SlideShare ist ein Scribd-Unternehmen logo
1 von 39
Arterial blood gas
“Life is a struggle, not against
sin, not against the Money
Power, not against malicious
animal magnetism, but against
hydrogen ions."
H.L. MENCKEN
What is an ABG
Arterial Blood Gas
Drawn from artery- radial, brachial, femoral
It is an invasive procedure.
Caution must be taken with patient on
anticoagulants.
Arterial blood gas analysis is an essential part of
diagnosing and managing the patient’s
oxygenation status, ventilation failure and acid
base balance.
What Is An ABG?
pH [H+]
PCO2 Partial pressure
CO2
PO2 Partial pressure O2
HCO3 Bicarbonate
BE Base excess
SaO2 Oxygen Saturation
Acid/Base Balance
 The pH is a measurement of the acidity or alkalinity of the
blood.
 It is inversely proportional to the no. of (H+) in the blood.
 The normal pH range is 7.35-7.45.
Changes in body system functions that occur in an acidic
state decreases the force of cardiac contractions, decreases
the vascular response to catecholamines, and a diminished
response to the effects and actions of certain medications.
An alkalotic state interferes with tissue oxygenation and
normal neurological and muscular functioning.
Significant changes in the blood pH above 7.8 or below 6.8
will interfere with cellular functioning, and if uncorrected, will
lead to death.
H2O + CO2  H2CO3  HCO3 +
H+
Acid/Base Relationship
There are two buffers that work in pairs
H2CO3 NaHCO3
Carbonic acid base bicarbonate
These buffers are linked to the
respiratory and renal compensatory
system
Buffers
The Respiratory buffer response
• The blood pH will change acc.to
the level of H2CO3 present.
• This triggers the lungs to either
increase or decrease the rate and
depth of ventilation
• Activation of the lungs to
compensate for an imbalance
starts to occur within 1-3 minutes
The Renal Buffer Response
• The kidneys excrete or retain
bicarbonate(HCO3-).
• If blood pH decreases, the kidneys
will compensate by retaining HCO3
• Renal system may take from hours
to days to correct the imbalance.
COMPONENTS OF THE
ABG
pH: Measurement of acidity or alkalinity, based on the hydrogen (H+)
7.35 – 7.45
Pao2 The partial pressure oxygen that is dissolved in arterial blood.
80-100 mm Hg.
PCO2: The amount of carbon dioxide dissolved in arterial blood.
35– 45 mmHg
HCO3
: The calculated value of the amount of bicarbonate in the blood
22 – 26 mmol/L
B.E:
The base excess indicates the amount of excess or insufficient
level of bicarbonate. -2 to +2mEq/L
(A negative base excess indicates a base deficit in blood)
SaO2:The arterial oxygen saturation.
>95%
ACID BASE DISORDER
Res. Acidosis
• is defined as a pH less than 7.35 with a
paco2 greater than 45 mmHg.
• Acidosis –accumulation of co2,
combines with water in the body to
produce carbonic acid, thus lowering
the pH of the blood.
• Any condition that results in
hypoventilation can cause respiratory
acidosis.
Causes
1. Central nervous system depression r/t medications
such as narcotics, sedatives, or anesthesia.
2. Impaired muscle function r/t spinal cord injury,
neuromuscular diseases, or neuromuscular
blocking drugs.
3. Pulmonary disorders such as atelectasis(lung
collapse), pneumonia, pneumothorax, pulmonary
edema or bronchial obstruction
4. Massive pulmonary embolus
5. Hypoventilation due to pain chest wall injury, or
abdominal pain.
Signs & symptoms of Respiratory
Acidosis
• Respiratory : Dyspnoea, respiratory
distress and/or shallow respiration.
• Nervous: Headache, restlessness and
confusion. If co2 level extremely high
drowsiness and unresponsiveness may be
noted.
• CVS: Tacycardia and dysrhythmias
Management
• Increase the ventilation.
• Causes can be treated rapidly include
pneumothorax, pain and CNS depression
r/t medication.
• If the cause can not be readily resolved,
mechanical ventilation.
Respiratory alkalosis
• is defined as a pH more than 7.45 with a
paco2 less than 35 mmHg
CAUSES:
• Psychological responses, anxiety or fear.
• Pain
• Increased metabolic demands such as fever,
sepsis, pregnancy or thyrotoxicosis(increased
thyroid hormone).
• Medications such as respiratory stimulants.
• Central nervous system lesions
Signs & symptoms
• CNS: Light Headedness, numbness,
tingling, confusion, inability to concentrate
and blurred vision.
• Dysrhythmias and palpitations
• Dry mouth, diaphoresis and tetanic
(muscular) spasms of the arms and legs.
Management
• Resolve the underlying problem
• Monitor for respiratory muscle fatigue
• When the respiratory muscle
becomes exhausted, acute
respiratory failure may occur
Metabolic Acidosis
• Bicarbonate less than 22mEq/L with a pH
