英文版血气分析课件.ppt

Partial causes of mixed acid-base disorders Disorder characteristic Partial causes R.Aci+M.Aci pH ↓ HCO3- ↓ PaCO2 ↑ ? cardiac arrest? intoxication? MOF R.Alk+M.Alk pH ↑ HCO3- ↑ PaCO2 ↓ ?diuresis in cirrhosis ?pregnancy complicated vomiting? hyperventilation in COPD R.Aci+M.Alk pH N HCO3- ↑ PaCO2 ↑ ? diuresis in COPD ? severe hypokalemia R.Aci+M.Aci pH N HCO3- ↓ PaCO2 ↓ ?severe sepsis? salicylic acid intoxication? RF complicated CHF ? late hepatic disease M.Aci+M.Alk pH N HCO3- N ? uremia complicated vomiting How to distinguish simple and mixed acid-base disorders？ Rule of acid-base disturbance Once HCO3- changes, it can lead PaCO2 to the same direction. The same to PaCO2. disorder pH Primary change Compensated reflection Metabolic acidosis ↓ HCO3-↓ PaCO2 ↓ Metabolic alkalosis ↑ HCO3-↑ PaCO2 ↑ Respiratory acidosis ↓ PaCO2 ↑ HCO3- ↑ Respiratory alkalosis ↑ PaCO2 ↓ HCO3- ↓ 2. Primary disorder is more obvious than compensated reflection. ①The pH value relies on the primary disorder. ②Mixed acid-base disorder could be found if HCO3- and PaCO2 changed in different direction. ③ When PaCO2 and HCO3- changed obviously with a normal pH value, mixed acid-base disorder should be pay close attention to. Case No.1: pH 7.32、HCO3- 15mmol/l，PaCO2 30mmHg。 analysis： PaCO2 30mmHg40mmHg, respiratory alkalosis? HCO3- 15mmol/l24mmol/l，metabolic acidosis? But pH 7.327.40。 conclusion：metabolic acidosis Case No.2： pH 7.45、 HCO3- 32mmol/l、PaCO2 48mmHg。 analysis： PaCO2 48mmHg40mmHg，respiratory acidosis? HCO3- 32mmol/l24mmol/l，metabolic alkalosis? But pH 7.457.40 conclusion：metabolic alkalosis * Arterial Blood Gas (ABG) Respiratory Department of the Second Affiliated Hospital of Guangzhou Medical University Huaxing Huang What’ ABG? Approach to ABG Interpretation Clinical causes of Abnormal ABG Objectives What’ ABG? Arterial Blood Gas Drawn from artery- radial, femoral It is an invasive procedure. Helps differentiate oxygen def