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Unit 3 Clin Lab Med > L9: ABGs > Flashcards

L9: ABGs Flashcards

1
Q

What’s an Arterial Blood Gas?

A

used to detect and monitor indices of: oxygenation, ventilation, acid-base balance
→ also quantify: carboxyhemoglobin, methemoglobin

Procedure: draw blood from an artery→ usually radial (+/- brachial, femoral) with an anticoagulant→ place on ice→ analysis in lab→ results in 5-15 minutes

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2
Q

Normal pH

A

7.35-7.45 (use 7.4)

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3
Q

Normal pO2

A

80-100 mmHg

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4
Q

Normal O2 saturation

A

> 95

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5
Q

Normal pCO2

A

35-45 mmHg

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6
Q

Normal HCO3

A

22-26 mmol/L

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7
Q

Is oxygenation/pO2 used to determine acid-base conditions?

A

NO

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8
Q

Why bother with pO2?

A

More reliable than pulse ox

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9
Q

Acidemia

A

pH<7.35

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10
Q

Alkalemia

A

pH>7.45

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11
Q

In a mixed disorder

A

pCO2 and HCO3 move in opposite directions

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12
Q

High anion gap metabolic acidosis

A 
“MUDPILES”
Methanol
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron/Isoniazid
Lactate (lactic acidosis)
Ethanol/Ethylene glycol
Salicylates (ASA)/Starvation
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13
Q

General rules for acid-base disorders

A

It is only possible to have one respiratory disorder at a time, but 2 metabolic disorders can be present at once

Normal pH does not mean there is not an acid-base disorder: could have acidosis+alkalosis

Low bicarb is usually pathologic

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14
Q

MUDPILES: M

A

Methanol

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15
Q

MUDPILES: U

A

Uremia

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16
Q

MUDPILES: D

A

Diabetic ketoacidosis

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17
Q

MUDPILES: P

A

Propylene glycol

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18
Q

MUDPILES: I (2)

A

Iron/Isoniazid

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19
Q

MUDPILES: L

A

Lactate (lactic acidosis)

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20
Q

MUDPILES: E (2)

A

Ethanol/Ethylene glycol

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21
Q

MUDPILES: S (2)

A

Salicylates (ASA)/Starvation

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22
Q

Non anion gap metabolic acidosis is caused by (3)

A

GI bicarb loss
Renal bicarb loss
Hyperchloremia

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23
Q

Treat metabolic acidosis:

A

Treat underlying cause +/- sodium bicarbonate (immediate period), allow for normal respiratory compensation

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24
Q

Hyperchloremia is due to

A

due to normal saline resuscitation

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25
Q

Renal bicarb loss is due to

A

Early renal failure
Renal tubular acidosis
Carbonic anhydrase inhibitors (acetazolamide)
Aldosterone inhibitors (spironolactone)

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26
Q

GI bicarb loss is due to

A

Diarrhea
GI fistulas
Utererosigmoidostomy

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27
Q

Effects of vomiting vs diarrhea

A

Vomiting: lose acid= metabolic alkalosis
Diarrhea: lose bicarb= metabolic acidosis

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28
Q

Urine chloride <25= chloride/fluid responsive metabolic alkalosis is caused by

A

GI losses: vomiting, NG suction
Diuretics→ contraction alkalosis
Cystic fibrosis
Treat with fluids

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29
Q

Urine chloride >25= non-chloride responsive metabolic alkalosis is caused by

A 
Barter’s syndrome
Cushing’s 
Hyperaldosteronism
Potassium depletion
Citrate toxicity→ massive blood transfusion protocol 
Chronic diuretics
Renin secreting tumor
Treat underlying cause +/- potassium
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30
Q

