Professional Documents
Culture Documents
Treatment
Treat underlying cause
Breathe into a paper bag
IV Chloride containing solution
Cl- ions replace lost
bicarbonate ions
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2
Metabolic Acidosis
Bicarbonate deficit
blood concentrations of bicarb drop below 22mEq/L
Causes:
Failure of kidneys to excrete H+
Loss of bicarbonate through diarrhea, vommitus, or
renal dysfunction
Accumulation of acids (lactic acid or ketones)
Ingestion of Acids
3
Symptoms
Headache, lethargy
Nausea, vomiting, diarrhea
Coma
Death
4
Compensation
Increased ventilation
Renal excretion of hydrogen ions if
possible
K+ exchanges with excess H+ in ECF
( H+ into cells, K+ out of cells)
Treatment
IV lactate solution
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Metabolic Alkalosis
Caused by excess retention of HCO3- or loss of H+
from the body
concentration in blood is greater than 26 mEq/L
Causes :
Excess vomiting (loss of stomach acid)
Excessive use of alkaline drugs
Certain diuretics
Endocrine disorders
Heavy ingestion of antacids
Severe dehydration
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Symptoms of Metabolic
Alkalosis
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Compensation
Alkalosis most commonly occurs with
renal dysfunction, so cant count on
kidneys
Respiratory compensation difficult
hypoventilation limited by hypoxia
Treatment
Electrolytes to replace those lost
IV chloride containing solution
Treat underlying disorder
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A. Respiratory acidosis
Phase PH PaCO2 HCO3
UNCOMPENSATED ------
15
How to count Base
Excess
Base excess can be estimated
from the serum bicarbonate
concentration (HCO3- ) and pH by
the equation
Base excess = 0.93 x ([HCO3- ]
24,4 + 14,8 x (pH 7,4))
With units mEq/L
Base Excess = 0,93 x [HCO3- ]
+ 13,77 x pH 124,58
Base Excess Interpretation
Disorder BE
BB
x (-BE) = mEq total base deficit
3
Half Correction from total BE deficit
1 ampul Bicarbonate = 50 mL
Wait in 15-30 minutes, then re-evaluation
Treat the cause of metabolic acidosis
Example :
Mr. A , BW= 65 kg with BE = -15
20
DEFINITION
A diagnostic procedure in which a blood
is obtained from an artery directly by an
arterial puncture or accessed by a way of
indwelling arterial catheter
INDICATION
To obtain information about patient
ventilation (PCO2) , oxygenation (PO2) and
acid base balance
Monitor gas exchange and acid base
abnormalities for patient on mechanical
ventilator or not
To evaluate response to clinical intervention
and diagnostic evaluation ( oxygen therapy )
An ABG test may be most useful when a
person's breathing rate is increased or
decreased or when the person has very high
blood sugar levels, a severe infection, or
heart failure
ABG component & Normal value
pH = 7.35 7.45
PCO2 = 35 45 mmhg
HCO3 = 22 28 meq/L
EQUIPMENT
Blood gas kit OR
1ml syringe
23-26 gauge needle
Stopper or cap
Alcohol swab
Disposable gloves
Plastic bag & crushed ice
Lidocaine (optional)
Vial of heparin (1:1000)
Par code or label
Preparatory phase:
Record patient inspired oxygen concentration
Check patient temperature
Explain the procedure to the patient
Provide privacy for client
If not using hepranized syringe , hepranize the
needle
Perform Allen's test
Wait at least 20 minutes before drawing blood
for ABG after initiating, changing, or
discontinuing oxygen therapy, or settings of
mechanical ventilation, after suctioning the
patient or after extubation.
Sites for obtaining ABG
Radial artery ( most common )
Brachial artery
Femoral artery
Arteriospasm
Hematoma
Hemorrhage
Distal ischemia
Infection
Numbness
Interpretation of ABG results
Respiratory acidosis
PH 7.30acidemia
PaCO255 mmhg increased (respiratory cause)
HCO325 meq/lnormal
PaO2 80 mmhg normal
Metabolic alkalosis
PH 7.49 alkalemia
PaCO2 40 mmhg normal
HCO3 29 meq/l increased (metabolic
cause)
PaO2 85 mmhg normal
Thank you