Understanding Acid-Base Imbalance Dynamics

let's do a comprehensive review on acid base imbalances starting with respiratory acidosis this condition occurs because we have a decrease in lung ventilation and whenever we have that our body starts to retain CO2 carbon dioxide which is going to drop our blood pH now what are some things that can lead to this condition and cause us to retain carbon dioxide we'll think about this for a moment whenever you're breathing you're breathing in oxygen and you're breathing out carbon dioxide and you got to get rid of that carbon dioxide because if you don't it's going to lower your blood pH so any conditions that lower our breathing rate where it causes us to breathe too slow like braad dpia and this is a respiratory rate less than 12 breaths per minute in an adult also if we have damage to those gas exchange structures in our lungs like those Alvar sacs where we're not having that proper exchange of oxygen and carbon dioxide we can for sure retain too much carbon dioxide and drop our blood pH in addition if we have an issue with the muscles that Aid in the respiratory rate for instance our diaphragm is too weak and we start getting into those neuromuscular disorders that will affect our ability to breathe so to help us really understand this condition let's go back and talk about carbon dioxide and gas exchange so with respiratory acidosis we have established that we have retained carbon dioxide levels so what is carbon dioxide anyways well carbon dioxide is a waste product that is cre created from cell metabolism and your body needs this certain little range of it about 35 to 45 U millim of mercury too much of it is bad and too little of it is bad so here in acidosis we're talking about having a level greater than 45 because we're retaining way too much CO2 so your body must deal with this carbon dioxide and what it does is it takes it dumps it into the blood and your blood will take it up through the heart to the lungs where G G exchange is going to occur it's really cool how gas exchang is in your body because whenever you're breathing in you're breathing in oxygen that oxygen goes in through your nose down into your lungs and then it's going to cross over into these little avoli sacks and it's going to go into your blood and your blood's going to take it replenish all your organs with oxygen that it desperately needs now that waste product that's built up in your blood that carbon dioxide it's going to cross over and it's going to go through the aviol sack but it's going to go up through your lung and you're going to Exhale it and your respiratory rate can adjust itself it can increase its rate or decrease its rate depending on how much CO2 it needs to get rid of now let's back up to whenever CO2 is being created from the cell metabolism so it's created it's that waste product so your body takes it dumps it into the blood now when CO2 enters the blood it's going to find some water molecules and it's actually going to bind with water so CO2 and H2O they bind together when they bind together we get the creation of carbonic acid carbonic acid is a very weak acid it doesn't stay together for too long so whenever we get the formation of it it actually breaks apart into like hydrogen ions and bicar and I want you particularly pay attention to hydrogen ions the hydrogen ions is the thing that really affects our blood pH because whenever we measure blood pH we're measuring the concentration of hydrogen ions and hydrogen ions are acidic so if you have too many hydrogen ions that is going to drop your blood pH and remember a normal blood pH is 7.35 to 7.45 so it's extremely narrow so whenever you have too many hydrogen ions hanging out in the body it's going to make your blood pH less than 7.35 it dropped it but if we don't have a lot of hydrogen ions we are going to actually increase our blood pH it's going to be greater than 7.45 but here in acidosis we have way too many hydrogen ions on board so we have a blood pH of less than 7.35 so you may be thinking what's the big deal about carbon dioxide and hydrogen ions well they're extremely related because whenever we get carbon dioxide binding with water we get the creation of that weak acid carbonic acid since it's a weak acid it breaks apart whenever it breaks apart we get hydrogen ions so if we have a lot of carbon dioxide in our body let's say we have a patient who has a neuromuscular disease they're not breathing very well the respiratory rate is extremely slow what are they retaining a lot of carbon dioxide so we have a lot of carbon dioxide hanging out in the blood that means it's binding with water when it binds with water we get carbonic acid being formed which is going to start giving us a lot of hydrogen ions in our blood when we have a lot of hydrogen ions in our blood that drops our blood pH and makes it acidic which is why we have respiratory acidosis so now let's look at some conditions that can lead us to retain carbon oxide because we've established that we have a depression in lung ventilation either we're breathing too slowly there's damage to the gas exchange structures in our lungs or our respiratory muscles are just too weak to help us exhale this carbon dioxide so to remember those causes let's remember the word depress D is for drugs such as opioids and sedatives those are really big ones they depress your respiratory rate cause your patient not to breathe very fast so whenever you do give these medications You' definitely got to monitor your patients breathing also diseases this goes along with this D diseases of the neuromuscular system such as gon Beret syndrome with that we start to get paralysis that will extend up to our respiratory system which will cause your patient not to be able to use the respiratory muscles to breathe which again will cause us to retain CO2 e is for edema particularly pulmonary edema this is where we have fluid in the lungs whenever you have fluid hanging out around those Ava sacs it's going to prevent proper gas exchange from occurring which also happens with the p of our pneumonic pneumonia and then we have R for the respiratory center of the brain is damaged this can occur in patients who have experienced a stroke so your breathing rate is really controlled A Lot in your brain and if someone's had esea to particular parts of their brain that control the respiratory rate it can affect how well they're able to ventilate e is for osma this is where the patient has overinflated avioli Sac so we're impairing gas exchange s is for spasms of the bronchial tubes like an asthma again impairing gas exchange and then lastly is py elasticity of Alvar sacs are damaged and these are in patients who experience COPD and in patients who have COPD they are known as being CO2 retainers because we are not having that proper gas exchange in their sack so one thing you want to remember about patients who have chronic COPD meaning they've had this condition for a very long time they are in this chronic state of acidosis because they retain CO2 and because they've been retaining the CO2 for a long time their body has adjusted to this so we have to be extremely careful with the amount of oxygen that we administer to these patients which we're going to talk about in nursing interventions now let's talk about how you can know if your patient is experiencing respiratory acidosis one big way is to look at those arterial blood gas values so let's quickly go over that so so whenever we're talking about respiratory acidosis the first thing you want to look at is that blood pH a normal blood pH as I said before is 7.35 to 7.45 and again that was the measurement of those hydrogen ion concentration in our blood so we have a very acidic blood level so what do you think that blood pH is going to be in respiratory acidosis it's going to be less than 7.35 then we want to look at that P2 level that is the amount of carbon dioxide in that bacterial blood a normal level is 35 to 45 mm of mercury so with this condition we have established that we are retaining carbon dioxide so what is our level going to be in respiratory acidosis it's going to be greater than 45 millim of mercury and then another thing we want to look at is the bicarb this is represented as H3 and a normal level is about 22 to 26 mil equivalents per liter so in respiratory acid is you can have a normal by carb level if this was the case that would mean that you have no compensation going on so it would