Metabolic/ respiratory acidosis and alkalosis

[jennielynn]

Call me stupid--but I'm having such a time with determining whether a person is in respiratory or metabolic acidosis/alkalosis based on the ABG levels. I know how to determine the acidosis/ alkalosis part---its the difference between metabolic and respiratory that screws me up. If anyone has any suggestions on how to tell the two apart--please share!!!!

[~Mi Vida Loca~RN, ASN, RN]

Intern67 said:

Just yesterday, I was in a study group where we reviewed ABG analysis for the final exam. The students who relied on memorization had almost no clue where to even start. The ones who understood the underlying mechanisms had nothing to remember and were able to address the questions without difficulty.

Now, when the test is tomorrow or in a couple hours, you do what you have to do. But if you are just learning, take the long road, it means less studying in the future!

Well yes, like I said, you need to know the WHY to all of this stuff, not just this stuff. But it's nice to have the quick reference tools during an exams for the direct questions or in this sense when you have the values only.

Maybe it's not for everyone, but I know it's been great for my group, we have talked about it after a test and said how it was nice to remember that quick trick on those questions. The questions that are again, stating only lab values. The students in my group get very good grades and do very well on tests and they still like the mnemonics. It can be very useful even when you do UNDERSTAND what is being talked about.

[TheSquire, DNP, APRN, NP]

Intern67 said:

Note to Vida Loca and everyone,

I posted my response to the OP before seeing the previous responses. My characterization of the use of memory tools as "nonsense" was in no way a response to your posts (as I had not seen them). I was trying to reinforce the idea that knowing the underlying processes was very beneficial.

In reading the thread, it looks like I am responding to your posts, but I was not. Of course I use mnemonics as much as any other nursing student, but in the case of ABGs, my personal experience with other students is that they should be used after the basics are understood.

Thanks!

That's alright - I'm still chuckling over the mental image of students in lecture desks vomiting on themselves.

[turnforthenurse, MSN, NP]

I typed up a response in a similar thread here (post no. 5):

https://allnurses.com/general-nursing-student/tips-for-respiratory-474977.html#post4258749

[JSlice., ASN, RN]

Mi Vida Loca,

Thank you for you first post. This is exactly what I wanted. A mnemonic that will better help me remember them in the first place. Once I have the mnemonic down I can work on better UNDERSTANDING why it is this way. I don't care what anyone says, you have to memorize certain information and later go back to better understand the info. Great job, thank you!!!

[~Mi Vida Loca~RN, ASN, RN]

JSlice. said:

Mi Vida Loca,

Thank you for you first post. This is exactly what I wanted. A mnemonic that will better help me remember them in the first place. Once I have the mnemonic down I can work on better UNDERSTANDING why it is this way. I don't care what anyone says, you have to memorize certain information and later go back to better understand the info. Great job, thank you!!!

You're welcome. There are these books Mnemonics memory books for nursing. Or something similar to that title, I think they're 2 editions. I got my close group of friends the first volume for Christmas and then another girl got me and her the second volume. I have found them really useful.

[davew43boss]

yes, I would like one package. I need some practice.

[jpainter0013]

I would like a packet! Can you email them??? If so my email is [email protected]

[lexicon28, BSN]

I'm about to have a test on this on tuesday lol

Respiratory Acidosis:

-high PCO2, low pH

--> Kidney Compensates (retaining HCO3)

Respiratory Alkalosis:

-low PCO2, high pH

--> Kidney Compensates (secretes HCO3)

Metabolic Acidosis:

-low HCO3, low pH

--> Lungs Compensate (Hyperventalation)

Metabolic Alkalosis:

-high HCO3, high pH

--> Lungs compensate (Hypoventalation)

Hope this helps. :)

[catken52]

I would like a packet also, please.

[email protected]

Thank you.

[diane jacobs]

[email protected] if u can id like one also

[nurseprnRN, BSN, RN]

Abgs Made Simple

You Want Simple Abgs? Piece O' Cake. People Who Have Seen This Before, Well, Just Scroll On By. Newbies Who Want A Brief Abg's Refresher, Take Out Your Pencils And A Piece Of Paper, Cuz You'll Need To Do A Bit Of Drawing .

I Taught Abg Interpretation For Yrs In A Way That Made It Pretty Foolproof. You Will Make Your Own Key To Interpret Abg's, And Will Be Able To Reproduce It From Memory Any Time You Need To With Very Little Trouble If You Learn A Very Few **key Concepts**, Labeled **thus**.

Take A Piece Of Paper. Make A Big Box On It, Then Draw Vertical And Horizontal Lines On It So You Have Four Boxes. I Will Try To Make This Come Out, But...you Should Have

Ab

Cd

Where The Four Boxes A,b,c,d Are Such That A Is Above C And B Is Above D. You Don't Need To Label The Boxes A,b,c,d, Just Get Them In The Right Alignment. (this Is Way Easier With A Blackboard Bear With Me).

