Why measure blood gases? A three-part introduction for the novice. Part 2.
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Arterial blood gases (ABG), a clinical test that involves measurement of the pH of arterial blood and the amount of oxygen and carbon dioxide dissolved in arterial blood, is routinely used in the diagnosis and monitoring of predominantly critically/acutely ill patients being cared for in hospital emergency rooms and intensive care units. The test allows assessment of two related physiological functions: pulmonary gas exchange and acid-base homeostasis. This is the second of three articles intended to explain the clinical value of ABG to those with little or no experience of the test. The first article focused on the physiological aspects that underpin an understanding of patient ABG results. The concepts of pH, acid, base and buffer were explained, and the parameters generated during ABG were defined and related to pulmonary gas exchange and acid-base homeostasis. In this second article attention turns to the clinical significance of abnormal ABG results, specifically abnormality in three ABG parameters (pH, pCO2(a) and bicarbonate) that determine patient acid-base status. A major focus of the article will be an explanation of the four classes of acid-base disturbance: respiratory acidosis, metabolic acidosis, respiratory alkalosis and metabolic alkalosis. The causes and physiological consequence of each of these disturbances will be discussed.
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