Arterial blood gas interpretation in clinical practice

133 Pages·2021·0.922 MB·English

by  Anil Mane

In Clinical Practice
Anil Mane
Arterial
Blood Gas
Interpretation in
Clinical Practice
In Clinical Practice
Taking a practical approach to clinical medicine, this series of
smaller reference books is designed for the trainee physician,
primary care physician, nurse practitioner and other general
medical professionals to understand each topic covered. The
coverage is comprehensive but concise and is designed to act
as a primary reference tool for subjects across the field of
medicine.
More information about this series at http://www.springer.
com/series/13483
Anil Mane
Arterial Blood
Gas Interpretation
in Clinical Practice
Anil Mane
Glan Clwyd Hospital
Rhyl, North Wales
UK
ISSN 2199-6652 ISSN 2199-6660 (electronic)
In Clinical Practice
ISBN 978-3-030-69844-7 ISBN 978-3-030-69845-4 (eBook)
https://doi.org/10.1007/978-3-030-69845-4
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Preface
The disorders of oxygen, carbon dioxide, bicarbonate, acids,
and alkalis are a complex interplay of multisystem malfunc-
tions in the human body. These disorders are common and
often pose diagnostic challenges. These disorders can be seri-
ous and life-threatening.
And yet, the knowledge on these topics is scattered in vari-
ous chapters in the textbooks of medicine. In fact, there are
very few chapters devoted to these topics. The knowledge is
fragmented in various chapters and books on nephrology,
respiratory medicine, biochemistry, emergency medicine, and
intensive care.
Hope this title fills the gap and brings the knowledge at
one place in a concise manner.
This comprehensive and practical book will help the doctors
and nurses on the floor to make the patients recover faster.
Enjoy becoming competent and confident.
I would like to thank the following medical professionals
for their advice, contributions, and review.
• Dr. George Bugelli, Consultant in anaesthesiology.
• Dr. Tony Shambrook, Consultant in anaesthesiology
• Dr. Martin Royale, Consultant in cardiology
• Dr. Ajay Dixit, Consultant in psychiatry
• Dr. Atanu Basu, Consultant in acute medicine
• Dr. Babukutty Korrula, Anaesthesioligist.
North Wales, UK Anil Mane
Normal Values and
Conversion Factors
Note: Normal values may change from laboratory to
laboratory.
Normal
value
Multiplied To convert to
Mg/dL by micro-mol/L
Random plasma glucose level 70–100 0.0555 4–6
Blood urea: 15–45 0.1665 2.4–7.1
blood urea nitrogen, BUN: 7–20 0.357
Total serum 8.5–10.2 0.2495 2.1–2.55
calcium
Serum phosphorous/ 2.5–4.5 0.3223 0.80–1.50
phosphate
Serum magnesium 1.8–3 0.4113 0.6–1.5
Electrolytes
Normal value To convert to
mEq/L Multiplied by mmol/Lh
Serum sodium 135–145 1 135–145
Serum potassium 3.5–5.5 1 3.5–5.5
Serum chlorides 95–105 1 95–105
Bicarbonate 22–26 1 22–26
(HCO–)
3
viii Normal Values and Conversion Factors
Normal values To convert to
Mg/dL Multiplied by micro-mol/L
Creatinine 0.8–1.4 88.4 70–124
• Blood H+ levels: 37–43 nmol/L
• Serum albumin: 37–50 g/L
• Arterial actual bicarbonate, aHCO–: 22–26 mEq/L
3
• Arterial standard bicarbonate, sHCO–: 21–27 mEq/L, at
3
body temperature or 37 °C, at normal CO levels, and full
2
normal oxygen levels.
Note:
1. The values of PaO and PaCO in kPa should be multiplied
2 2
by 7.5 to convert them to mmHg.
2. If your laboratory provides the value of serum total CO
2
(t CO in mM), and if you need to calculate the HCO–,
2 3
then subtract 1 from the value of tCO.
2
Disclaimer
Management of an individual patient depends on the clinical
situation, clinical judgement, patient’s choices, clinicians’
options, local guidance, and laboratory parameters. This book
provides general principles in diagnoses and an approach to
the common acid–base disturbances.
Contents
1 Practical Aspects of ABG ........................ 1
2 Oxygen Parameters .............................. 5
3 Type 2 Respiratory Failure/Hypercarbia/
Hypercapnia (Hypercarbia) ...................... 23
4 Respiratory Alkalosis ............................ 35
5 Pearls of Wisdom and Examples ................... 41
6 Metabolic Disorders: 1 ........................... 45
7 Metabolic Disorders: 2 ........................... 63
8 Metabolic Disorders 3: Metabolic Alkaloses ........ 81
9 Mixed Acid-Base Disorders ....................... 97
10 Important Topics ............................... 115