Hyperchloremia

A

Non-anion gap metabolic acidosis

31
Q

Diarrhea

A

Non-anion gap metabolic acidosis

32
Q

Cushing’s

A

non-chloride responsive metabolic alkalosis

33
Q

Hyperaldosteronism

A

non-chloride responsive metabolic alkalosis

34
Q

Diabetic ketoacidosis

A

High anion gap metabolic acidosis

35
Q

Potassium depletion

A

non-chloride responsive metabolic alkalosis

36
Q

Citrate toxicity

A

non-chloride responsive metabolic alkalosis

37
Q

Ethanol

A

High anion gap metabolic acidosis

38
Q

Diuretics

A

chloride/fluid responsive metabolic alkalosis

contraction alkalosis

39
Q

Renin secreting tumor

A

non-chloride responsive metabolic alkalosis

40
Q

Chronic diuretics

A

non-chloride responsive metabolic alkalosis

41
Q

Barter’s syndrome

A

non-chloride responsive metabolic alkalosis

42
Q

Methanol

A

High anion gap metabolic acidosis

43
Q

Ethylene glycol

A

High anion gap metabolic acidosis

44
Q

Isoniazid

A

High anion gap metabolic acidosis

45
Q

Uremia

A

High anion gap metabolic acidosis

46
Q

Treatment for chloride/fluid responsive metabolic alkalosis

A

Fluids

47
Q

Cystic fibrosis

A

chloride/fluid responsive metabolic alkalosis

48
Q

Aldosterone inhibitors (spironolactone)

A

Non-anion gap metabolic acidosis

49
Q

non-chloride responsive metabolic alkalosis treatment

A

Treat underlying cause +/- potassium

50
Q

Carbonic anhydrase inhibitors (acetazolamide)

A

Non-anion gap metabolic acidosis

51
Q

Renal tubular acidosis

A

Non-gap metabolic acidosis

52
Q

Carbonic anhydrase inhibitors (acetazolamide)

A

Non-anion gap metabolic acidosis

53
Q

Respiratory acidosis

A

poor ventilation causing accumulation of CO2

54
Q

Causes of Respiratory acidosis

A

Acute airway obstruction: foreign body, tumor, laryngospasm/bronchospasm
Lung disease: severe pneumonia/PE/COPD exacerbation, pulmonary edema, pulmonary fibrosis
CNS depression: narcotics, CNS event, trauma, central sleep apnea
Neuromuscular disorder: Guillain-Barre, Myasthenia Gravis, Brain stem/spinal cord injury,
Impaired lung motion
Inappropriate mechanical ventilation settings

55
Q

Respiratory alkalosis

A

excess elimination of CO2 from the lungs→ pCO2<35

lightheadedness, palpitations, tachypnea, +/- paresthesias

56
Q

Causes of Respiratory alkalosis

A 
Hyperventilation 
Compensatory mechanism in sepsis
Anxiety, pain
CNS: neurogenic hyperventilation
Salicylate overdose
Pregnancy
High altitude, Hypoxemia
Hepatic encephalopathy
57
Q

Hyperventilation

A

Respiratory alkalosis

58
Q

Acute airway obstruction: foreign body, tumor, laryngospasm/bronchospasm

A

Respiratory acidosis

59
Q

Compensatory mechanism in sepsis

A

Hyperventilation causing Respiratory alkalosis

60
Q

Inappropriate mechanical ventilation settings

A

Respiratory acidosis

61
Q

CNS depression: narcotics, CNS event, trauma, central sleep apnea

A

Respiratory acidosis

62
Q

Anxiety, pain

A

causes Hyperventilation causing Respiratory alkalosis

63
Q

Impaired lung motion

A

Respiratory acidosis

64
Q

CNS: neurogenic hyperventilation

A

Respiratory alkalosis

65
Q

Neuromuscular disorder: Guillain-Barre, Myasthenia Gravis, Brain stem/spinal cord injury

A

Respiratory acidosis

66
Q

Lung disease: severe pneumonia/PE/COPD exacerbation, pulmonary edema, pulmonary fibrosis

A

Respiratory acidosis

67
Q

Salicylate overdose

A

causes Hyperventilation causing Respiratory alkalosis

68
Q

High altitude, Hypoxemia

A

causes Hyperventilation causing Respiratory alkalosis

69
Q

Hepatic encephalopathy

A

causes Hyperventilation causing Respiratory alkalosis

70
Q

Pregnancy

A

causes Hyperventilation causing Respiratory alkalosis

71
Q

Pregnancy

A

causes Hyperventilation causing Respiratory alkalosis

72
Q

Treat respiratory acidosis

A

Treat underlying cause, respiratory support (BiPAP)

Differentiate from chronic acidosis→ more stable (COPD) especially if with good compensation, won’t need BiPAP

73
Q

Treat respiratory alkalosis

A

Treat underlying cause

Unit 3 Clin Lab Med (5 decks)

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