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Basic Questions
Normal Values
Etiology and Clinical Manifestations
Step 1
Step 2
Step 3
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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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Review :: it is time to review the three essential steps of ABG analysis!

    Number One!

    Determine if the client is demonstrating an acidotic (remember: pH less than 7.35) or alkalotic (pH greater than 7.45).

    Number Two!

    What is the 'primary problem'

    If the client is acidotic with a PaC02 greater than 45 mmHg it is RESPIRATORY

    If the client is acidotic with a HC03 less than 22 mEq/L it is METABOLIC!

    If the client is alkalotic with a PaC02 less than 35 mmHg it is RESPIRATORY!

    If the client is alkalotic with a HC03 greater than 26 mEq/L it is METABOLIC!

    Number Three!

    Is the client compensating?

    Are both components (HCO3 and PaCO2) shifting in the same direction? Up or down the continuum? Above or below the normal ranges? If this is noted, you know that the client’s buffering systems are functioning and are trying to bring the acid-base balance back to normal.

    Would you like to try some examples? Come on...let's give it a try!

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