Blood Gas Interpretation RES 142 week one

The arterial blood gas report is the cornerstone in the diagnosis and management of clinical acid-base disturbances and oxygenation. An arterial blood gas (ABG) is an invasive test that requires the use of a needle to draw blood from an artery. Invasive tests are still the “gold standard” for many diagnostic studies. The gold standard refers to the superior or best possible test compared to all other tests. An abnormal blood gas report may be the first clue to an acid-base or oxygenation problem. It may indicate the onset or culmination of cardiopulmonary crisis and may serve as a gauge with regard to the appropriateness or effectiveness of therapy. Thus, the arterial blood gas report plays a pivotal role in the overall care of cardiopulmonary disease. The arterial blood gas report allows for diagnosis, assessment, and intervention of clinical acid-base and oxygenation abnormalities.

Arterial blood gas results are used to give two pieces of information to the clinician

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The Acid-Base Status
The Oxygen Status of the blood
The pH is closely regulated in the body and as you have learned, there are numerous mechanisms to maintain the pH at a constant value such as buffers. Another way the body maintains a normal acid-base balance is through compensation. Compensation is the body’s attempt to return the pH to normal. It is important to understand that the body will compensate just enough to return the pH to a normal state but will never overcompensate. The two components of acid-base regulation (pH) are the respiratory and metabolic/renal systems. The respiratory system eliminates volatile acids through the lungs and the metabolic system eliminates nonvolatile or fixed acids through urine as well as maintains an adequate level of buffers such as bicarbonate. Compensation is accomplished by either the respiratory or the renal system in the case that either system does not function, as they should. If the respiratory system becomes suppressed such as with a drug overdose, then it becomes ineffective at eliminating the appropriate amount of CO 2. In this case, the metabolic system will attempt to correct the buildup of H + by reabsorbing more bicarbonate and excreting more H + through the urine.

Whenever a metabolic acidosis exists, the body’s chemoreceptors located in the medulla oblongata, in the carotid bodies sense these changes and send signals for the respiratory system to increase respiratory rate and depth (tidal volume). This is done in an attempt to blow off CO2 (volatile acid) to try to keep the pH constant. Ventilation will also decrease to compensate for metabolic alkalosis. This is an immediate response to bring the pH to a normal range.

When a metabolic acidosis is present then the anion gap can be calculated to determine the cause of the acidosis. The anion gap is the difference in the primary measured cations (positively charged ions) and anions (negatively charged ions). The anion gap allows us to determine whether fixed acid is being added or bicarbonate is being lost. Metabolic acidosis is due to one of two causes: fixed acids being added or a loss in bicarbonate due to kidney malfunction. An example of a fixed acid being added is lactic acid, which is the result of anaerobic metabolism. Renal failure is indicated when inadequate bicarbonate (HCO3-) is reabsorbed by the kidneys.

In response to respiratory acidosis, the renal system (kidneys) will compensate by retaining higher levels of bicarbonate in an attempt to correct the ph. Bicarbonate will be decreased by the renal system to balance the pH in the case of chronic hyperventilation. This is a slow response and can take days to bring the pH to a normal range.

The anion gap calculation is as follows:

Na+ – (HCO3- + Cl-)

Normal AG is 9-14 (K + has little effect on the calculated gap so it is acceptable to omit it)

Sodium (Na + )
The most plentiful electrolyte, found in high concentrations in extracellular fluid and in low concentrations in intracellular fluid. (Normal 135 – 145 mmol/L)
***Na produces the majority of osmotic pressure and regulates the amount of water in the body.***
Hypernatremia
Elevated plasma sodium concentrations, may result if the body’s water storage is depleted.
Hyponatremia
Decreased plasma serum sodium concentration., may result in vomiting, prolonged diarrhea.
Potassium (K + )
The most abundant of the intracellular cations, found in small quantities in the extracellular fluid.
(Normal 3.5 – 5.0 mmol/L)
***K + is essential for normal nerve and muscle function. ***
Hyperkalemia
Excessive plasma potassium levels often the result of later stages of renal disease.
Hypokalemia
Potassium levels of less than 3.0 mmol/L often the result of gastrointestinal loss through vomiting and diarrhea, prolonged administration of laxatives, and diuretic therapy. Hypokalemia is associated with neuromuscular abnormalities
Chloride (Cl – )
Maintained predominately in the extracellular fluid. Chloride plays a special function in the blood by maintaining electrical neutrality. Chloride is obtained almost entirely as sodium chloride absorbed in the intestinal tract, and its intake and output are essentially inseparable from sodium.
Hyperchloremia
Elevated chloride levels are associated with kidney dysfunction, Cushing’s disease, dehydration, hyperventilation.
Hypochloremia
Decreased chloride levels observed in diabetic ketoacidosis and through prolonged vomiting and diarrhea. Heat exhaustion and Addison’s disease also promote excessive chloride excretion.
Calcium (Ca ++ )
Present in the body in larger amounts than any other mineral element. About 99% of body calcium is found in the skeleton and teeth; only about 1% circulates in the bloodstream.
(Normal plasma calcium is 8.5 – 10.0 mg/dL)
Normal Ranges

Cl – 97 – 108 mmol/L
Ca ++ 8.5 – 10.0 mg/dL
HCO 3 –
22 -26 mEq/L

K + 3.5 – 5.0 mmol/L
Na +
135 – 145 mmol/L

Prompt
Interpret the acid-base blood level of each example. Be sure to identify

Acidosis or alkalosis
Respiratory or metabolic
Acute/uncompensated or compensated
If compensated is it partially or fully compensated
If the patient has metabolic acidosis, calculate the anion gap and state if acid is being added or blood bicarbonate levels are lost
How would you correct the acid-base imbalance?

(See Below)

pH 7.31

PaCO2 41

HCO3 20

Na+ 135

Cl- 100

Anion Gap if applicable

Interpretation:

(See Below)

pH 7.33

PaCO2 35

HCO3 18

Na+ 128

Cl- 95

Anion Gap if applicable

Interpretation:

(See Below)

pH 7.39

PaCO2 32

HCO3 19

Na 142

Cl 105

Anion Gap if applicable

Interpretation:

(See Below)

pH 7.51

PaCO2 32

HCO3 25

Na 128

Cl 110

Anion Gap if applicable

Interpretation:

(See Below)

pH7.21

PaCO2 38

HCO3 15

Na 142

Cl 102

Anion Gap if applicable

Interpretation:

(See Below)

pH 7.40

PaCO2 40

HCO3 24

Na 142

Cl 102

Anion Gap if applicable

Interpretation:

(See Below)

pH 7.34

PaCO2 49

HCO3 26

Na 140

Cl 100

Anion Gap if applicable

Interpretation:

(See Below)

pH 7.12

PaCO2 48

HCO3 15

Na 142

Cl 102

Anion Gap if applicable

Interpretation:

(See Below)

pH 7.57

PaCO2 25

HCO3 22

Na 141

Cl 111

Anion Gap if applicable

Interpretation:

(See Below)

pH 7.55

PaCO2 42

HCO3 36

Na 140

Cl 110

Anion Gap if applicable

Interpretation:

Submit your answers in at least 500 words on a Word document. You must cite at least three references in the IWG format to defend and support your position.

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