory acidosis Metabolic Al
7、kalosis For every 10 increase in HCO3 - pCO2 increases by 6,EXAMPLE,ABG 7.23/17/235 on 50% VM BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5. Winters formula : 17= 1.5 (7) +8 = 18.5 So correct compensation so there is only one disorder Primary metabolic,Step 5: Calculate the anion gap,AG = Na Cl HCO3 (norm
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