Question

1. A patient in respiratory distress is to have arterial blood gases (ABGs) drawn stat. ●        What are the common specific acid--base imbalances that the nurse could encounter in ascertaining the underlying cause and determining appropriate treatment from the ABG results? ●        Who has the responsibility of drawing ABG’s?

Answer 1

ARTERIAL BLOOD GAS ANALYSIS.(ABG)

ABGs are obtained to determine oxygenation status and acid-base status.

COMMON ACID-BASE IMBALANCES

1.Respiratory Acidosis

It is a state of relative excess of acid in the body fluid resultin from retension or excessive production of CO2.

Here PH will decrease,Pco2 will increase,HCO3( bicarbonate) will increase and K+ will increase.

Causes

• Always result from hypoventillation.
• COPD
• Cardiac disease
• Respiratory infection
• Obesity hypoventillation syndrome
• Excessive fatigue
• Weakness
• Severe deformalities of rib cage muscle and spine

Management

Goals

• regain normal breathing
• restore acid base balance
• treat the cause of respiratory failure

Treatment

1. non-invasive ventillation such as CPAP,BiPAP

2.Bronchodialators and corticosteroids

3.oxygen therapy

Respiratory alkalosis

Respiratory alkalosis is a state of relative excess of base in body fluids,resulting from increased respiratory elimination

Here ph-increase,Paco2-Decrease,HCO3-Decrease,K+-Decrease.

Causes

Mainly resulting from alveolar hyperventillation.

1.Pneumonia

2.Pulmonary edema

3.Cystic fibrosis

4.Stroke

5.Intracranial lesions

6.High altitude

7. Pregnacy

8.Pulmonary fibrosis

Treatment

respiratory support-Oxygen therapy may be used to correct underlying hypoxemia,rebreathing of CO2 can result in prompt but short term relief in anxiety related respiratory acidosis

Metabolic Acidosis

INt is a state of relative excess od base or H= deficit in the body fluid resulting from a gain of bocarbonate or loss of fixed acid.

HerePH-decreased, PCO2- Decreased, HCO3-Decreased,K+-Increased

Causes

1. Bicarbonate loss(Diarrhea,Pancreatic drainage,Billiary drainage,Dilusion acidosos, Carbonic anhydrase inhibition,Type 2RTA.)

2.Increased acid load(Latic acid acidosis,Diabetic ketoacidosis,Ethylene glycol intoxicationSalicylate intoxication,HCL administration,cationic amino acid administration)

3.Impaied acid excretion( Renal failure,Type1RTA,Adrenal insufficiency)

Treatment

Diabetic treatment

IVsodium bicarbonate

Hemodialysis

Metabolic Alkalosis

It is a state of relative excess of base in body fluids resulting from a gain of bicarbonate or loss of fixed acid.

Here PH-increase, PCO2-increaseE,HCO2-incfease,K+-Decrease.

Causes

Vomiting

suction through nose-feedingg tube

Treatment

• treatment for underlying disorder( fluid replacement,renal support possiblely by dialysis)
• administration of acetazolamide(it is a diuretic that promote loss of bicarbonate in the urine0
• administration of exogeneous acid.