{"id":4912,"date":"2020-07-28T10:37:49","date_gmt":"2020-07-28T10:37:49","guid":{"rendered":"http:\/\/edren.org\/ren\/acid-base-interpretation\/"},"modified":"2020-12-17T08:12:15","modified_gmt":"2020-12-17T08:12:15","slug":"acid-base-interpretation","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/education\/other-resources\/acid-base-interpretation\/","title":{"rendered":"Acid Base Interpretation"},"content":{"rendered":"\n<p>How to interpret acid base abnormalities in blood gases, by Dr Jess McNiff.<\/p>\n\n\n\n<p>Using an arterial blood gas or ABG is one of the common way&#8217;s of determining acid base status in a patient. It is a skill that many individuals find difficult. This page hopes to help you by explaining a simple way of looking through an ABG result and determining the acid\/base abnormality.<\/p>\n\n\n\n<p>In renal disease acid\/base profiles are important mainly due to the management of decreased bicarbonate production by the kidney or intoxication of the agent leading to renal impairment.<\/p>\n\n\n\n<p>For the purpose of this teaching we will refer mainly to the terms acidaemic and alkaleamic (acidaemia\/alkalaemia) describing the balance of ions in the blood.<\/p>\n\n\n\n<iframe loading=\"lazy\" id=\"kaltura_player\" src=\"https:\/\/cdnapisec.kaltura.com\/p\/2010292\/sp\/201029200\/embedIframeJs\/uiconf_id\/32599141\/partner_id\/2010292?iframeembed=true&amp;playerId=kaltura_player&amp;entry_id=1_28d7vyhd&amp;flashvars[streamerType]=auto&amp;flashvars[localizationCode]=en&amp;flashvars[leadWithHTML5]=true&amp;flashvars[sideBarContainer.plugin]=true&amp;flashvars[sideBarContainer.position]=left&amp;flashvars[sideBarContainer.clickToClose]=true&amp;flashvars[chapters.plugin]=true&amp;flashvars[chapters.layout]=vertical&amp;flashvars[chapters.thumbnailRotator]=false&amp;flashvars[streamSelector.plugin]=true&amp;flashvars[EmbedPlayer.SpinnerTarget]=videoHolder&amp;flashvars[dualScreen.plugin]=true&amp;flashvars[Kaltura.addCrossoriginToIframe]=true&amp;&amp;wid=1_0dfak51o\" allowfullscreen=\"\" webkitallowfullscreen=\"\" mozallowfullscreen=\"\" allow=\"autoplay *; fullscreen *; encrypted-media *\" sandbox=\"allow-forms allow-same-origin allow-scripts allow-top-navigation allow-pointer-lock allow-popups allow-modals allow-orientation-lock allow-popups-to-escape-sandbox allow-presentation allow-top-navigation-by-user-activation\" title=\"Kaltura Player\" width=\"400\" height=\"285\" frameborder=\"0\"><\/iframe>\n\n\n\n<p>The text below is covered in the video above but acts as a supplementary reminder.<\/p>\n\n\n\n<p class=\"has-text-color has-medium-font-size\" style=\"color:#d81a1a\"><strong>Hydrogen Ions\/pH<\/strong><\/p>\n\n\n\n<p>Most ABG strips will have normal values on them so do not worry about memorising them.<\/p>\n\n\n\n<p>We have determined whether there is an acidaemia or an alkalaemia, next we determine the cause.<\/p>\n\n\n\n<p class=\"has-text-color has-medium-font-size\" style=\"color:#e01616\"><strong>Is there a respiratory cause?<\/strong><\/p>\n\n\n\n<p>So Carbon Dioxide is the marker of respiratory causes of acid base disturbance, however there is another cause.<\/p>\n\n\n\n<p class=\"has-medium-font-size\"><strong><span style=\"color:#da1313\" class=\"tadv-color\">Is there a metabolic component?<\/span><\/strong><\/p>\n\n\n\n<p>So we have discussed about primary causes of acid\/base disturbance and had a quick introduction to compensation but here is a bit of a further explanation.<\/p>\n\n\n\n<p class=\"has-text-color has-medium-font-size\" style=\"color:#dd1616\"><strong>Compensation and Anion Gap<\/strong><\/p>\n\n\n\n<p>The example in the video is acidaemia however it is the same for alkalaemia where CO2 can be increased to try to compensate for a metabolic alkalaemia. If only one of either carbon dioxide or bicarbonate is changed there is likely to be a primary abnormality but if both have changed there is likely to be compensation.