be uncompensated or if we had partial compensation going on that bicarb level would be greater than 26 because a level that is greater than 26 on that high side is considered alkaline and a level less than 22 is considered acidic so if we have acidosis going on our body's in an acid state so to help compensate our bicarb can come in because it is a base and it can help put itself on the alkaline Side by reserving more bicarb like our kidneys retaining more bicarb so hopefully becoming more alkaline this will help that pH to increase a little bit and get out of that acidic range therefore with this bicarb our kidneys can play a role with helping conserve some of that bicarb and excrete some of those hydrogen ions so we can get that pH normalized now let's look at the signs and symptoms of respiratory acidosis so a big thing that you're going to see with these patients is that they are going to have some neurostatus changes where before they may have been alert and oriented but all of a sudden you're noticing that they're getting confused they're not responding to you properly or while you're actually talking to them they're falling asleep so they're getting drowsy and they can report a headache plus they're going to be hypoxic where they have low oxygen in their blood and that goes back to how we were talking about with the patho because how they're breathing let's say that their respiratory rate has slowed down they're not taking in a lot of oxygen or if they have damage to their avolar sacs we're not having the gas exchange occurring properly where the oxygen is crossing over into the blood so we're dropping those oxygen levels and because we're dropping our oxygen levels our body is going to sense this so it's going to increase that heart rate in hopes of trying to get more oxygen throughout our body because it desperately needs it plus they can have a low blood pressure now in clinical practice whenever I've seen patients with respiratory acidosis I have noticed the neuro changes in the hypoxia as one of the biggest signs that tip me off that we might have an acid base imbalance for example I had a patient come back from surgery and the patient before they left for surgery was alert oriented normal and whenever they come came back you know I knew they were going to be a little bit drowsy but as they were supposed to be coming off the sedation and recovering they were starting to progressively get worse they were getting confused didn't really know where they were um in addition while they were talking to me they would just completely just knot off and fall asleep and it was very just outwardly told me something was going wrong and then whenever I had them on their O2 sat monitor their oxygen was just plummeting downwards so notifi the doctor got an arterial blood gas and yes the patient was in respiratory acidosis so really pay attention to that neuro status and their oxygen status if they have an O2 monitor now let's talk about our rle as a nurse where we're providing care to a patient with respiratory acidosis so we've established that these patients are going to have a low oxygen level because we're retaining carbon dioxide we have issues with ventilation gas exchange so the doctor May order us to administer oxygen now with this you want to be really careful with what patients you're administering oxygen to and how much so look at your Patients health history because as we were talking about in our pneumonic that last part when we were talking about patients who have COPD whenever a patient has chronic COPD they are in this chronic state of acidosis because they are retaining CO2 and their body has actually compensated for this and has become used to these high CO2 levels so a low oxygen level actually guides their respiratory function so you want to be really careful that you don't go too high with their oxygen levels because it could decrease their breathing rate in addition whenever we have a patient respiratory acidosis we want to make sure we are paying attention to their respiratory status how are they breathing what's their rate and we want to look at their neuro status because again as I was talking about with signs and symptoms that is one of the most subtle changes that I have seen whenever a patient starts to experience this condition plus if your patient let's say has pneumonia or they have some type of issue going on with gas exchange coughing and deep breathing using that incentive spomer can help improve gas exchange so we want to educate the patient on that this and how to do it and if your patient has a lot of fluid in the lungs suctioning could be helpful along with providing mouth care because Studies have shown that the bacteria in our mouth if it gets down into our lungs it could lead to pneumonia so we want to make make sure that we're routinely cleaning that mouth from those secretions and Bronco dilators can be beneficial so administering a breathing treatment can go in there dilate those Airways so we can improve gas exchange and holding any medications that could decrease their respiratory rate so if you have a patient respiratory acidosis go look at their medication history or they're what they're currently receiving and ask yourself is there anything in this list that could be de increasing their breathing rate we don't want to give that to them right now and we want to make sure that we're monitoring their electrolytes because whenever acidosis presents it can affect potassium levels because it will cause potassium to leave the inside of the cell and go to the outside of the cell the extracellular compartment which is our blood plasma which could lead to hyperemia and if we get hyperemia this can affect our heart causing disys rythmia so we want to make sure we're watching the ECG as well and then lastly if the pat Pati CO2 levels are getting really too high they may need some help blowing off that carbon dioxide so they may be intubated so they can get mechanical ventilation where we can actually decrease those CO2 levels so you want to help get your patient pre for that now let's focus on respiratory alkalosis respiratory alkalosis occurs in the body whenever we have increased lung ventilation so whenever a patient is increasing their lung ventilation unfortunately this causes es the CO2 level in your body the carbon dioxide level to drop down but it causes the pH level to increase so we now have an alkalic state in the body so one of the main causes of respiratory alkalosis is actually called tnia in tpia Tac means fast is a really fast respiratory rate typically in adults this is greater than 20 breaths per minute so we don't want someone breathing that fast so let's think about it for a second you have this person they breathing breathing extremely fast what is coming out of their mouth what are they exhaling whenever they're breathing really fast they're exhaling carbon dioxide CO2 and we don't want to get rid of too much of this so here with respiratory alkalosis we have already said that we have a low carbon dioxide level so when you have a low carbon dioxide level you don't have a lot of carbon dioxide binding with water you're not getting the formation of a lot of carbonic acid which is a weak acid and therefore whenever breaks apart you're not getting a lot of hydrogen ions so we're dropping our hydrogen ions which is increasing our blood pH so do you see why whenever we have a low CO2 carbon dioxide level we have a high blood pH so we have alkalosis and again the main cause is pipia so whenever the patient is breathing really fast they're exhaling that CO2 so what are some conditions or things that could cause your patient to breathe really fast well to help us remember those things let's remember the tachypnea T is for temperature increase fever so whenever your patient has a really high fever it can cause them to breathe really fast and blow off CO2 putting them in respiratory alkalosis A is for aspirin toxicity like salicylates C for controlled ventilation is too excessive so we have them on some type of mechanical ventilation it's just way too fast for them and they're just blowing off too much CO2 H is for hyperventilation whenever patients get a lot of anxiet if you've ever seen one someone having a panic attack or severe anxiety notice that they really breathe very fast this can cause this and then why is for Yelp they have pain whenever a patient's in pain it will affect their Vital Signs their heart rate can go