If the ph is basic identify which parameter paco2 or

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If the pH is basic, identify which parameter (PaCO2 or HCO3-) is also basic THIS IS YOUR PRIMARY ABNORMALITY!!
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pH 7.32 PaCO2 58 HCO3- 24 Is the pH acidic, alkaline or neutral? 1. Acidic 2. Alkaline 3. Neutral
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pH 7.32 PaCO2 58 HCO3- 24 Is the PaCO2 acidic, alkaline or neutral? 1. Acidic 2. Alkaline 3. Neutral
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pH 7.32 PaCO2 58 HCO3- 24 Is the HCO3- acidic, alkaline or neutral? 1. Acidic 2. Alkaline 3. Neutral
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pH 7.32 PaCO2 58 HCO3- 24 What is the patient’s acid-base disorder? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory alkalosis 4. Respiratory acidosis
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Assessing Acid-Base Status 3. Is there compensation? •. If a metabolic disorder is present, the respiratory system attempts to correct it Respiratory response is rapid •. If a respiratory disorder is present, the metabolic system attempts to correct it Metabolic response is slow If there is no metabolic compensation, the respiratory disorder is acute If there is metabolic compensation, the respiratory disorder is chronic •. The body cannot fully compensate for an acid-base disturbance!
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Assessing Acid-Base Status 3. Is there compensation? Is the “other” parameter normal? If so, there is no compensation If not, there is compensation If your pH is acidic, identify which parameter (PaCO2 or HCO3-) is basic THIS IS YOUR COMPENSATORY MECHANISM!! If your pH is basic, identify which parameter (PaCO2 or HCO3-) is acidic THIS IS YOUR COMPENSATORY MECHANISM!!
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pH 7.32 PaCO2 58 HCO3- 24 Is there compensation? 1. Yes 2. No
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Assessing Acid-Base Status 4. If there was compensation, was the compensatory response appropriate? If it was not, then there may be a second acid-base disorder present Equations will be provided
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Assessing Acid-Base Status 5. Is there an anion gap? AG = [Na+] – [Cl-] – [HCO3-] Normal = 7-16 mEq/L To maintain electroneutrality, cations = anions [Na+] + unmeasured cations = [Cl-] + [HCO3-] + unmeasured anions Unmeasured cations include Mg2+, Ca2+, K+ Unmeasured anions include proteins, sulfates, phosphates, organic anions
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Assessing Acid-Base Status 5. Is there an anion gap? Anion gap indicates excess unmeasured anions Indicates that the patient has an organic, not a mineral, acidosis
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145 109 12 0.8 88 3.7 18 What is the patient’s AG? 1. 18; normal 2. 18; elevated 3. 22; normal 4. 22; elevated
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Which acid-base disorder is present? ABG: pH: 7.1 HCO3- 12 mEq/L PCO2 25 mmHg 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
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Is there compensation? ABG: pH: 7.1 HCO3- 12 mEq/L PCO2 25 mmHg 1. Yes, metabolic 2. Yes, respiratory 3. No compensation
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Was the compensation appropriate? For a metabolic acidosis, the PaCO2 should decrease by 1.3 times the fall in plasma HCO3- Normal HCO3- ~24 mEq/L
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Was the compensation appropriate? 24 mEq/L – 12 mEq/L = 12 mEq/L The plasma bicarbonate fell by 12 mEq/L 12 mEq/L x 1.3 = 15.6 Expect the PaCO2 to fall by ~15 mmHg from the normal PaCO2 (~ 40 mmHg) PaCO2 = 40 mmHg – 15.6 mmHg = 24.4 mmHg Actual PaCO2 = 25 mmHg Compensation was appropriate
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What is the patient’s anion gap?
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