<\/p>\n\n\n\n<p>The anion gap, quoted normal values for AG vary; some say &lt;16 meq\/l (&lt;11 or 12 if calculated without potassium. Anion gap can be useful, but it isn&#8217;t very reliable for spotting unmeasured anions when it is only moderately elevated, and is sometimes not as high as you&#8217;d expect, for example in some patients with lactic acidosis.&nbsp;&nbsp;Renal failure increases it.<\/p>\n\n\n\n<p>Common causes of acid base disturbance<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong><span style=\"color:#d81616\" class=\"tadv-color\"> Respiratory Acidosis<\/span><\/strong><br>&#8211; Sleep apnoea<br>&#8211; Opiates<br>-Sedatives<br>&#8211; COPD<br>&#8211; Asthma with T2RF<br>&#8211; Neuromuscular diseases<br>&#8211; Some pneumonia<br><br><\/td><td><strong><span style=\"color:#db1818\" class=\"tadv-color\">Metabolic Acidosis<\/span><\/strong><br>-Renal tubular Acidosis eg. Fanconi&#8217;s syndrome<br>&#8211; Uraemia<br>&#8211; Diabetic ketoacidosis<br>&#8211; Lactic acidosis<br>&#8211; Toxins &#8211; ethylene glycol         <br>               &#8211; Methanol<br>               &#8211; Salicylates aspirin etc<br><\/td><\/tr><tr><td><strong><span style=\"color:#dd1414\" class=\"tadv-color\">Respiratory Alka<\/span><span style=\"color:#dc1515\" class=\"tadv-color\">lalosis<\/span><\/strong><br>&#8211; Hypoxaemia<br>&#8211; Any cause of hyperventilation &#8211; Pain, anxiety, panic etc<br><br><\/td><td><strong><span style=\"color:#df1616\" class=\"tadv-color\">Metabolic alk<\/span><span style=\"color:#df1919\" class=\"tadv-color\">alosis<\/span><\/strong><br>&#8211; Vomiting and diarrhoea<br>&#8211; Diuretics &#8211; especially loop diuretics<br>&#8211; Continued antacid overuse<br><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>Now test yourself on the following cases\u00a0<\/p>\n<ul>\n<li><a href=\"http:\/\/edren.org\/ren\/education\/acid-base-interpretation\/acid-base-teaching-case-1\/\">Case 1<\/a>\u00a0<\/li>\n<li><a href=\"http:\/\/edren.org\/ren\/education\/acid-base-interpretation\/case-2\/\">Case 2<\/a>\u00a0<\/li>\n<li><a href=\"http:\/\/edren.org\/ren\/education\/acid-base-interpretation\/acid-base-teaching-case-3\/\">Case 3<\/a><\/li>\n<li><a href=\"http:\/\/edren.org\/ren\/education\/acid-base-interpretation\/acid-base-teaching-case-4\/\">Case 4<\/a><\/li>\n<li><a href=\"http:\/\/edren.org\/ren\/education\/acid-base-interpretation\/acid-base-teaching-case-5\/\">Case 5<\/a><\/li>\n<li><a href=\"http:\/\/edren.org\/ren\/education\/acid-base-interpretation\/acid-base-teaching-case-6\/\">Case 6<\/a>\u00a0<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>How to interpret acid base abnormalities in blood gases, by Dr Jess McNiff. Using an arterial blood gas or ABG is one of the common way&#8217;s of determining acid base status in a patient. It is a skill that many individuals find difficult. This page hopes to help you by\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/education\/other-resources\/acid-base-interpretation\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":5302,"menu_order":51,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-4912","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/4912","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=4912"}],"version-history":[{"count":9,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/4912\/revisions"}],"predecessor-version":[{"id":5276,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/4912\/revisions\/5276"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/5302"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=4912"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}