of less than 7.35.
CAUSES:
• Renal failure
• Diabetic ketoacidosis
• Anaerobic metabolism
• Starvation
• Salicylate intoxication
Sign & symptoms
• CNS: Headache, confusion and
restlessness progressing to lethargy, then
stupor(daze) or coma.
• CVS: Dysrhythmias
• Kussmaul’s respirations(deep & labored
breathing pattern)
• Warm, flushed skin as well as nausea and
vomiting
Management
• Treat the cause
• Hypoxia of any tissue bed will produce metabolic
acidosis as a result of anaerobic metabolism
even if the pao2 is normal
• Restore tissue perfusion to the hypoxic tissues
• The use of bicarbonate is indicated for known
bicarbonate - responsive acidosis such as seen
with renal failure
Metabolic alkalosis
• Bicarbonate more than 26m Eq /L with a pH
more than 7.45
• Excess of base /loss of acid can cause
• Ingestion of excess antacids, excess use of
bicarbonate, or use of lactate in dialysis.
• Protracted vomiting, gastric suction, excess use
of diuretics, or high levels of aldesterone.
Signs/symptoms
• CNS: Dizziness, lethargy
disorientation, siezures & coma.
• M/S: weakness, muscle twitching,
muscle cramps and tetany.
• Nausea, vomiting and respiratory
depression.
• It is difficult to treat.
STEPS TO AN ABG
INTERPRETATION
• Step:1
• Assess the pH –acidotic/alkalotic
• If above 7.5 – alkalotic
• If below 7.35 – acidotic
Contd…..
• Step 2:
• Assess the paCO2 level.
• pH decreases below 7.35, the paCO2
should rise.
• If pH rises above 7.45 paCO2 should fall.
• If pH and paCO2 moves in opposite
direction – primary respiratory problem.
contd
• Step:2
• Assess HCO3 value
• If pH increases the HCO3 should also
increase
• If pH decreases HCO3 should also
decrease
• They are moving in the same direction
• primary problem is metabolic
Respiratory
acidosis
pH PaCo2 HC03
normal
Respiratory
Alkalosis
normal
Metabolic
Acidosis
normal
Metabolic
Alkalosis
normal
• Step 3
Assess pao2 < 80 mm Hg - Hypoxemia
For a resp. disturbance : acute, chronic
The differentiation between Acute & Chronic,
respiratory disorders is based on whether there
is associated acidemia / alkalemia.
If the change in paco2 is associated with the
change in pH, the disorder is acute.
In chronic process the compensatory process
brings the pH to within the clinically acceptable
range ( 7.30 – 7.50)
• J is a 45 years old female admitted with the severe attack of
asthma. She has been experiencing increasing shortness of
breath since admission three hours ago. Her arterial blood
gas result is as follows:
• pH : 7.22
• paCO2 : 55
• HCO3 : 25
• Follow the steps
• pH is low – acidosis
• paCO2 is high – in the opposite direction of the pH.
• Hco3 is Normal.
• Respiratory Acidosis
• Need to improve ventilation by oxygen therapy,
mechanical ventilation, pulmonary toilet or by
administering bronchodilators.
• EXAMPLE 2: Mr. D is a 55 years old
admitted with recurring bowel
obstruction has been experiencing
intractable vomiting for the last several
hours. His ABG is:
• pH : 7.5
• paCO2 :42
• HCO3 : 33
• Metabolic alkalosis
• Management: IV fluids, measures to
reduce the excess base
BASE EXCESS
• Is a calculated value estimates the
metabolic component of an acid based
abnormality.
• It is defined as the amount of strong acid
or base added to blood to restore plasma
pH to 7.40 at a Paco2 40 mmHg.
• Positive value: Base Excess(increases in met. Alkalosis)
• Negative value: Base Deficit(decreases in met. Acidosis)
Formula
• With the base excess is -10 in a 50kg
person with metabolic acidosis mM of
Hco3 needed for correction is:
= 0.3 X body weight X BE
= 0.3 X 50 X10 = 150 mM
Take Home Message:
Valuable information can be gained from an
ABG as to the patients physiologic condition
Remember that ABG analysis if only part of the patient
assessment.
Be systematic with your analysis, start with ABC’s as always
and look for hypoxia (which you can usually treat quickly),
then follow the four steps.
A quick assessment of patient oxygenation can be achieved
with a pulse oximeter which measures SaO2.
It’s not magic understanding
ABG’s, it just takes a little
practice!
Practice ABG’s
1. PaO2 90 SaO2 95 pH 7.48 PaCO2 32 HCO3 24
2. PaO2 60 SaO2 90 pH 7.32 PaCO2 48 HCO3 25
3. PaO2 95 SaO2 100 pH 7.30 PaCO2 40 HCO3 18
4. PaO2 94 SaO2 99 pH 7.49 PaCO2 40 HCO3 30
5. PaO2 95 SaO2 99 pH 7.31 PaCO2 38 HCO3 15
6. PaO2 65 SaO2 89 pH 7.30 PaCO2 50 HCO3 24
7. PaO2 110 SaO2 100 pH 7.48 PaCO2 40 HCO3 30
What is going on?
Answers to Practice ABG’s
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic acidosis
4. Metabolic alkalosis
5. Metabolic acidosis
6. Respiratory acidosis
7. Metabolic alkalosis
Any Questions?
Understanding ABGs