up their blood pressure can go up along with their respiratory rate then P for pneumothorax this is where we have a collapse lung so whenever you have a collapse lung that's definitely going to alter gas exchange and affect how well you can get rid of carbon dioxide and is for neuro change we're talking about our brain like inflammation of the brain or brain injury we know that there's centers in our brain that control our respiratory rate so if those are inflamed or damaged it can affect how the patient breathes which could cause them to go into an alkalic State e is for embolism in the lungs and then a is for ascending altitude so whenever you go up in altitude you have low oxygen and whenever you have low oxygen your body's like hey I need to breathe some conentration of carbon dioxide in that arterial blood a normal level is 35 to 45 mm of mercury so with this pac2 level anything that's less than 35 is going to be considered alkalic anything greater than 45 is considered acidic so here we don't have a lot of carbon dioxide so it's going to be you'll see results less than 35 mm of mercury which is on the alkal side then you want to quickly look at the B card level the hc3 so this tells us if we got some compensation going on this value can be normal or it could be abnormal so a normal by carb level is about 22 to 26 mil equivalents per liter so anything with this spy carb when it's less than 22 is considered to be on the acidotic side and anything greater than 26 is on the alkalotic side so again it could be normal if it was normal and all those the blood pH and the P2 were abnormal showing the values for what it should be for Respiratory alkalosis we would have respiratory alkalosis no compensation so be uncompensated but if this by carb was less than 22 and we have the abnormal values for blood pH and the P CO2 which is telling us restory alkalosis and our bicarb is less than 22 we would have partial compens ation because this bicarb is trying to make things a little bit more acidic for us so we can bring that blood PH down because right now it's too high we need to bring it down so with compensation our body has a lot of systems in place that help balance these acids and bases so we can get our blood pH back into 7.35 to 7.45 range and we have you know the hydrogen ions which is our acids but we also have bases and a big base in our body that our body likes to use is by carb the H3 so here in this case we really have too much basic stuff going on so we can get the kidneys involved and the kidneys help tweak bicarb and hydrogen ions so what the kidneys can do is that it can excrete the extra bicarb because we don't need too much of that because we already have alkalosis and it can start to retain hydrogen ions which again are acidic so if we're going to add hydrogen ions back into our blood we can make it a little bit more acidic and Hope y decrease that blood pH which is why you're going to start to see this bicarb level start to decrease get less than 22 now let's talk about the signs and symptoms of respiratory alkalosis so we just talked about how they're going to look on a sheet of paper with their blood gas results but what are they going to be presenting with whenever you go in and you look at them well one big sign and symptom you're going to see of course is an increase respiratory rate you're also going to start to see neuro changes as it progresses to get worse so you could could start to see anxiety especially if this is caused by a panic attack you're going to start to see fear dizziness which could progress to seizures in severe cases in addition their heart rate can be elevated and you particularly want to pay attention to this heart rate because they can start to experience ECG changes and these ECG changes are going to come from electrolyte imbalances which can be very serious so two electrolyte imbalances I want you to remember that can occur with respiratory alkalosis they are hypoc calmia and hypoc calmia so we're talking about a low calcium level in the blood and a low potassium level in the blood so why is this occurring well first let's talk about the low potassium level so whenever a patient has a low carbon dioxide level in the blood like in this condition it causes pottassium to move inside that cell so intracelular which drops our blood levels now with calcium what happens is that whenever the blood pH becomes too alkalic it causes calcium to misbehave in a sense it causes calcium to want to bind to albumin and when it bind albumin it's no longer in our blood it drops our blood level so we'll have a low calcium level now because of these electrolyte imbalances it could cause not only the ECG changes but your patient could start to have muscle cramping and tetany as well so what is our role with respiratory alkalosis what are our interventions and What treatments can we expect to be ordered so with respiratory alkalosis the big thing is that we want to find the cause and we want to fix that cause because of the patients having a fever let's give them some antipyretics to decrease that fever if they're having anxiety Let's help get them calm whatever it is you want to find it and treat it so the big thing is is we want the patient to decrease the respiratory rate and rest because if we can get them to slow that respiratory rate it's going to decrease how much carbon dioxide they are putting out ex expelling so to help us remember our role we're going to remember the word rest R is for rebreather mask or paper bag so just helping them slow down their respiratory rate it's going to slow down how much carbon dioxide they're going to be putting out so these are very simple things that we can do to help possibly correct that imbalance e is for electrolytes monitored particularly again what were those two big Electro electrolytes they were potassium and calcium s is for sedatives or anti-anxiety medications to be administered this is just going to help calm them down which when we calm them down they're going to decrease their breathing and again quit hyperventilating and then te is for teach relaxation and de-stressing techniques so the big thing if you have a patient who goes into respiratory alkalosis because of stress anxiety a big thing is teaching them prevention what are some things that they can do to prevent this from happening avoiding certain situations and then whenever the attack comes on what they can do to help decrease that breathing and decrease the stress associated with it now let's break down metabolic acidosis metabolic acidosis occurs whenever we have too many acids in the body and this leads our blood pH to fall along with our bicarb level which is the hco3 level now this tends to occur really due to two reasons the first reason being there is just too much acid production in the body some process in the body is messed up and we have way too many acids hanging out there or secondly there is failure of our body to actually excrete or rid itself of these acids so what are some things that can do this well to help us remember those things let's remember the word acids so A is for accumulation of lactate which leads to lactic acidosis and this happens in cases of sepsis C is for chronic diarrhea where the patient is just losing too much by carb through their stool so bicarb is this like basic substance it helps neutralize acids and if we're losing a lot of this substance that helps neutralize acids we're losing the ability to keep those acids in control which could lead to acidosis I is for impaired renal function so your kidneys play a huge role in helping you balance those acids in your body body it can help get rid of those hydrogen ions so if we have kidneys that aren't working very well we're going to start to have high amounts of waste hence acids in the body which leads us to acidosis and then D for dka which stands for diabetic keto acidosis so already in that name you see acidosis so we're dealing with something that's acidic and with this condition we have an increase of Ketone production which is acidic and causes our blood pH to fall and then lastly we have for S salic toxicity so these are acidic substances so if a patient has too much of these in their system it could cause acidosis now to help us understand metabolic acidosis a little bit better let's take a moment and talk about acids so your body metabolizes substance to function this process is going to break down fats carbs and proteins and it's going