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Quick Reference

    Metabolic Acidosis
    Clinical Manifestations
    • hyperkalemia: shift of acid to ICF and K+ to the ECF
    • anorexia, nausea, and vomiting
    • warm, flushed skin
    • cardiac dysrhythmias & CNS dysfunction
    • headache, diarrhea, tremors

    Metabolic Alkalosis
    Clinical Manifestations
    • cardia dysrhythmias; seizures; confusion; muscle twitching, agitation
    • >pH;>HC03; normal PaCo2 or elevated if compensation occurs

    Respiratory Acidosis
    Clinical Manifestations
    • > PaCo2; HCO3 is normal or > with renal compensation
    • vasodilatation; cardiac dysrhythmias, tachycardia, somnolence, decreased ventilation

    Respiratory Alkalosis
    Clinical Manifestations
    • > pH; < PaC02; HCO3 normal or low due to compensation
    • nausea, vomiting, tingling of fingers
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Welcome to the ABG Tutorial

A note about pre-requisite learning: A clear understanding of human acid-base physiology is necessary before you begin this learning activity

An introduction to acid-base imbalances will facilitate your understanding of the contents within this tutorial.

    Upon completion of this learning activity, you will be able to

    o recognize clinical manifestations associated with acid-base imbalances.

    o match pH values with acid-base imbalances.

    o select the correct answer following the review of each case study.

    o compare and contrast the step-wise assessment of determining the acid-base balance of the blood.

    o identify the appropriate etiology of metabolic acidosis/alkalosis and respiratory acidosis/alkalosis.

    o differentiate between compensatory and non-compensatory ABG changes.

    Sometimes reading and deciphering Arterial Blood Gases (ABGs) can be a challenge! I have provided an interactive online tutorial for your review.

    Arterial blood gas values reflect ventilation and acid-base balance. The results include the arterial blood pH (concentration of hydrogen ions in the blood) , partial pressure of carbon dioxide (PaCO2) dissolved in the arterial plasma, and the concentration of sodium bicarbonate (HCO3-) in the blood. Our bodies regulate an acid-base balance through a "buffer system." This buffer system neutralizes acids. There are three buffer systems that exist for the maintenance of our acid-base equilibrium: a buffer system in our blood, respiratory system, and renal system.

    Some of the common causes of the retention of carbon dioxide (respiratory acidosis) are:
    pneumonia, drug overdose, pulmonary edema, pneumothorax

    Some of the common causes of the respiratory alkalosis are:
    pain, fever, asthma, congestive heart failure (CHF), anxiety, fear, pulmonary embolus

    Some of the common causes of a gain of metabolic acids or a loss of base (metabolic acidosis) are:
    Increased acids: renal failure, diabetic ketoacidosis, aspirin overdose, anaerobic metabolism
    Loss of base: diarrhea

    Some of the common causes of gain of base or loss of metabolic acids (metabolic alkalosis) are:
    Gain of base: Increased ingestion of antacids or an excessive administration of sodium bicarbonate
    Loss of metabolic acids: vomiting, nasogastric suctioning, low potassium and/or chloride levels, diuretics, steroids, increase in aldosterone

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