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    How To Interpret BGA (Ali Haedar)

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    Bayu Akbar
    The document provides guidance on evaluating acid-base abnormalities, including identifying primary vs. secondary disturbances and their causes based on pH, PCO2, HCO3, and anion gap. It outlines how to determine if a metabolic acidosis or alkalosis is accompanied by respiratory compensation. Causes of high anion gap metabolic acidosis are summarized using the "SCATMUD" mnemonic.

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    How To Interpret BGA (Ali Haedar)

    Uploaded by

    Bayu Akbar
    28 views15 pages
    The document provides guidance on evaluating acid-base abnormalities, including identifying primary vs. secondary disturbances and their causes based on pH, PCO2, HCO3, and anion gap. It outlines how to determine if a metabolic acidosis or alkalosis is accompanied by respiratory compensation. Causes of high anion gap metabolic acidosis are summarized using the "SCATMUD" mnemonic.

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    The document provides guidance on evaluating acid-base abnormalities, including identifying primary vs. secondary disturbances and their causes based on pH, PCO2, HCO3, and anion gap. It outlines how to determine if a metabolic acidosis or alkalosis is accompanied by respiratory compensation. Causes of high anion gap metabolic acidosis are summarized using the "SCATMUD" mnemonic.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views15 pages

    How To Interpret BGA (Ali Haedar)

    Uploaded by

    Bayu Akbar
    The document provides guidance on evaluating acid-base abnormalities, including identifying primary vs. secondary disturbances and their causes based on pH, PCO2, HCO3, and anion gap. It outlines how to determine if a metabolic acidosis or alkalosis is accompanied by respiratory compensation. Causes of high anion gap metabolic acidosis are summarized using the "SCATMUD" mnemonic.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 15

    Ali Haedar

    Department of Emergency Medicine


    Saiful Anwar General Hospital
    Faculty of Medicine – University of Brawijaya, Indonesia
    Special Tips
     Hyperventilation is a diagnosis of exclusion in
    tachypnea patients
     Always exclude underlying metabolic acidosis with
    Kussmaul breathing, pulmonary embolism, and severe
    asthma
     Paper bag rebreathing for hyperventilation is
    potentially hazardous ai it can couse significant
    hypoxia while raising PCO2 only slightly
    Anion Gap
     AG = [Na+} – [HCO3] – [Cl]

     Normal: 3-11 mmol/L


     An elevated AG suggests High Anion Gap Metabolic
    Acidosis (HAGMA)
    Causes of HAGMA
     S : salicylates, exogenous toxins  C : Cyanides, carbon monoxide
    (eg metformin, methanol,  A : Alcoholic ketoacidosis
    toluene, ethylene glycol, iron,  T : Toluene
    paraldehydes)
     M : Methanol,
     U : Uraemia
    methaemoglobinemia
     L : Lactate acidosis
     U : Uraemia
     K : ketoacidosis (DKA,
     D : Diabetic Ketocidosis
    stavation)
     P : Paraldehyde
     I : INH, Iron
     L : Lactate acidosis
     E : Ethylene glycol (not ethanol)
     S : Salycilates, solvents
    Low Anion Gap
     If AG is very low, consider:
     Hypoalbuminemia
     AG decreases by 2.5 mmol/L for every 1 g/dL decreases
    in albumin
     Paraproteinemia
     Hyponatremia
     Mypermagnesemia
     Hypercholestrolemia
     Lab errors
    Identify the abnormality for respiratory
    failure
    Type I: PaO2  60 mmHg (8 kPa)
     A hypoxic pt is often agitated, and sometimes, violent.

    Type II: PaCO2  55 mmHg (7 kPa) with/without poor


    oxygenation
     A hypercarbic pt is drowsy, so pt may look deceptively ‘comfortable’,
    often not tachypneoic.
     Do not treat the high PaCO2 level in pts with chronic compensated
    type II respiratory failure (normal pH)

    * Consider advance airway management for type I and type II acute respiratory
    failure
    Look for abnormalities in pH, HCO3,
    PCO2, AG for albumin
    1. Any abnormalities in any 3, is associated with an acid
    base without exception
    2. An elevated AG is a marker of HAGMA, even in the
    presence of normal pH or HCO3
    If pH normal, check for balanced acid
    base disorder
    1. HCO3<20 PCO2<35 Met Acid + Resp Alka
    2. HCO3>24 PCO2>45 Met Alka + Resp Acid
    3. HCO3, PCO2 normal AG>11 HAGMA + Met Alka
    4. HCO3, PCO2 normal AG normal normal
    If pH abnormal, identify the primary
    abnormality
     pH < 7.35 and HCO3 < 20 mmol/L : acidosis metabolic

     pH < 7.35 and PCO2 > 45 mmol/L : Acidosis respiratoric

     pH > 7.35 and HCO3 > 24 mmol/L : Alkalosis metabolic

     pH > 7.35 and PCO2 < 35 mmol/L : Alkalosis respiratoric


    Identify any secondary abnormalities by
    adequacy of compensation
    1. Metabolic acidosis: expected PCO2 = (1.5 x HCO3) + 8
    mmHg (2)
    a. If measured PCO2 is lower than expected, concurrent respiratory
    alkalosis
    b. If measured PCO2 is higher than expected, concurrent
    respiratory acidosis
    c. For HAGMA, account for access or missing anions by calculating
    the excess anion gap
    1) Excess anion gap, AG = AG – 11
    2) Add AG to measure HCO3
    3) If total = normal HCO3, simple HAGMA
    4) If total > normal HCO3, concurrent metabolic acidosis
    5) If total < normal HCO3, concurrent NAGMA
    2. Metabolic Alkalosis:
    expected PCO2 = (0.6 x [HCO3 – 24] = 40 mmHg

    a. If measured PCO2 is lower than expected, consider


    concurrent respiratory alkalosis
    b. If measured PCO2 is higher than expected, consider
    concurrent respiratory acidosis
    3. Respiratory acidosis or alkalosis
    a. Acute
    1) HCO3 changes 1 to 2 mmol/L for every change in
    PCO2 by 10 mmHg
    2) pH changes 0.08 for every change in PCO2 by 10
    mmHg
    b. Chronic
    1) HCO3 changes 4 to 5 mmol/L for every change in
    PCO2 by 10 mmHg
    2) pH changes 0.03 for every change in PCO2 by 10
    mmHg
    C. If measured HCO3 is lower than expected, consider
    concurrent metabolic acidosis
    D. If measured HCO3 is higher than expected, consider
    concurrent metabolic alkalosis

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