*inside* Each Of The 4 Boxes Write The Following, Down The Left Edge:

Ph

Co2

Bic

Now, Outside The Big Box Do The Following: Above The "a" Box Write "resp"; Above The "b" Box Write "metabolic"

To The Left Of The "a" Box Write "acidosis" And To The Left Of The "c" Box Write "alkalosis"

Now You Have A "resp" Column And A "metabolic" Column, An "acidosis" Row And An "alkalosis" Row. So You Have Respiratory Acidosis And Alkalosis Boxes, Metabolic Acidosis And Alkalosis Boxes.

With Me So Far?

Now, You're Going To Label The Primary Derangements, So Later You Can Tell What's The Derangement And What's The Compensation. Ok? In The Respiratory Column, Underline Co2's. In The Metabolic Column, Underline The Bicarb's. That's Because In **respiratory Disorders, The Co2 Gets Messed Up**, And In **metabolic Disorders, The Bicarb Is Messed Up**. You Knew That, Or Could Figure It Out Pretty Quick If You Thought About It, Right? Thought So.

Now. You Are Going To Put Upward-pointing And Downward-pointing Arrows Next To The Ph, Co2, And Bicarb Labels Inside Every Box. Ready?

Ph First. In The "alkalosis" Row, Make Up Arrows Next To Ph, Because **ph Is Elevated In Alkalosis (by Definition)**. Put Down Arrows In The Acidosis Row's Phs, Because **acidosis Means A Lower That Nl Ph**.

Remember That **co2 Is Acid** And **bicarb Is Alkaline** (this Is The End Of The Key Concepts. Not Too Bad, Huh?). (oops, I Forgot: **nls Are Generally Accepted As Ph 7.35-7.45, Co2 35-45 (nice Symmetry There), Bic 19-26**)

Now Go To The Box That Is In The Respiratory Column And The Acidosis Row. Figured Out That Co2 Must Be Elevated? Good. Put An Up Arrow Next To That Co2. Go To The Respiratory Alkalosis Box. Figures That Co2 Must Be Low To Cause This, Right? Put A Down Arrow Next To That Co2.

Ok, Now Go To The Next Column, The Metabolic One. I Think You Can Figure Out What Happens Here: In The Metabolic Alkalosis Box, Put An Up Arrow Next To The Bic, Because High Bicarb Makes For Metabolic Alkalosis. Put A Down Arrow Next To The Bic In The Metabolic Acidosis Box, Because In Metabolic Acidosis The Bicarb Is Consumed By The Acids And Is Low.

You Are Now Going To Put Arrows Next To The Blank Spots In Your Boxes That Show Compensatory Movements. Ready? Ok, What Does Your Body Want To Do If It Has Too Much Acid? Right, Retain Base. Yes, Of Course If Your Body Has Too Much Acid It Would Like To Get Rid Of It...but If It Can't Do That, Then Retaining Bicarb Is The Compensation. So For Every Elevated Co2 You See, Put An Up Arrow With Its Bicarb.( Chronic Co2 Retainers Always Have Elevated Bicarbs, And This Is Why.) You Will Find An Up Arrow Next To The Co2 In The Resp/acidosis Box.

So If Your Body Is Short On Acids, What Does It Do? Right, Excrete Base. So Put A Down Arrow Next To The Bicarb In The Resp/alkalosis Box, Because Chronic Low Co2 Makes The Body Want To Get Back Into Balance By Getting Rid Of Bicarb.

Likewise In The Metabolic/alkalosis Box, A High Bicarb Makes Your Body Want To Retain Acid, Increasing Co2 Being The Fastest Cuz All You Have To Do Is Hypoventilate, To Bring Your Ph Back Towards Nl. Put An Up Arrow Next To The Co2 In The Met/alk Box. See The Pattern Here? Put A Down Arrow Next To The Co2 In The Met/acidosis Box, Because If Your Body Has Too Much Acid In It (think : Asa Overdose? Dk**a**?) It Will Want To Get Rid Of Co2 To Compensate, And The Fastest Way To Do That Is To Hyperventilate.

Ok, I Hear You Wailing: But How Do I Know Whether That Elevated Or Decreased Co2 Or Bicarb In My Abg Report Is Primary Or Compensatory?

Well, Now You Have Your Key. So Take Your Abg Reports And Look At Them. Say, Try These. (notice That O2 Levels Have Nothing To Do With Acid-base Balance Abg Interpretation) (ok, If You Are Very Hypoxic You Can Get Acidotic...but You See That In The Metabolic Component, Not The O2 Measurement, Because It's Lactic Acid Your Body Is Making If It's Working In An Anaerobic Way)

1) Ph = 7.20, Co2 = 60, Bic = 40.