to take energy from that and give it to us now unfortunately a by product of this process is the creation of acids so what are acids well these are materials that once broken down in a solution they create hydrogen ions and this is what a pH level measures the hydrogen ion concentration and our body needs a narrow PH range in order to function it needs a range between 7.35 to 7.45 anything less than 7.35 is too acidic and anything greater than 7.45 is to alkaline so hydrogen ions play a huge role in affecting our pH level it actually decreases the level and makes the body acidic so if you have too many hydrogen ions in the body that is going to lower our blood pH and make it less than 7.35 if you don't have a lot of hydrogen ions in the body it's going to raise that blood pH and make it greater than 7.45 making it to alkaline now our body knows that this can happen so it has these systems in place to help balance this out the body want a 20:1 ratio of bases versus acids so for every 20 bases you have it wants one acid so it can keep the acid base balance so the body uses systems to remove and neutralize these acids and what really neutralizes an acid a base so bases neutralize acids and the body can use the respiratory and the renal system to help remove or conserve them now how do we get the creation of hydrogen ions in the body well it's through carbonic acid carbonic acid is a weak acid in the body that plays a role in acid base balance it comes from carbon dioxide and it's formed when carbon dioxide binds with water in the body so when you breathe in and you take in carbon dioxide it in as your blood it's going to bind with that water whenever those two bind together it forms carbonic acid now carbonic acid is weak it doesn't stay together too long it actually breaks apart and creates hydrogen ions and hydrogen ions can neutralize bases so now let's take a deeper look into to the respiratory and renal system that helps us balance these acids and bases with the respiratory system it will control the carbon dioxide levels either it will cause us to retain CO2 or blow off CO2 so it will control the rate of how fast we breathe and how deep we breathe with acidosis one of the big things you're going to see with these patients because their body is trying to compensate for this is that they're going to have fast deep breathing known as Cal breathing and why their body is doing this is because it's trying to blow off all that carbon dioxide now why does your body want to blow off carbon dioxide well what we just discussed is whenever carbon dioxide enters the body it hits the blood binds with water we get the formation of carbonic acid carbonic acid is a weak acid it breaks apart and it's going to affect our hydrogen ions too many hydrogen ions in the body lowers that blood pH so we can get rid of that extra carbon dioxide through breathing we can alter carbonic acid which is going to alter hydrogen ion concentration so in hopes we're going to increase that blood pH to normal now the respiratory system usually does this within minutes so it's a pretty fast acting system however the renal system I like to refer to it as the slow and steady system once it takes over it does a pretty good job of helping us balance the acid and bases but it can take up to days so what are renal syst system can do is that it can mess with the bicarb levels the H3 so we've learned that hc3 by carb it's basic it neutralizes acids so if we're hanging out in some acidotic conditions like with metabolic acidosis we need us some bicarb so the kidneys they know this so what they can try to do is they can start to retain bicarb which will help neutralize those acids we neutralize acids we incre increase blood pH back up plus the kidneys specifically those nephrons within the kidneys can start tweaking the hydrogen ion concentration so we can start excreting extra hydrogen ions now how are a patient arterial blood gas results going to look whenever they're in metabolic acidosis because abgs is one of the great ways we can tell if a patient is in this type of acid base imbalance so whenever you look at those abgs you're going to look at three things you're going to look at the blood pH again what was a normal 7.35 to 7.45 so with acidosis it's going to be less less than 7.35 next you want to look at that bicarb level the hc3 a normal level is 22 to 26 M equivalents per liter with acidosis because we're talking about metabolic acidosis H3 that's telling us we're dealing with a metabolic disorder it's going to be less than 22 on the acidic side and then the P2 which represents our respiratory system a normal level of that is 35 to 45 millim of Mercury with acidosis it could be normal so it could be within that normal range but if the respiratory system is trying to compensate like how we just talked about a moment ago that level will be less than 35 because it's telling us it's trying to lower those carbon dioxide levels so if it was that and our blood pH was still abnormal it would be partially compensating so we just seen what some ABG results can look like on a patient in metabolic acidosis but how's the patient going to look whenever you're in room assessing them well number one we establish that their breathing rate is going to be abnormal they're going to have that cosmol breathing where it's fast and deep and why are they doing that to breathe off that CO2 also nurly they're going to be confused they can be weak they're blood pressure can be affected another big thing is you want to look at their ECG you want to make sure that their t- waves are abnormal because they can present with hyperemia acidosis leads to this now why is this well whenever a patient has severe acidosis it causes the potassium inside the cell intercellularly to move outside of the cell extracellularly which is going to elevate those levels now what are some nursing interventions for the patient that you want to remember well one thing you want to remember is that with metabolic acidosis they need to find the cause and treat it and there's a lot of causes that can lead to metabolic acidosis when we talked about our pneumonic acid so the treat why your patients in metabolic acidosis but some fluids could include sodium bicarb or normal saline and if this is being caused by renal failure the patient can go for dialysis which will in a sense act as the kidneys and filter out the blood and help increase our blood pH back to normal now let's take a look at metabolic alkalosis metabolic alkalosis results in an elevated blood pH and an elevated bicarbonate level hc3 and this usually occurs because we've had excessive loss of acids such as hydrogen ions or we've had an increase in the amount of bases like bicarbonate that hc3 now what are some conditions that could cause either of these two things to happen well to help us remember those conditions let's remember the word Alkali Alkali is a synonym for base first we have a for acid loss via the stomach your stomach acid is really rich in hydrogen ions so if we are over suctioning the patient removing too much of their GI juices or they're vomiting they're losing a lot of hydrogen ions which when we drop hydrogen ion concentration we increase that blood pH because all blood pH is is measuring the concentration of hydrogen ions in the body then we have L for low chloride level when we have a low chloride level in the body this causes our kidneys to start to decrease its excretion of bicarbonate so when we decrease excreting bicarbonate in our urine that's actually going to raise the levels in our body when we have too much bases they are going to neutralize those acids which will throw us into these alkalic conditions and then we have k for potassium loss so whenever we have hypokalemia in a patient what happens is that it really affects hydrogen ions it causes those hydrogen ions to move inside the cell so instead of being in the fluid surrounding that cell in that extracellular fluid it will start to migrate inward which will drop our hydrogen ion amounts which is going to increase our blood pH then we have a for aldosterone increase so whenever we have a condition like hyper aldosterone ISM we have a high level of aldosterone in the body it's going to do three things one thing is it's going to cause our body to keep sodium which in the end is going to cause us to waste more hydrogen ions again we're losing our hydrogen ions which raises our blood pH and keep by carb and then we have