Weitere ähnliche Inhalte

Was ist angesagt?

Arterial blood gas analysis 1
Arterial blood gas analysis 1Arterial blood gas analysis 1
Arterial blood gas analysis 1Ajay Kurian
 
Arterial Blood Gas Interpretation
Arterial Blood Gas InterpretationArterial Blood Gas Interpretation
Arterial Blood Gas InterpretationTauhid Iqbali
 
Acid Base Balance and ABG by Dr.Tinku Joseph
Acid Base Balance and ABG by Dr.Tinku JosephAcid Base Balance and ABG by Dr.Tinku Joseph
Acid Base Balance and ABG by Dr.Tinku JosephDr.Tinku Joseph
 
ARTERIAL BLOOD GAS ANALYSIS
ARTERIAL BLOOD GAS ANALYSISARTERIAL BLOOD GAS ANALYSIS
ARTERIAL BLOOD GAS ANALYSISGOPAL GHOSH
 
Blood Gas Analysis
Blood Gas AnalysisBlood Gas Analysis
Blood Gas AnalysisSCGH ED CME
 
cardiac output monitoring
cardiac output monitoringcardiac output monitoring
cardiac output monitoringmadhu chaitanya
 
Abg.2 Arterial blood gas analysis and example interpretation
Abg.2 Arterial blood gas analysis and example interpretationAbg.2 Arterial blood gas analysis and example interpretation
Abg.2 Arterial blood gas analysis and example interpretationsamirelansary
 
Interpreting Blood Gases, Practical and easy approach
Interpreting Blood Gases, Practical and easy approachInterpreting Blood Gases, Practical and easy approach
Interpreting Blood Gases, Practical and easy approachMuhammad Asim Rana
 
Interpretation of the Arterial Blood Gas analysis
Interpretation of the Arterial Blood Gas analysisInterpretation of the Arterial Blood Gas analysis
Interpretation of the Arterial Blood Gas analysisVishal Golay
 
ABG INTERPRETATION.pptx
ABG INTERPRETATION.pptxABG INTERPRETATION.pptx
ABG INTERPRETATION.pptxakash chauhan
 
Arterial blood gas.ppt1 (1)
Arterial blood gas.ppt1 (1)Arterial blood gas.ppt1 (1)
Arterial blood gas.ppt1 (1)Manu Jacob
 
Arterial Blood Gases Talk
Arterial Blood Gases TalkArterial Blood Gases Talk
Arterial Blood Gases TalkDang Thanh Tuan
 

Was ist angesagt? (20)

Arterial Blood Gases
Arterial Blood GasesArterial Blood Gases
Arterial Blood Gases
 
Arterial blood gas analysis 1
Arterial blood gas analysis 1Arterial blood gas analysis 1
Arterial blood gas analysis 1
 
ABG
ABGABG
ABG
 
ABG interpretation.
ABG  interpretation.ABG  interpretation.
ABG interpretation.
 
