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MIME-Version: 1.0 Content-type: multipart/mixed; boundary="simple boundary" --simple boundary Content-Type: Text/plain; charset=ISO-8859-1 ABG (chang/obra) neonate x older x ph 7.3-7.4 7.35 7.35-7.45 7.4 pCO2 30-40 35 35-45 40 HCO3 20-22 22 22-26 24 O2 50-80 >95 HCO3/CO2 MET ACID pCO2:1.5 x HCO3 + 8.4 +- 2 {limit of 10} MET ALK chang: CO2: inc by 0.5-1 per HCO3 inc 1 35 or 40 + {limit of 55} obra: pCO2: 0.9 x HCO3 + 9 +- 2 RESP ACID obra: HCO3(24+):^ pCO2/10 x 2.5 chang: acute= HCO3(24+):0.1 x ^pCO2 +-3 {max 27-28} chronic= HCO3(24+):0.4 x ^pCO2 +-3 {>30} RESP ALK obra: HCO3 (24-):^ pCO2/10 x 4 chang: acute= HCO3(24-):0.1-0.3 x ^ pCO2 {20-22} chronic= HCO3(24-):0.5 x ^ pCO2 {12-15} ACUTE VS CHRONIC RESPI ACID ^H: 24 x pCO2 : ^H -40 --------- ------- HCO3 ^pCO2 if = <0.3 : chronic 0.3-0.8:acute/chronic >0.8:acute RESPI ALK
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pH=7.41-7.45 : chronic >7.45 : acute HCO3 DEFICIT ABE x wt x 0.3 (1/2 correction) half bolus, half drip hco3 + dist water ABE HCO3 (desired-actual) x 0.6 desired=22 --simple boundary ABG INTERPRETATION Rule #1: An acute change in PaCO2 of 1mmHg is asso w/ an inc or a dec in pH of 0.008 units thus, when the PaCO2 increases by 10mmHg will dec by 0.08 units (inversely proportional). > determine the resp component of acid-base balance To asses the resp component of aid-base balance: 1. calculate the amt by which the reported PaCO2 either falls below or exceeds 4 0mmHg. Subtract the patient's PaCO2 from 40mmHg. 2. Predict the pH based on the measured PaCO2 accdg to rule #1. 3. Compare the measured pH w/ the predicted pH. *If the predicted pH is equal to the measured pH, all change in the oH are resp in origin. *If the measured pH is > than the predicted pH, an asso. metabolic alkalosis is present. *If the measured pH is < than that predicted from PaCO2 an asso. metabolic acidosis is present. Rule #2: A pH change w/ 0.01 units is the result of a base change of 0.67 mEq/L, therefore, pH inc or dec by 0.15 units, corresponding inc or dec in base by 10 mEq/L (directly proportional). > the diff bet calc pH & measured pH (ABG result) x 2/3 (0.66)meq/L is equal to base excess > if BE is > 4 either +/- AbN + 4: met alkalosis - 4: met. acidosis
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BD/BE calculated by multiplying the difference between the actual pH and predict ed pH from the PaCO2 by 67. The predited pH is always subtracted from the actual pH before multiplying the difference by 67. If the actual pH is lower than the predicted pH, the difference will be anumber indicating a base deficit & the pre sence of metabolic acidosis. Rule #3: The total body HCO3 deficit = base deficit x pt's wt (kg) x 0.3 --simple boundary ABG READING METABOLIC ACIDOSIS Expected pCO2 = HCO3 x 1.5 + 8.4+-2 Limit = 10mmHg METABOLIC ALKALOSIS Expected pCO2 = each mEq inc in HCO3 will inc pCO3 by 0.5 - 1mmHg Limit = 55mmHg RESPIRATORY ACIDOSIS Acute = HCO3 inc by 3-4mEq/L every10 Limit = 30mmHg Chronic = each mmHg inc in pCO2 will inc HCO3 by 0.4mEq/L RESPIRATORY ALKALOSIS Acute = HCO3 dec by 2-4mEq/L every 10 Limit = 18mmHg Chronic = each mmHg dec in pCO2 will dec HCO3 by 0.5mEq/L Limit = 12 - 15mmHg --simple boundary ABG VALUES pH pCO2 HCO3 NV 7.35-7.45 35-45 22-26 ACID < 7.35 >45 <22 ALK > 7.45 <35 >26 Ex: pCO2 = 50 mmHg pH = 7.26 Rule # 1: 50-40 = 10 10 = 10 0.08 x x = 0.08 N pH : 7.40 - 0.08 = 7.32
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Actual pH - Measured pH 7.26 - 7.32 = -0.06 BD/BE=0.06 x 67=4.02 (met acidosis) Total HCO3 deficit: 4.02 x wt x 0.03 = amt of HCO3 givenas 1/2, 1/4, 1/4 corection
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