L for Loop and thide diuretics these diuretics they increase urinary output but also in that urine will be potassium so we're at risk for hypokalemia and whenever we put a patient in hypokalemia we just learned it messes with the hydrogen ion concentration which will increase the risk of developing metabolic alkalosis and then lastly I for infus using too much sodium bicarb IV so this could happen if the patient was in let's say metabolic acidosis where they were ordered sodium bicarbonate they receive too much so now we flipped them over into alkalosis because bicarbon that sodium bicarb fluid acts as a base so if we give them too much of a base that will go in there neutralize too many hydrogen ions which we don't want and send them into alkalosis now to help us understand metabolic alkalosis a little bit better let's talk more in depth about bases bases are materials that once you break them down in a solution they neutralize acids by binding with the hydrogen ions so in a sense what it does is it acquires a hydrogen ion and then neutralizes it and an important base in the body is called bicarbonate hc3 and this is actually a weak base that will help neutralize hence bind to acids like hydrogen ions and when they do this they increase the pH level now your body has these internal systems that help maintain this acid base balance the two systems I want to talk about are the respiratory and renal system with the respiratory system it works fairly fast whenever we have an acid base in balance and how it works is that it affects carbon dioxide levels by causing you to change your respiratory rate and depth for example your respiratory system can cause you to breathe faster and deeper and whenever you're doing that think about what's happening water you blow blowing off if you're breathing really fast and deep you're blowing off carbon dioxide and this is really beneficial whenever you are experiencing acidosis on the flip side your respiratory system can cause you to breathe slower so think about it whenever you're breathing slower what are you keeping more of you're keeping more of carbon dioxide and this is very beneficial whenever you have alkalosis going on where you're too basic because keeping carbon dioxide is going to cause you to create more hydrogen ions so a lot of times whenever you have a patient in an alkalotic State you will see that they have bradipo where the respirations are slow they're having hypoventilation and the whole purpose of this is to keep that carbon dioxide because when we keep the carbon dioxide that stays in our blood that carbon dioxide is going to bind with water when it binds with water it's going to form carbonic acid carbonic acid is a weak acid and it breaks apart when it breaks apart it increases hydrogen ions those hydrogen ions will go in there and neutralize the bicarbonate whenever we neutralize the bicarbonate that is going to help bring down that blood pH to normal and then the renal system will come into play now I like to think of the renal system as the slow and steady system it's like the turtle it's slow but once it gets going it does its thing so with this system what's going to happen is it is going to help retain hydrogen ions so why do we need hydrogen ions because they're going to help make things more acidic which is really needed when we have metabolic alkalosis so those hydrogen ions will go and neutralize that bicarbonate plus the kidneys can start to excrete extra bicarb which again will help lower that blood pH now one of the ways you can tell that your patients in metabolic alkalosis is that you can look at their arterial blood gas results they're abgs so what are abgs going to look like in a person with metabolic alkalosis well there's three things you got to look at you got to look at the blood pH the bicarbonate level and the pH CO2 so the blood pH again a normal was what 7.35 to 7.45 with this the blood pH is going to be greater than 7.45 it's going to be on the alkaline side the bicarbonate which represents our metabolic system a normal is 22 to 26 Mill equivalents per liter and with this it's going to be elevated so it's going to be greater than 26 it's going to be on the alkaline side and then our P2 which represents our respiratory system it can be one of two things it could be normal or it could be elevated so a normal level is 35 to 45 millim of mercury if the body isn't trying to compensate that respiratory the P2 is going to be normal because our body hasn't decrease our respiration jet in Hope of retaining that CO2 so it'll just be within that 35 to 45 range however if it was trying to compensate like partially compensate it would start to cause your respiratory system to keep that CO2 so you would start to see the CO2 levels rise and they would be greater than 45 now that we know what a patient's arterial blood gases will look like with metabolic alkalosis how will they be presenting with their signs and symptoms a big one you're going to see is bradia that's those slow respirations now that's a compensatory me mechanism but it can become really severe where it leads to respiratory failure and the patient can have dymia so you really want to pay attention to their ECG because this is arising from hypokalemia where we have a low potassium level so whenever a patient has a low potassium level you want to look specifically at that ST segment with a low potassium level it will be depressed and you'll want to look after their t-wave which could be inverted like flipped upside down now normally after the t-wave is a flat line but whenever you have hypokalemia where it's severe you can actually have what's called a uwave after that t-wave also arising from this low potassium level could be tetany trimmers muscle cramping they can feel tired and irritable what are some nursing interventions for the patient with metabolic alkalosis well of course we want to monitor that ECG the respiratory status and neurostatus we also want to keep an eye on their electrolyte levels particularly pottassium due to hypoa and that chloride level which could be hypochloremia so the healthcare provider May order supplementation that you will be administering to the patient and if the patient is vomiting we want to address that because remember those GI juices are really rich in hydrogen ions and we need to keep those hydrogen ions in this condition so an anti medic may be ordered also certain diuretics may need to be held particularly those Loop and thoi diuretics and the reason for that is because they drop our potassium level when we drop our potassium level way too low it affects hydrogen ion concentration making alkalosis worse and sometimes a medication can be ordered called acetazolamide which brand name is diox and this is a Carbonic and hydrates inhibitor and it's actually a diuretic and what it does is it decreases the reabsorption of bicarb so we're not keeping more bicarb instead it's going to help us excrete it via the urine which is really helpful when we're in alkalosis next let's talk about the ABG sample collection process by reviewing the modified Allen test the modified Allen test is performed before collecting an arterial blood gas on the radial artery now what is an arterial blood gas this is also sometimes referred to as an ABG and it's a blood test that's collected from an artery that assesses the oxygenation and acid base balance of a patient and the blood sample for this test can be obtained through an arterial line also known as an art line and think of this as like direct access to a patient's radial artery a lot of patients who are in the ICU have an arterial line or it can be obtained through a needle stick via an artery the most common artery used for this type of test typically is the radial artery but the femal and the brachial artery can be used as well now why do we do a modified Allen test before we collect an arterial blood gas sample from the radial artery well let's talk about the radial artery for a moment so find your thumb locate ated just below your thumb over where your radial bone would be is your radial artery and you can feel it pulsating and then just next door on the other side where your Ona bone is located that's your owner artery now these two arteries work together to deliver fresh oxygenated blood to your hand and its structures and we always want to make sure that these arteries can do that so this modified Allen test is going to check blood flow to the hand to ensure