Arterial Blood Gas Interpretation
Arterial Blood Gas InterpretationArterial Blood Gas Interpretation
Arterial Blood Gas Interpretation
 
Acid Base Balance and ABG by Dr.Tinku Joseph
Acid Base Balance and ABG by Dr.Tinku JosephAcid Base Balance and ABG by Dr.Tinku Joseph
Acid Base Balance and ABG by Dr.Tinku Joseph
 
ABG
ABGABG
ABG
 
ARTERIAL BLOOD GAS ANALYSIS
ARTERIAL BLOOD GAS ANALYSISARTERIAL BLOOD GAS ANALYSIS
ARTERIAL BLOOD GAS ANALYSIS
 
ARTERIAL BLOOD GAS
ARTERIAL BLOOD GASARTERIAL BLOOD GAS
ARTERIAL BLOOD GAS
 
Blood Gas Analysis
Blood Gas AnalysisBlood Gas Analysis
Blood Gas Analysis
 
cardiac output monitoring
cardiac output monitoringcardiac output monitoring
cardiac output monitoring
 
Sasi ARTERIAL BLOOD GAS ANALYSIS
Sasi ARTERIAL BLOOD GAS ANALYSIS Sasi ARTERIAL BLOOD GAS ANALYSIS
Sasi ARTERIAL BLOOD GAS ANALYSIS
 
Capnography
CapnographyCapnography
Capnography
 
Abg.2 Arterial blood gas analysis and example interpretation
Abg.2 Arterial blood gas analysis and example interpretationAbg.2 Arterial blood gas analysis and example interpretation
Abg.2 Arterial blood gas analysis and example interpretation
 
Interpreting Blood Gases, Practical and easy approach
Interpreting Blood Gases, Practical and easy approachInterpreting Blood Gases, Practical and easy approach
Interpreting Blood Gases, Practical and easy approach
 
Interpretation of the Arterial Blood Gas analysis
Interpretation of the Arterial Blood Gas analysisInterpretation of the Arterial Blood Gas analysis
Interpretation of the Arterial Blood Gas analysis
 
ABG INTERPRETATION.pptx
ABG INTERPRETATION.pptxABG INTERPRETATION.pptx
ABG INTERPRETATION.pptx
 
ABG
ABGABG
ABG
 
Arterial blood gas.ppt1 (1)
Arterial blood gas.ppt1 (1)Arterial blood gas.ppt1 (1)
Arterial blood gas.ppt1 (1)
 
Arterial Blood Gases Talk
Arterial Blood Gases TalkArterial Blood Gases Talk
Arterial Blood Gases Talk
 

Ähnlich wie Understanding ABGs

Arterial Blood Gas and Acid Base Balance
Arterial Blood Gas and Acid Base BalanceArterial Blood Gas and Acid Base Balance
Arterial Blood Gas and Acid Base BalanceDr Riham Hazem Raafat
 
PRESENT: Acid base balance hossam (1).ppt
PRESENT: Acid base balance hossam (1).pptPRESENT: Acid base balance hossam (1).ppt
PRESENT: Acid base balance hossam (1).pptMbabazi Theos
 
Arterial blood gas analysis in clinical practice (2)
Arterial blood gas analysis in clinical practice (2)Arterial blood gas analysis in clinical practice (2)
Arterial blood gas analysis in clinical practice (2)Mohit Aggarwal
 
Acid Base disorder Concept.pptx
Acid Base disorder  Concept.pptxAcid Base disorder  Concept.pptx
Acid Base disorder Concept.pptximrulsujon1
 
Acid Base disorder Concept.pptx
Acid Base disorder  Concept.pptxAcid Base disorder  Concept.pptx
Acid Base disorder Concept.pptxImrul Sujon
 
Diagnosis and treatment of acid base disorders(1)
Diagnosis and treatment of acid base disorders(1)Diagnosis and treatment of acid base disorders(1)
Diagnosis and treatment of acid base disorders(1)aparna jayara
 
Arterial blood gas analysis and interpretation
Arterial blood gas analysis and interpretationArterial blood gas analysis and interpretation
Arterial blood gas analysis and interpretationAlisha Talwar
 
Arterial Blood Gases Interpretation, Bit-by-Bit approach
Arterial Blood Gases Interpretation, Bit-by-Bit approachArterial Blood Gases Interpretation, Bit-by-Bit approach
Arterial Blood Gases Interpretation, Bit-by-Bit approachKerolus Shehata
 
ABG, step by step approach (Updated)
ABG, step by step approach (Updated)ABG, step by step approach (Updated)
ABG, step by step approach (Updated)Kerolus Shehata
 
Acid Base Balance
Acid Base BalanceAcid Base Balance
Acid Base Balancewashinca
 
Acid base disorders
Acid base disordersAcid base disorders
Acid base disordersFara Dyba
 
