ABG.txt

pH – 7.35-7.45 – free H+ in blood; pCO2 – 35-45 mmHg –respiratory component; HCO3 – 22-26 mEq/L – renal/metabolic component; Base Excess - +2 to –2mEq/L –HCO3 concentration

"Buffering, respiratory compensation, metabolic compemsation"

prevents major changes in pH by removing or releasing H+; uses chemical reaction between acids and bases to maintain neutral environment. The major reversible reaction is H+ + HCO3 < --> H2CO3 < --> CO2 + H2O; The body maintains 20:1 ratio of HCO3 to H2CO3; This mechanism occurs within minutes

increase or decrease alveolar ventilation; Hyperventilate to decrease CO2 levels thus decrease H2CO3 and increase pH; Hypoventilate to increase CO2 levels thus increase H2CO3 and decrease pH; This mechanism takes minutes to hours

compensates through rate of elimination or reabsorption of H+ and HCO3 in the kidneys; This mechanism takes hours to days

"uncompensated (acute), partially compensated, compensated (chronic), Corrected"

"—the pH is within normal limits, all acid-base parameters return to normal ranges "

"the pH is within normal limits, the acid-base imbalance has been neutralized but not corrected. The acid-base components are abnormal but balanced. Remember the body maintains the 20:1 ratio. Examples : pH – 7.36, pCO2 – 55, HCO3 – 33 (comp respiratory acidosis); pH-7.36, pCO2 – 23, HCO3 –13 (comp metabolic acidosis)"

"the pH is abnormal but the body buffers and regulatory mechanisms have started to respond to the imbalance. Thus, the acid-base components are abnormal. Examples – pH – 7.26, pCO2 – 23, HCO3 –8 ( part compensated met acidosis)"

"ABNORMAL pH due to buffer and regulatory mechanisms have not begun to correct the imbalance. (also described as acute); Also the acid or base component is abnormal examples- pH – 7.16, pCO2 – 82, HCO3 – 26 (resp acidosis); pH – 7.52, pCO2 – 42, HCO3 – 35 (metabolic alkalosis)"

"Primary H2CO3 deficit or decreased CO2; pH >7.45, pCO2 < 35mmHg, & HCO3 - normal or < 22mEq/L"

"—dizziness, diaphoresis, palpitations, dyspnea, panic, anxiety, tetany, convulsions"

"—reduce anxiety by sedation, rebreathe CO2"

"Primary H2CO3 excess or increased CO2; pH <7.35, pCO2 > 45mmHg, HCO3 -normal or > 26mEq/L"

"—warm flushed skin, tachycardia, H/A, decreased LOC, muscle twitching, papilledema"

—breathing treatments; O2 and IV therapy – be careful when giving oxygen to COPD clients; if client in pain administer medication as ordered

"Primary excess in ECF of HCO3 due to loss of acid or addition of excess HCO3; pH>7.45, HCO3>26mEq/L, pCO2 – normal or > 45mmHg"

"—hypotension, tachycardia, hyperreflexia, tetany, dysrhythmias, confusion, decreased LOC, seizures, respiratory failure"

"—monitor GI symptoms and treat, monitor Cardiac output r/t volume depletion, give KCL, treat cause of condition"

"alveolar hypoventilation; chest trauma, pain, opiates, brain tumor, chronic conditions like COPD, MS, Stroke"

increased H+ loss – gastric suction; vomiting; diuretics; mineralcorticoid-aldosterone- hypercalcemia; decreased K+; alkali ingestion; blood administration; bicarb administration during a code;

"alveolar hyperventilation –fever, infection, mechanical ventilators, salicylate poison, stimulate resp. center, anxiety"

"Primary loss of HCO3 from ECF and/or due to increased acid production; pH<7.35, HCO3<22mEq/L, pCO2 –normal or < 35mmHg"

"increased acid production – lactic acids; DKA; starvation; poisons; loss of bicarb – diarrhea, ileostomy, biliary or pancreatic fistulas; increased CL- production; renal failure causes retention of acids"

"—anorexia, n/v, abd pain, weakness, decreased LOC, bradycardia, dysrhythmias, warm flushed skin, hyperventilation, Kussmaul’s breathing in the diabetic"

—monitor for cardiac dysrhythmias; replacement of electrolytes; neuro status assess; EKG; GI assess; fluid I & O; correct underlying problem