there is good collateral blood flow to the hand in case that radial artery develops problems after the ABG collection so in other words it wants to make sure that your owner artery can work as backup in case we need it so now let me demonstrate how to perform the modified Allen test before you perform the modified Allen test you want to turn the patient's hand so the Palm is facing up have the patient make a clinch Fist and then find the radial and oler artery and to help you remember the steps of this test remember remember the word Allen first you're going to apply firm pressure to the radial and oler artery at the same time with your thumbs or fingertips this will temporarily stop blood flow to the hand then let the patient open and close their hands several times the hand will start to lose its color hence it's going to appear lighter or blanched loosen pressure on the ner artery only but keep pressure on the radial artery then evaluate the return of blood flow from the oner artery to the hand normal response will be that the hand returns to normal color hence appears flush within less than 5 seconds and if this is the case you know that this radial artery is good to go for collecting an arterial blood gas now that we've reviewed that material let's focus on solving arterial blood gas problems you can solve these problems in many ways but first i'm going to demonstrate the TIC taac toe method the Tic-Tac toe method is a method you can use to solve arterial blood gases and it's very simp similar to the childhood game that you may have played as a kid where you set up the little grid lines and you use X's and O's and you're trying to get that three in a row it has the same concept except we're not using X's and O's we're using arterial blood gas values like P2 bicarbon pH and we're not um just getting any type of three in a row we have to get a vertical three in a row so I'm talking about a three in a row that goes up and down so first let's look at an overview of how this method is set up so whenever I go to solve these problems because I want to be solving uncompensated ones partial and full compensation you'll have a little bit of an idea as I'm setting up this problem so here is a completed one I want you to look at the grids notice how we set up the grids just how you would in a childhood tic tac toe and we've labeled each like column so you have acid over there all the way to the left then you have normal in the middle and then you have base all the way at the right then we've plugged in in our arterial blood gas results so we've had to interpret them so we've plugged in the P2 that represents the respiratory system we figured out that that was normal so we put it under the normal column then we looked at the ph and it is basic so we put that under the basic column and then the H3 was basic which represents the metabolic system and we put it under the basic side so now we're looking at the Tic Tac Toe we're looking for that three in a row and we're looking for a vertical three in a row so we got one right here with base pH and hc3 so how do we interpret What It Is Well you say base which is another way of saying base is alkalic it's alkalic and the pH is alkalotic and the hco3 is considered alkalic so when we put all that together we get metabolic alkalosis and this problem is uncompensated which we'll be going over that here in a second so that is how you set up the problem now before you even go working these problems you have to first have a basic understanding of how to interpret ABG results so let's quickly go over that first thing whenever you're looking at ABG results you need to look at the patient's blood pH this is like the measure of the hydrogen ion concentration so your body likes a narrow range 7.35 to 7.45 is the range that's considered normal so anything less than 7.35 is considered acidotic an acid and anything greater than 7.45 is considered basic which another way of saying basic is alkalotic those are like synonyms you can interchange those then next you want to look at the P2 this is the carbon dioxide level concentration in the arterial blood whenever we're talking about P2 that always represents the respiratory system so remember that so a normal level is about 35 to 45 mm of mercury so when you're looking at these results anything that's less than 35 is considered alkalic basic and anything that is greater than 45 is considered acidotic and acid then you want to look at the bicarb which is hc3 this always represents the metabolic system so hc3 metabolic P2 is respiratory so a normal bicarb level is anywhere between 202 to 26 of a mil equivalents per liter so anything that is less than 22 is an acid and anything greater than 26 is a base now whenever you're looking at these lab results and you're thinking how am I going to memorize this try to keep these few things in mind one thing is about that respiratory system it's a little bit special when it comes to its values it's the opposite on whether it's an acid or a base compared to pH and the bicarb because notice with ph and by carb its low values like 7.35 or 22 are automatically cons considered an acid but when we go over here and look at P2 it's low value that 35 it's considered a base so notice its opposite always remember that or you'll get confused in addition remember 35 to 45 because if you can remember that number you've knocked out two of the values for instance 7.35 to 7.45 is a normal pH see the 35 and the 45 and then remember for P2 respiratory it's 35 to 45 that's its normal so if you remember those two numbers you've just memorized two values so now let me test you okay you have a blood pH of 7.52 what is that it is a base so it's alkalic in your Tic Tac Toe you put it on the base side how about a P2 of 32 that is a base that's considered alkalic how about a bicarb hco3 of 28 it's considered basic alkalic okay how about a pH of 7.31 that is acidic we put it on the acid side and how about the pH was 7.36 that's normal so you put under the normal side so these next problems we're going to solve are actually from my book I just released on ABG interpretation and in this book I include a lot of practice problems to make sure you know how to solve all these different types of AG problems along with cheat sheet style notes to help you remember those important Concepts about acid base imbalances and so four so now that we have that out of the way let's set up our first Tic TCT toe problem okay patients ABG results are pH of 7.25 a p CO2 of 50 and a bicarb H CO3 of 24 so the very first thing you want to do is that you want to set up the problem so go ahead put out your lines and then label each column we have acid all the way over there at the left we have normal in the middle and then we have base here on the right right so the first thing what you want to do is you want to interpret those results let's start with the blood pH the pH is 7.25 that is acidic so we're going to write pH under the acid column then we're going to look at the P2 it was 50 that is considered an acid so we're going to put P2 under acid and I'm seeing something I'm seeing some vertical activity going on but let's finish out the problem and then um we're going to look look at the B carb the hc3 it is 24 so that is normal so we're going to put our bicarb under normal so again just remember pac2 represented the respiratory system and uh the bicarb the hco3 represented the metabolic system so now what we're going to do is we're asking ourself do we see a vertical three in a row and the answer is yes we do so we can actually finish solving this so what we have is we're going to say acid plus pH plus P2 what do we get when we do that we're going to get respiratory acidosis and it's uncompensated so we don't have any compensation going on what how would we know if we had any where it would be a partial compensation instead of uncompensated well our hc3 which is the system that's not the imbalance should be trying to help us correct these acidotic conditions by becoming more alkaline so that b carb the hco3 should be going up being greater than 26 if it was partial compensated and our pH was still abnormal so that would be partial compensation but right now our bicarb is normal so it's not trying to make itself more alkalic so it's staying within that normal range so it's uncompensated but let's say that whenever we did this Tic Tac Toe we didn't have a vertical three in a row because that sometimes happens