SIMPLE AND SYSTEMATIC APPROACH TO Acid base disorders
SIMPLE AND SYSTEMATIC APPROACH TO Acid base disorders  SIMPLE AND SYSTEMATIC APPROACH TO Acid base disorders
SIMPLE AND SYSTEMATIC APPROACH TO Acid base disorders aishwaryajoshi18
 

Ähnlich wie Understanding ABGs (20)

Arterial Blood Gas and Acid Base Balance
Arterial Blood Gas and Acid Base BalanceArterial Blood Gas and Acid Base Balance
Arterial Blood Gas and Acid Base Balance
 
PRESENT: Acid base balance hossam (1).ppt
PRESENT: Acid base balance hossam (1).pptPRESENT: Acid base balance hossam (1).ppt
PRESENT: Acid base balance hossam (1).ppt
 
Arterial blood gas analysis in clinical practice (2)
Arterial blood gas analysis in clinical practice (2)Arterial blood gas analysis in clinical practice (2)
Arterial blood gas analysis in clinical practice (2)
 
Acid Base disorder Concept.pptx
Acid Base disorder  Concept.pptxAcid Base disorder  Concept.pptx
Acid Base disorder Concept.pptx
 
Acid Base disorder Concept.pptx
Acid Base disorder  Concept.pptxAcid Base disorder  Concept.pptx
Acid Base disorder Concept.pptx
 
Abg interpretation
Abg interpretation Abg interpretation
Abg interpretation
 
ABG Analysis & Interpretation
ABG Analysis & InterpretationABG Analysis & Interpretation
ABG Analysis & Interpretation
 
ABG
ABGABG
ABG
 
ABG.pdf
ABG.pdfABG.pdf
ABG.pdf
 
Acid base imbalance disorder2020
Acid base imbalance  disorder2020Acid base imbalance  disorder2020
Acid base imbalance disorder2020
 
Diagnosis and treatment of acid base disorders(1)
Diagnosis and treatment of acid base disorders(1)Diagnosis and treatment of acid base disorders(1)
Diagnosis and treatment of acid base disorders(1)
 
Pathophysiology of ph
Pathophysiology of phPathophysiology of ph
Pathophysiology of ph
 
Ncm Ppt6
Ncm Ppt6Ncm Ppt6
Ncm Ppt6
 
Arterial blood gas analysis and interpretation
Arterial blood gas analysis and interpretationArterial blood gas analysis and interpretation
Arterial blood gas analysis and interpretation
 
Basic ABG notes
Basic ABG notesBasic ABG notes
Basic ABG notes
 
Arterial Blood Gases Interpretation, Bit-by-Bit approach
Arterial Blood Gases Interpretation, Bit-by-Bit approachArterial Blood Gases Interpretation, Bit-by-Bit approach
Arterial Blood Gases Interpretation, Bit-by-Bit approach
 
ABG, step by step approach (Updated)
ABG, step by step approach (Updated)ABG, step by step approach (Updated)
ABG, step by step approach (Updated)
 
Acid Base Balance
Acid Base BalanceAcid Base Balance
Acid Base Balance
 
Acid base disorders
Acid base disordersAcid base disorders
Acid base disorders
 
SIMPLE AND SYSTEMATIC APPROACH TO Acid base disorders
SIMPLE AND SYSTEMATIC APPROACH TO Acid base disorders  SIMPLE AND SYSTEMATIC APPROACH TO Acid base disorders
SIMPLE AND SYSTEMATIC APPROACH TO Acid base disorders
 

Kürzlich hochgeladen

97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAAjennyeacort
 
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any TimeCall Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Timevijaych2041
 
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Case Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxCase Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxNiranjan Chavan
 
Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.ANJALI
 
LUNG TUMORS AND ITS CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS  CLASSIFICATIONS.pdfLUNG TUMORS AND ITS  CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS CLASSIFICATIONS.pdfDolisha Warbi
 
Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)Mohamed Rizk Khodair
 
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfMedicoseAcademics
 
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara RajendranMusic Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara RajendranTara Rajendran
 
BIOLOGICAL ASSAY OF ANTIBIOTICS , VITAMIN D , DIGOXIN & INSULIN
BIOLOGICAL ASSAY  OF ANTIBIOTICS , VITAMIN D , DIGOXIN  & INSULINBIOLOGICAL ASSAY  OF ANTIBIOTICS , VITAMIN D , DIGOXIN  & INSULIN
BIOLOGICAL ASSAY OF ANTIBIOTICS , VITAMIN D , DIGOXIN & INSULINHasnat Tariq
 
