外文血气分析.pptVIP

Mixed Acid-Base Disorders ? ABG pH 7.50, PCO2 38 mmHg, HCO3 31 mmol/L, K 3.5 mmol/L Interpretation Alkalemic with low PCO2 and high bicarbonate concentration High HCO3 as a primary disorder – metabolic alkalosis PCO2 55 in the presence of elevated HCO3 – primary respiratory alkalosis PCO2 55 in the presence of elevated HCO3 – primary respiratory acidosis Mixed Acid-Base Disorders ? ABG pH 7.48, PCO2 29 mmHg, HCO3 23 mmol/L Interpretation Alkalemic with low PCO2 and normal bicarbonate concentration Low PCO2 as a primary disorder – respiratory alkalosis (secondary to asthma) HCO3 20 in the presence of acutely decreased PCO2 – primary metabolic acidosis HCO3 15 in the presence of chronically decreased PCO2 – primary metabolic acidosis HCO3 20 in the presence of acutely decreased PCO2 or HCO3 15 in the presence of chronically decreased PCO2 – primary metabolic acidosis Is There Another Solution ? Rules of Thumb for Recognizing Primary Acid-Base Disorders Without Using a Nomogram Rule 1 Look at the pH. Whichever side of 7.40 the pH is on, the process that caused it to shift to that side is the primary abnormality. Principle: The body does not fully compensate for primary acid-base disorders Rule 2 Calculate the anion gap. If the anion gap is ? 20 mmol/L, there is a primary metabolic acidosis regardless of pH or serum bicarbonate concentration Principle: The body does not generate a large anion gap to compensate for a primary disorder Rule 3 Calculate the excess anion gap (the total anion gap minus the normal anion gap [12 mmol/L]) and add this value to the measured bicarbonate concentration; if the sum is greater than a normal serum bicarbonate ( 30 mmol/L), there is an underlying metabolic alkalosis; if the sum is less than a normal serum bicarbonate ( 23 mmol/L), there is an underlying nonanion gap metabolic acidosis. Principle: 1 mmol of unmeasured acid titrates 1 mmol of bicarbonate (+ ? anion gap = - ? [HCO3]) The Relation Between Level of Anion Gap and Bioch