and when that happens it automatically tips you off you have full compensation which I'm going to go more into detail about that when we solve those problems plus if it was full compensation our pH would have been normal so if you don't get a vertical three in a row and your pH is normal you can know that you do have full compensation so with this problem it says our patient has the following abgs a pH of 7.26 a P2 of 31 and an hco3 of 20 so very first thing what we want to do is we want to set up that Tic Tac Toe so set up our problems label each column acid normal and base then what we want to do is we want to interpret that blood pH is it acidic normal or basic alkalic so um our blood pH was 7.26 that is on the acidic side so we're going to put pH under acid then we're going to look at the P2 it was 31 that is on the base side so we're going to put that under base and then we're going to look at the B carb the hc3 and it was 20 and when we interpret that that is going to go under acid so we're going to put that there now we're going to look for a vertical three in a row do we see one we do we have one over here on the acid side acid plus pH plus by carb again what did hc3 represented it represented metabolic so when we put all of that together we get metabolic acidosis so now we need to determine what kind of compensation we got going on so we know this is not full compensation because as I started out before we do have a vertical three in a row plus our pH is abnormal our pH would have to be normal for it to be full compensation so we'll go ahead and forget about that one so it's either uncompensated or partial compensated so we need to further look at the system that isn't causing our imbalance our system that is causing the imbalance is the metabolic system so we know we have metabolic acidosis so let's look over at that respiratory system value and it's represented by the P2 when we look at that we put it under the base side so it is abnormal so the respiratory system is trying to compensate by making itself more alkalic and in hopes of bringing that pH to normal so we have metabolic acidosis partially compensated in our next problem the patient has a pH of 7.54 a P2 of 27 and a by carb of 23 so first thing we do is we set up our Tic Tac Toe grid with acid normal and base now let's interpret that pH the pH is 7.54 what is that acid base or normal our pH is basic alkalic so we're going to put that under base now let's look at the P2 it is 27 that is basic alkalotic so we're going to put that under base and then our bicarb hc3 it is 23 so a normal one for that was 22 to 26 so we're going to put that under normal okay next thing we've interpreted everything now we need to see do we have a vertical three in a row the answer is yes we do it's on that base side so when we take base plus pH plus P2 again represent the respiratory system we get respiratory alkalosis so now we need to determine what kind of compensation we have going on we can go ahead throw out full compensation because we don't because we do have a vertical three in a row and our blood pH is abnormal so is this uncompensated or partial compensated so let's look at that system's value that isn't causing our problem the problem is being caused by the respiratory system so let's look at the metabolic systems representation which was by the bicarb the bicarb is normal it's within that normal range so it's not really trying to compensate by throwing itself in more acidic value so we would say it is respiratory alkalosis uncompensated this problem says our patient has a pH of 7.36 a P2 of 50 and an hc3 of 30 1 so first thing we're going to do is set up that Tic Tac tog grid label it acid normal base then what we want to do is we want to interpret that pH so let's analyze that our pH is 7.36 okay that is normal Falls within that 7.35 to 7.45 range so we're going to put pH under normal okay right now we're already thinking hm I think we got full compensation but let's further analyze everything else next we're going to look at the P2 it was 50 This falls on the acid side so we're going to put that under acid and then our hc3 is 31 and that falls under the basic side so it's alkalotic so we're going to put it under base now we need to see do we have that vertical three in a row the answer is no we don't so we know we're dealing with full compensation but we need to figure out what type of disorder this actually is so what we want to do is further look at that blood pH so we know it's 7.36 and the normal range is 7.35 to 7.45 but the absolute normal smack dab right in the middle is 7.4 so we're going to use 7.40 as our home base so we have a line here drawn and in the middle right there is 7.40 so we're normal but are we acidic normal on that blood pH or are we alkalic normal on that blood pH and how you figure that out is anything that is less than 7.4 is considered acidotic normal and anything greater than 7.40 is considered alkalic normal so here because we're 7.36 we're considered to be on that acidic side so we've established that we have a normal pH but it's acidic now let's look at that system either respiratory or met metabolic that matches also being acidic because that's the type of disorder we most likely have so we have P2 under acid and we have hc3 under base so what's under acid our respiratory system the P2 so we have respiratory acidosis full compensated and how this full compensation was achieved was that our bicarb or hco3 through itself into an alkalic value a basic value which helped incre increase that pH back to normal but it's normal but it's a little acidic normal because it just came from being on the acid side so now it's hopefully trending upward and it was helped by this byard by making itself alkalic the Rome method is another way to solve these ABG problems so let me demonstrate this method so Rome is an acronym that stands for Respiratory opposite metabolic equal and whenever you're using this method to help you solve arterial blood gases I really recommend that you keep the r and the O together and the m and E together think of them going together because it'll help you understand how to use this method so rno o it means respiratory opposite whenever we're talking about respiratory we're talking about the pac2 so that La value goes with this part of the acronym and then me is metabolic equal and when we're talking about the metabolic system the lab value we're looking at is the B card the H3 so that's going to go with this part of the acronym so now let's look at how we use these letters to get the answer to our ABG problem so you want to memorize this little chart here and first off we have the r and the O which again is respiratory opposite and we're particularly looking at two values with this we're looking at the P2 and the blood pH and we're looking for them to be opposite of each other so we're paying attention to which way the arrow is pointing up down so one's going to be up and one's going to be down or vice versa and if we have that presenting with our blood pH and that value we have a respiratory problem for instance let's look at this okay so we have a high P2 and we have a low blood pH that means we have respiratory acidosis because we know when our blood pH drops it's acidic and we know when we're keeping too much carbon dioxide we're going to have acidosis because CO2 helps helps create carbonic acid which influences our hydrogen ion concentration which makes us more acidic now whenever we have a low P2 and a high pH we're going to have respiratory alkalosis so see how they're opposite those values are in opposite directions now let's look at our M and our e so this is metabolic equal and with metabolic we're talking about the bicarb the H3 so for this part of the method we're talking about out the bicarb and the blood pH so they have to be equal meaning they're going in the same direction either they're both high or they're both low and if that's happening we have a metabolic problem so for instance if we have a low bicarb and a low blood pH we have metabolic acidosis or if we have a high bicarb and a high blood pH we have metabolic alkalosis now to help you interpret these values if they're high low or normal you have to have the normal ranges memorize and what each range means so let's quickly go over that for blood pH a normal blood pH is 7.35 to 7.45 this is the measurement of hydrogen ion concentration in our blood so a value of less than 7.35 would be