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxSYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxdrashraf369
 
POST NATAL EXERCISES AND ITS IMPACT.pptx
POST NATAL EXERCISES AND ITS IMPACT.pptxPOST NATAL EXERCISES AND ITS IMPACT.pptx
POST NATAL EXERCISES AND ITS IMPACT.pptxvirengeeta
 
Report Back from SGO: What’s New in Uterine Cancer?.pptx
Report Back from SGO: What’s New in Uterine Cancer?.pptxReport Back from SGO: What’s New in Uterine Cancer?.pptx
Report Back from SGO: What’s New in Uterine Cancer?.pptxbkling
 
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATROApril 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATROKanhu Charan
 
Radiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxRadiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxDr. Dheeraj Kumar
 
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...DrGoharMushtaq
 
Hematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsHematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsMedicoseAcademics
 

Kürzlich hochgeladen (20)

97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA97111 47426 Call Girls In Delhi MUNIRKAA
97111 47426 Call Girls In Delhi MUNIRKAA
 
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any TimeCall Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
 
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in aerocity DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in dwarka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Epilepsy
EpilepsyEpilepsy
Epilepsy
 
Case Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptxCase Report Peripartum Cardiomyopathy.pptx
Case Report Peripartum Cardiomyopathy.pptx
 
Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.Statistical modeling in pharmaceutical research and development.
Statistical modeling in pharmaceutical research and development.
 
LUNG TUMORS AND ITS CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS  CLASSIFICATIONS.pdfLUNG TUMORS AND ITS  CLASSIFICATIONS.pdf
LUNG TUMORS AND ITS CLASSIFICATIONS.pdf
 
Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)Primary headache and facial pain. (2024)
Primary headache and facial pain. (2024)
 
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in paharganj DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdfHemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
 
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara RajendranMusic Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
Music Therapy's Impact in Palliative Care| IAPCON2024| Dr. Tara Rajendran
 
BIOLOGICAL ASSAY OF ANTIBIOTICS , VITAMIN D , DIGOXIN & INSULIN
BIOLOGICAL ASSAY  OF ANTIBIOTICS , VITAMIN D , DIGOXIN  & INSULINBIOLOGICAL ASSAY  OF ANTIBIOTICS , VITAMIN D , DIGOXIN  & INSULIN
BIOLOGICAL ASSAY OF ANTIBIOTICS , VITAMIN D , DIGOXIN & INSULIN
 
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxSYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
 
POST NATAL EXERCISES AND ITS IMPACT.pptx
POST NATAL EXERCISES AND ITS IMPACT.pptxPOST NATAL EXERCISES AND ITS IMPACT.pptx
POST NATAL EXERCISES AND ITS IMPACT.pptx
 
Report Back from SGO: What’s New in Uterine Cancer?.pptx
Report Back from SGO: What’s New in Uterine Cancer?.pptxReport Back from SGO: What’s New in Uterine Cancer?.pptx
Report Back from SGO: What’s New in Uterine Cancer?.pptx
 
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATROApril 2024 ONCOLOGY CARTOON by  DR KANHU CHARAN PATRO
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
 
Radiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptxRadiation Dosimetry Parameters and Isodose Curves.pptx
Radiation Dosimetry Parameters and Isodose Curves.pptx
 
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...
The New Standard of Care__Leveraging the Benefits of SGLT2 Inhibitors Across ...
 
Hematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes FunctionsHematology and Immunology - Leukocytes Functions
Hematology and Immunology - Leukocytes Functions
 