First Thing To Look At Is The Ph. 1) Is Acidosis, With A Low Ph. Look At Your Acidosis Choices (you Have Two). Find The Acidosis Where Both Co2 And Bicarb Are Elevated, And You Find Your Answer: Respiratory Acidosis With Metabolic Compensation. This Is What You See In Chronic Lungers Who Have Had High Co2's For So Long Their Kidneys Have Adapted To Things By Retaining Bicarb. (it Takes About 24 Hrs For Your Kidneys To Make This Compensatory Effort, So You Can Tell If Your Resp Acidosis Is Acute (no Or Little Change In Bicarb) Or Chronic)). (remember, Your Lungs' First And Most Important Job Is Not Getting Oxygen In, It's Getting Co2 Out, And When Chronic Lungers Have Co2 Retention, They're Really Getting Bad. People With Acute Bad Lungs Will Often Have Low Oxygens And Low Co2's , Because Their Ability To Gain O2 Goes First, And While They're Trying To Deep Breathe Their Way Back To A Decent Pao2, They Hyperventilate Away Their Co2. ....but I Digress....)

2) Ph = 7.54, Co2 = 60, Bic = 40

Ph Here? This Is Alkalosis, With A High Ph.

The Only Box Where Ph Is High And Co2 & Bic Are Both Elevated Is Metabolic Alkalosis With Respiratory Compensation. Sometimes You'll See This In People Who Have A Bigtime Antacid Habit. Really. (you Can Get A Short-term Metabolic Alkalosis With Rapid Severe Vomiting, Because The Body's Nl Balance Betwreen Acid And Base Has Been Disrupted Due To A Sudden Loss Of Acid. Things Will Equilibrate Pretty Quickly, Though, All Things Considered.)

So Even Though You Have Identical Co2's And Bicarbs, You Can Look In Your Boxes, Find The Match, And See What You Have. Remember You Underlined The Primary Disorder In Each Box?

Wanna Try Another One?

3) Ph = 7.19, Co2 = 24, Bic = 12. Bingo, You Found It: An Acidosis Where The Co2 And The Bic Are Both Low. Only Fits In The Metabolic Acidosis Box, So You Have A Metabolic Acidosis With A Respiratory Compensation Effort. Incidentally, This Is What You See In Diabetic Ketoacidosis, When They Come In Huffing And Puffing To Blow Out That Co2 Because Their Ketosis Is So High. Also You See This Picture In Asa Od's, Because This Is Acetylsalicylic Acid They Ate, And The Fastest Way To Get Rid Of Acid Is To Blow It Off Via Hyperventilation. Increasing Your Bicarb Takes 24-48 Hrs. Another Quick Way To Get A Metabolic Acidosis Is To Poop Out A Lot Of Diarrhea, Because You Lose A Lot Of Bicarb That Way. Another Classic Place For This Is In Mesenteric Artery Thrombosis, In Which You Have A Lot Of Ischemic Bowel Sitting In There Screaming For Oxygen And Making Lactic Acid When It Can't Have Any.

I Know This Is Long, But Trust Me, You'll Never Go Wrong With It, And You Can Recreate It Anytime. It Doesn't Really Even Matter How You Set Up Your Boxes, So Long As You Have A Metabolic And A Respiratory Axis And An Acid/alkaline Axis. Rotate Your Paper And You'll See What I Mean.

Why Don't I Care About Pao2 Here? Well, Because Abg's Mostly Tell You About A/b Balance And Co2 And Bicarb, That's Why. Probs With Them Can Be Serious Probs Without Any Abnormality In Oxygenation At All.

Remember That Pao2 (arterial Oxygen, Measured In Torr Or Mmhg) Is Not The Same As Spo2,( Hemoglobin Saturation, A Percentage Of Red Cells Carrying Oxygen). If You Think They Are, Your Pt Could Be In Serious Trouble Before You Do Anything. There Is A Nomogram That Shows You The Relationship Between Arterial Oxygen And Saturation, Which I Regret I Cannot Reproduce Here. But You Can Sketch Out A Basic Version...

Draw A Graph Where Sats Are On The Vertical (left) Axis And Pao2's Are On The Horizontal (bottom) Axis. Draw Little Shaded Band Across The Top At The 95%-100% Sat Areas. That's Your Normal Saturation. Draw A Few Dots There Indicating A Line Of Pao2's Of 80-100, Because Those Are Normal Pao2's.

Now Draw A Dot For Spo2 Of 90 And Pao2 Of About 75. Now, Another Dot Showing Spo2 Of 85 And Pao2 Of About 60. Another Dot: Spo2 Of About 80 And Pao2 Of About 55. Connecting All These Dots Should Give You A Sort Of S Curve, Indicating That While The Top Is Pretty Flat In The Pao2 80-100, Spo2 95-100 Range, Pao2 Drops Off Like A Shot At Decreasing Spo2 Levels.

Your Pt With A Sat Of 85 Is Not Doing Ok, He's In Big Trouble. While A Pao2 Of 75 Torr Isn't Too Bad At All, A Sat Of 75% Is Heading For The Undertaker Unless Dealt With.

Here's My Very Favorite Abg Of All Time: Ph = 7.11, Pao2 = 136, Paco2 = 96, Bicarb = 36.

What Happened To This Lady? What Will Happen Next?

"call" If You Have Any Questions...

[heelnurse]

R.O.M.E-->

Respiratory- Opposite

Metabolic- Equal

If your pH and your CO2 are opposites then youll be in respiratory acidosis/alkalosis

if your pH and you HCO3 are equal youll be in metabolic acidosis/alkalosis