considered acidic and we would put a down arrow because it's down if the blood pH is greater than 7.45 that is basic alkaline it is elevated so we would have an up Arrow now for P2 this is the amount of carbon dioxide in the arterial blood a normal level is about 35 to 45 mm of mercury with respiratory it's opposite hence the part of our pneumonic or acronym that says respiratory opposite so whenever we're talking about 35 to 45 it's like flipped what's going to be a base and what's going to be an acid for instance if it's greater than 45 that's considered an acid so it's elevated because we have a lot of carbon dioxide in our body so we would have an up Arrow now if it's less than 35 it's a base and we have low CO2 so it's a down arrow don't let that confuse you commit that to memory make sure you graph that because that'll help you whenever you're using this method to solve then we're going to look over at the bicarb the hco3 a normal level of this is 22 to 26 Milli equivalent so this is going to follow the same thing like how our blood pH did so a level less than 22 is considered acidic it's low so we put a down arrow and a level greater than 26 is considered basic alkaline and we would have an up Arrow now let me quiz you on this let's see how well you grasp this okay we have a blood pH of 7.23 what is that it's acidic so we would put a down arrow next we have a P2 of 30 32 is this acidic is it normal or a base it is a base and because it's 32 it's low so we would have a down arrow then we have a bicarb hc3 of 18 what's this this is an acid and it's low so we would have a down arrow and then lastly we have a pac2 of 51 what would this be it is acidic and because it's high we would put an up Arrow now let's solve some ABG problem problems using this method so these problems I'm actually going to solve come from a book I just released on ABG interpretation which is a workbook that has a lot of cheat sheet style notes and extra practice problems so you can get proficient at solving these problems now let's look at our first problem so it says we have a blood pH of 7.27 a P2 of 42 and a bicarb hc3 of 17 very first thing what we want to do is we want to set up this method so we're going to put r o m e vertically and then just over here to the side we're going to put our pH now what we want to do is we want to analyze that blood pH is it acidic normal or basic so our blood pH is 7.27 that is low so we're going to put a down arrow and it's acidic so in parentheses we're going to put acid just so we can keep it straight then we're going to look at the P2 it's 42 a normal is 35 to 45 so this Falls within that normal range so so next to R because that is representing our P2 we're just going to put normal then we're going to go look at that by carb hc3 it's 17 a normal is 22 to 26 so this is on the low side we're going to put a down arrow next to the m because that is the metabolic part and we're going to put in parenthesis acid just to let us know it's an acid now we're going to look do we have what we talked about earlier that we need to memorize that chart do we have respiratory opposite or metabolic equal we have metabolic equal because notice our bicarb is low and our blood pH is low they're equal they're same respiratory system was normal so we don't even have that so we have metabolic equal so we're going to put an X up here at the o and a check mark at the E So based on all that we have metabolic acidosis now we need to look and see if we have some type of compensation going on so first off we can look for full compensation and do we have full compensation the answer is no because our blood pH is abnormal our blood pH would have to be normal in order for us to have full compensation and here in a moment we'll be solving full compensation problem so you can get familiar with that now we need to move on do we have partial compensation or uncompensated and the reason we know is because we have a metabolic problem so we're going to look over at that respiratory system seeing if it's trying to help balance it out what what's going on because we have acidosis did the respiratory system try to make itself more alkaline by making that P2 less than 35 it did not so it's not trying to partially compensate so here we have uncompensated now this problem says we have a blood pH of 7.55 a P2 of 32 and an hco3 of 18 so the first thing what we want to do is we want to write out our little acronym r o m e vertically and then put a pH over here to the right so first let's analyze our pH it's 7.55 a normal is 7.35 to 7.45 so this is high so next to pH we're going to put an up arrow and we're going to put its basic it's alkaline then let's look at that P2 it is 32 so over here on the r and The O Part with the r it is low because a normal is 35 to 45 and this is basic so we're going to put base in parentheses then we're going to look at the bicarb the hc3 normal is 22 to 26 this is on the low side so down here at the M we're going to put a down arrow and put in parentheses that it's an acid so let's think back to that chart we needed to memorize do we have respiratory opposite or metabolic equal well let's look at that blood pH it is elevated our respiratory P2 is decreased so we have resp respiratory opposite so we definitely have a respiratory disorder we don't have metabolic equal because notice our H3 is low and our pH is high so they're opposite of each other so we have respiratory opposite and what we have is respiratory alkalosis so we want to determine if we have compensation or not so first we can look to see if we have full compensation and we don't because our blood pH is abnormal it is 7.55 normal is 7.35 7. 4 five so we can roll that out but we need to determine do we have uncompensated or partial compensation so we have a respiratory problem let's look at that metabolic system the bicarb to see if it's abnormal or normal because that can help tell us where we stand so our bicarb hc3 is 18 it's abnormal it's on the acidic side so we have alkalosis going on respiratory therefore the metabolic system try to make things a little bit more acidic so we can hopefully decrease that pH so it's trying to compensate so it would be respiratory alkalosis partial compensation now if that b carb was normal within that 22 to 26 range it would be uncompensated our next problem says that we have a blood pH of 7.44 a pac2 of 49 and a bicarb of 33 so the first thing we're going to do is write out Ram r m vertically and then put our blood pH over here to the right so we want to First analyze that blood pH it's 7.44 a normal is 7.35 to 7.45 so our blood pH is normal so next to pH we're going to write normal now let's further analyze this Blood pH because this should be tipping us off that we have full compensation but to help us further solve the problem we've got to analyze this Blood pH just a little bit more so an absolute normal blood pH right there in the middle is 7.4 anything less than 7.40 is considered to be normal acidic blood pH so it's on the acid side so it Bel low and anything greater than 7.40 is elevated on the normal side it's basic alkalic so here ours is 7.44 so we would consider this normal but it's basic it's alkaline so it's elevated normal so we're going to put a little up air AR right there and just put in parentheses base cuz it's on the base side then we're going to look at the P2 it is 49 any a normal is 35 to 45 so it's on the high side so we're going to put an up arrow and we're going to put it's on the acid and then we're going to look down at the bicarb the hc3 it's 33 and normal is 22 to 26 so this is elevated so where m is we're going to put metabolic we're going to put an up Arrow and then we're going to put in parentheses it's a base CU that's what that value is looking at our chart that we memorized earlier we are looking for Respiratory Ober metabolic equal and based on that blood pH it is equal with metabolic they're both going in the same direction so we have metabolic equal we do not have a respiratory opposite because notice that those arrows are going in the same direction so our answer is metabolic alkalosis and we know that we have full compensation because our blood pH is normal okay so that wraps up this video on using the Rome method to solve ABG problems if you'd like more problems you can access the free quiz in the description below

Transcript for:Understanding Acid-Base Imbalance Dynamics

Transcript for:
Understanding Acid-Base Imbalance Dynamics