Understanding ABGs

  • 2. “Life is a struggle, not against sin, not against the Money Power, not against malicious animal magnetism, but against hydrogen ions." H.L. MENCKEN
  • 3. What is an ABG Arterial Blood Gas Drawn from artery- radial, brachial, femoral It is an invasive procedure. Caution must be taken with patient on anticoagulants. Arterial blood gas analysis is an essential part of diagnosing and managing the patient’s oxygenation status, ventilation failure and acid base balance.
  • 4. What Is An ABG? pH [H+] PCO2 Partial pressure CO2 PO2 Partial pressure O2 HCO3 Bicarbonate BE Base excess SaO2 Oxygen Saturation
  • 5. Acid/Base Balance  The pH is a measurement of the acidity or alkalinity of the blood.  It is inversely proportional to the no. of (H+) in the blood.  The normal pH range is 7.35-7.45. Changes in body system functions that occur in an acidic state decreases the force of cardiac contractions, decreases the vascular response to catecholamines, and a diminished response to the effects and actions of certain medications. An alkalotic state interferes with tissue oxygenation and normal neurological and muscular functioning. Significant changes in the blood pH above 7.8 or below 6.8 will interfere with cellular functioning, and if uncorrected, will lead to death.
  • 6. H2O + CO2  H2CO3  HCO3 + H+ Acid/Base Relationship
  • 7. There are two buffers that work in pairs H2CO3 NaHCO3 Carbonic acid base bicarbonate These buffers are linked to the respiratory and renal compensatory system Buffers
  • 8. The Respiratory buffer response • The blood pH will change acc.to the level of H2CO3 present. • This triggers the lungs to either increase or decrease the rate and depth of ventilation • Activation of the lungs to compensate for an imbalance starts to occur within 1-3 minutes
  • 9. The Renal Buffer Response • The kidneys excrete or retain bicarbonate(HCO3-). • If blood pH decreases, the kidneys will compensate by retaining HCO3 • Renal system may take from hours to days to correct the imbalance.
  • 10.
  • 11. COMPONENTS OF THE ABG pH: Measurement of acidity or alkalinity, based on the hydrogen (H+) 7.35 – 7.45 Pao2 The partial pressure oxygen that is dissolved in arterial blood. 80-100 mm Hg. PCO2: The amount of carbon dioxide dissolved in arterial blood. 35– 45 mmHg HCO3 : The calculated value of the amount of bicarbonate in the blood 22 – 26 mmol/L B.E: The base excess indicates the amount of excess or insufficient level of bicarbonate. -2 to +2mEq/L (A negative base excess indicates a base deficit in blood) SaO2:The arterial oxygen saturation. >95%
  • 12. ACID BASE DISORDER Res. Acidosis • is defined as a pH less than 7.35 with a paco2 greater than 45 mmHg. • Acidosis –accumulation of co2, combines with water in the body to produce carbonic acid, thus lowering the pH of the blood. • Any condition that results in hypoventilation can cause respiratory acidosis.
  • 13. Causes 1. Central nervous system depression r/t medications such as narcotics, sedatives, or anesthesia. 2. Impaired muscle function r/t spinal cord injury, neuromuscular diseases, or neuromuscular blocking drugs. 3. Pulmonary disorders such as atelectasis(lung collapse), pneumonia, pneumothorax, pulmonary edema or bronchial obstruction 4. Massive pulmonary embolus 5. Hypoventilation due to pain chest wall injury, or abdominal pain.
  • 14. Signs & symptoms of Respiratory Acidosis • Respiratory : Dyspnoea, respiratory distress and/or shallow respiration. • Nervous: Headache, restlessness and confusion. If co2 level extremely high drowsiness and unresponsiveness may be noted. • CVS: Tacycardia and dysrhythmias
  • 15. Management • Increase the ventilation. • Causes can be treated rapidly include pneumothorax, pain and CNS depression r/t medication. • If the cause can not be readily resolved, mechanical ventilation.
  • 16. Respiratory alkalosis • is defined as a pH more than 7.45 with a paco2 less than 35 mmHg CAUSES: • Psychological responses, anxiety or fear. • Pain • Increased metabolic demands such as fever, sepsis, pregnancy or thyrotoxicosis(increased thyroid hormone). • Medications such as respiratory stimulants. • Central nervous system lesions
  • 17. Signs & symptoms • CNS: Light Headedness, numbness, tingling, confusion, inability to concentrate and blurred vision. • Dysrhythmias and palpitations • Dry mouth, diaphoresis and tetanic (muscular) spasms of the arms and legs.
  • 18. Management • Resolve the underlying problem • Monitor for respiratory muscle fatigue • When the respiratory muscle becomes exhausted, acute respiratory failure may occur
