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A Squint on ABG ANALYSIS

pH 7.35-7.45 pCO2 35-45mmHg Remember the cue? We write CO2 as HCO322-26mEq/L Remember the cue? We write HCO3- as

<7.35: ACIDIC

>7.45 ALKALOSIS

<35mmHg ALKALOSIS

>45mmHg ACIDIC

<22mEq/L ACIDIC

>26mEq/L ALKALOSIS

CO2
i d
So its like as CO2 level increases acidity also increases.

Bicarbonate a s e
So its like as HCO3- level increases alkalinity also increases.

Determining Acid-Base Imbalance: If pH and pCO2 are primarily affected, RESPIRATORY acid-base imbalance will result. If pH and HCO3 are primarily affected, METABOLIC acid-base imbalance will result To determine specifically which is Respiratory Acidosis or Alkalosis, and Metabolic Acidosis or Alkalosis conversely, remember the mnemonic ROME. 1. We first look on 2 same acidic or alkalinic ABG factors: E.g. ph 7.20(acid), pCO2 50(acid), HCO3 30(base) 2 acids: pH and pCO2, therefore RESPIRATORY in problem E.g. pH 7.5(base), pCO2 54 (acid), HCO3 30(base) 2 bases: pH and HCO3, therefore METABOLIC in problem E.g. pH 7.24(acid), pCO2 52(acid), HCO3 18(acid) 3 acids or even 3 bases are impossible findings in ABG results, since either the lungs or kidneys are expected to compensate in any particular imbalance. This is quite opposite to what I taught you before that when this finding (3acids/bases) appears we should call it uncompensated acid-base imbalance. Thats why here is an updated and more reliable lecture about ABG analysis and sorry though. 2. After looking for 2 same acidic or alkalinic ABG factors, next is to use ROME as for: Respiratory Opposite Metabolic Equal Arrow signifies decreasing level whereas arrow is for increasing level. If it is in normal range/value, no arrows needed.

Word Opposite denotes opposite direction of 2 arrows, specifically pH *acid() or base()+ being in contrast to pCO2 *base() or acid ()]. Example: pH: 7.15 (), pCO2 (): 54, HCO3-: 25(normal) - From the given example we will find two (2) acids pH and pCO2 respectively; -Then looking at the arrows of two found acids they are pointing in opposite directions; - Since the two (2) acids were found with arrows in opposite direction, this just more suggest of RESPIRATORY imbalance as for ROME that Respiratory Opposite; - Also, since two (2) acids from 3 ABG factors were found already, then justifiable to say that it is an ACIDOSIS imbalance. INTERPRETATION: RESPIRATORY ACIDOSIS Word Equal denotes same direction of 2 arrows, specifically pH *acid() or base()+ being adjacent to HCO3 *acid() or base()+ Example: pH: 7.58 (), PaCO2: 53(), HCO3- 28 () - From the given example we will find two (2) bases pH and HCO3- respectively; -Then looking at the arrows of two found bases they are pointing in the same (equal) direction; - Since the two (2) acids were found with arrows in same (equal) direction, this just more suggest of METABOLIC imbalance as for ROME that Metabolic Equal; - Also, since two (2) bases from 3 ABG factors were found already, then justifiable to say that it is an ALKALOSIS imbalance. INTERPRETATION: METABOLIC ALKALOSIS

Determining Presence of Compensation: 1. When PaCO2 and HCO3 are found in OPPOSITE ACID-BASE IMBALANCE [e.g. PaCO2 58(:acidic) and HCO3 32(:alkalinic)+ in response to abnormal pH level *7.10(:acid)+, THERE IS COMPENSATION.

Example 1: pH: 7.58 (), PaCO2: 53(), HCO3-: 28 () - Here, we find pH and HCO3- both primarily affected since they are both alkalinic in nature; theoretically speaking, alkalosis caused by increasing pH and HCO3- could mean failing kidney function. - But looking at pCO2, it is actually compensating as evidenced by its increasing level (going acidic); theoretically speaking, this is the respiratory mechanism which intentionally traps CO2 (highly acidic) in the lungs to counteract increasing alkalinity in the body. INTERPRETATION: COMPENSATED METABOLIC ALKALOSIS Example 2: pH: 7.15 (), PaCO2: 53(), HCO3-: 28 () - Here, we find pH and pCO2 both primarily affected since they are both acidic in nature; theoretically speaking, acidosis caused by acidic pH and pCO2 could mean entrapment of CO2 in the respiratory airways. - At a glance in HCO3- level, it is actually compensating as evidenced by its increasing level (going alkalinic); theoretically speaking, this is the renal mechanism which intentionally retain HCO3- (increasing alkalinity) thus trying to offset the acidity in the respiratory system. INTERPRETATION: COMPENSATED RESPIRATORY ACIDOSIS 2. If ONE IS NORMAL [e.g. PCO2 38(normal)] and THE OTHER IS OUT-OF-NORMAL RANGE [e.g. HCO3- of 29(:alkalinic)] in response to abnormal pH level [e.g. pH 7.52(:alkalinic), IT IS CONSIDERED UNCOMPENSATED. Example 1: pH: 7.52 (), PaCO2: 28(), HCO3-: 24 (normal) - Here, we find pH and pCO2 both primarily affected since they are both alkalinic in nature; theoretically speaking, alkalosis caused by alkalinic pH and pCO2 could mean excessive loss of CO2 from the lungs. - Although expecting kidneys to compensate, here we will assess HCO3- which remains normal indicating no apparent changes in kidney function in attempt to correct the existing alkalosis in the respiratory system thus reflecting no compensation. INTERPRETATION: UNCOMPENSATED RESPIRATORY ALKALOSIS

3. Some questions, especially in the board exam, will ask about PARTIAL COMPENSATION but dont get confused with it because in ABG Analysis, Compensation is like ALL or NOTHING!! COMPENSATED AND UNCOMPENSATED only! If you would be left with no choice, I suggest that you may consider partial compensation and complete compensation as THE SAME since its only between COMPENSATED and UNCOMPENSATED acid-base imbalances. 4. And since I am your ex-lecturer who did the faulty concept, the blameworthiness is mine 5. Please give me this chance 6. I AM SO SORRY 7. By the way, youre reading the JOKERS GUIDE 8. Lastly, God bless yall.

Principal of the Crime, John Paul E. Mendoza RN 3rd Level Instructor