This document provides guidance on interpreting arterial blood gases. It discusses acid-base disorders and their compensation, provides an approach to identifying primary disturbances and evaluating compensation, and discusses calculating the plasma anion gap and osmolar gap to help diagnose specific acid-base disorders. Common causes of increased anion gap metabolic acidosis are also summarized.
This document provides guidance on interpreting arterial blood gases. It discusses acid-base disorders and their compensation, provides an approach to identifying primary disturbances and evaluating compensation, and discusses calculating the plasma anion gap and osmolar gap to help diagnose specific acid-base disorders. Common causes of increased anion gap metabolic acidosis are also summarized.
This document provides guidance on interpreting arterial blood gases. It discusses acid-base disorders and their compensation, provides an approach to identifying primary disturbances and evaluating compensation, and discusses calculating the plasma anion gap and osmolar gap to help diagnose specific acid-base disorders. Common causes of increased anion gap metabolic acidosis are also summarized.
This document provides guidance on interpreting arterial blood gases. It discusses acid-base disorders and their compensation, provides an approach to identifying primary disturbances and evaluating compensation, and discusses calculating the plasma anion gap and osmolar gap to help diagnose specific acid-base disorders. Common causes of increased anion gap metabolic acidosis are also summarized.
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Interpretación de gasometría arterial
Acid-Base Disorders • acid-base homeostasis influences protein function and can critically affect tissue and organ function with consequences to cardiovascular, respiratory, metabolic and CNS function • see Respirology. R5 for more information on respiratory acidosis/alkalosis • normal concentration of HC03- = 24 mEq/L • normal pC02 = 40 mmHg • each acid base disorder has an appropriate compensation • inadequate compensation or overcompensation can indicate the presence of a second acidbase disorder • e.g. in metabolic acidosis, inadequate compensation means there is also respiratory acidosis; overcompensation means there is also respiratory alkalosis
2. Evaluate compensation. If compensation is not appropriate, a second acid-base disorder is
likely present • metabolic acidosis: pC02 - 1.5[HC03-]+8 • alternative: fall in pC02 should equal fall in HC03- • metabolic alkalosis: pC02 - 0.9[HC03-]+ 16 • alternative: fall in pC02 should equal the fall in HC03- • respiratory acidosis: for every 10 change in pC02, pH decreases by 0.08 if acute and 0.03 if chronic • respiratory alkalosis: for every 10 change in pC02, pH increases by 0.08 if acute and 0.03 if chronic 3. Calculate Plasma Anion Gap (AG) • AG = [Na+] - ([HC03-] + [CI-]) • baseline= 12, range 10-14 • AG can be altered by plasma albumin level: for each 10 g/L fall in albumin, lower baseline AG by 3 (e.g. if plasma [albumin]= 20 g/L, expect AG = 6)
4. If AG elevated, compare increase in AG with decrease in HC03-
• if increase in AG < decrease in HC03-, there is a coexisting non-AG metabolic acidosis • if increase in AG > decrease HC03-, there is a coexisting metabolic alkalosis
5. Calculate Osmolar Gap
• osmolar gap = measured osmolality - calculated osmolality • calculated osmolality= (2 x [Na+]) +[urea]+ [glucose] (all units are in mmol/L) • normal osmolar gap < 10 • if AG > 10, consider: methanol poisoning, ethylene glycol poisoning, OR another cause of acidosis plus ethanol ingestion