  • 19. Metabolic Acidosis • Bicarbonate less than 22mEq/L with a pH of less than 7.35. CAUSES: • Renal failure • Diabetic ketoacidosis • Anaerobic metabolism • Starvation • Salicylate intoxication
  • 20. Sign & symptoms • CNS: Headache, confusion and restlessness progressing to lethargy, then stupor(daze) or coma. • CVS: Dysrhythmias • Kussmaul’s respirations(deep & labored breathing pattern) • Warm, flushed skin as well as nausea and vomiting
  • 21. Management • Treat the cause • Hypoxia of any tissue bed will produce metabolic acidosis as a result of anaerobic metabolism even if the pao2 is normal • Restore tissue perfusion to the hypoxic tissues • The use of bicarbonate is indicated for known bicarbonate - responsive acidosis such as seen with renal failure
  • 22. Metabolic alkalosis • Bicarbonate more than 26m Eq /L with a pH more than 7.45 • Excess of base /loss of acid can cause • Ingestion of excess antacids, excess use of bicarbonate, or use of lactate in dialysis. • Protracted vomiting, gastric suction, excess use of diuretics, or high levels of aldesterone.
  • 23. Signs/symptoms • CNS: Dizziness, lethargy disorientation, siezures & coma. • M/S: weakness, muscle twitching, muscle cramps and tetany. • Nausea, vomiting and respiratory depression. • It is difficult to treat.
  • 24. STEPS TO AN ABG INTERPRETATION • Step:1 • Assess the pH –acidotic/alkalotic • If above 7.5 – alkalotic • If below 7.35 – acidotic
  • 25. Contd….. • Step 2: • Assess the paCO2 level. • pH decreases below 7.35, the paCO2 should rise. • If pH rises above 7.45 paCO2 should fall. • If pH and paCO2 moves in opposite direction – primary respiratory problem.
  • 26. contd • Step:2 • Assess HCO3 value • If pH increases the HCO3 should also increase • If pH decreases HCO3 should also decrease • They are moving in the same direction • primary problem is metabolic
  • 28. • Step 3 Assess pao2 < 80 mm Hg - Hypoxemia For a resp. disturbance : acute, chronic The differentiation between Acute & Chronic, respiratory disorders is based on whether there is associated acidemia / alkalemia. If the change in paco2 is associated with the change in pH, the disorder is acute. In chronic process the compensatory process brings the pH to within the clinically acceptable range ( 7.30 – 7.50)
  • 29. • J is a 45 years old female admitted with the severe attack of asthma. She has been experiencing increasing shortness of breath since admission three hours ago. Her arterial blood gas result is as follows: • pH : 7.22 • paCO2 : 55 • HCO3 : 25 • Follow the steps • pH is low – acidosis • paCO2 is high – in the opposite direction of the pH. • Hco3 is Normal. • Respiratory Acidosis • Need to improve ventilation by oxygen therapy, mechanical ventilation, pulmonary toilet or by administering bronchodilators.
  • 30. • EXAMPLE 2: Mr. D is a 55 years old admitted with recurring bowel obstruction has been experiencing intractable vomiting for the last several hours. His ABG is: • pH : 7.5 • paCO2 :42 • HCO3 : 33 • Metabolic alkalosis • Management: IV fluids, measures to reduce the excess base
  • 31. BASE EXCESS • Is a calculated value estimates the metabolic component of an acid based abnormality. • It is defined as the amount of strong acid or base added to blood to restore plasma pH to 7.40 at a Paco2 40 mmHg. • Positive value: Base Excess(increases in met. Alkalosis) • Negative value: Base Deficit(decreases in met. Acidosis)
  • 32. Formula • With the base excess is -10 in a 50kg person with metabolic acidosis mM of Hco3 needed for correction is: = 0.3 X body weight X BE = 0.3 X 50 X10 = 150 mM
  • 33. Take Home Message: Valuable information can be gained from an ABG as to the patients physiologic condition Remember that ABG analysis if only part of the patient assessment. Be systematic with your analysis, start with ABC’s as always and look for hypoxia (which you can usually treat quickly), then follow the four steps. A quick assessment of patient oxygenation can be achieved with a pulse oximeter which measures SaO2.
  • 34. It’s not magic understanding ABG’s, it just takes a little practice!
  • 35. Practice ABG’s 1. PaO2 90 SaO2 95 pH 7.48 PaCO2 32 HCO3 24 2. PaO2 60 SaO2 90 pH 7.32 PaCO2 48 HCO3 25 3. PaO2 95 SaO2 100 pH 7.30 PaCO2 40 HCO3 18 4. PaO2 94 SaO2 99 pH 7.49 PaCO2 40 HCO3 30 5. PaO2 95 SaO2 99 pH 7.31 PaCO2 38 HCO3 15 6. PaO2 65 SaO2 89 pH 7.30 PaCO2 50 HCO3 24 7. PaO2 110 SaO2 100 pH 7.48 PaCO2 40 HCO3 30
  • 37. Answers to Practice ABG’s 1. Respiratory alkalosis 2. Respiratory acidosis 3. Metabolic acidosis 4. Metabolic alkalosis 5. Metabolic acidosis 6. Respiratory acidosis 7. Metabolic alkalosis