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How to Interpret Acid Base Disorders

Interpreting the Acidic-lemon and Baking-soda-base with a Disorder
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Interpreting Acid-Base disorders is an essential nursing skill that involves a three step process: checking the pH, partial pressure of carbon dioxide in the blood (pCO2), and bicarbonate levels (HCO3). These indicators will allow you to determine the type of disorder.
12 KEY FACTS
pH, pCO2, HCO3 (Bicarbonate)
pH-strip, Partial-pressure-gauge CO2, and Bi-car-bomb

Mastering quick interpretation of acid base lab values is a key element to success of the Nurse. Three components are included in typical lab value assessment.  pH, pCO2, HCO3 (Bicarbonate)

STEP 1
pH
pH-strip

The first step to interpret this is to look at pH. Blood pH is normally 7.35-7.45. pH is determined by the amount of hydrogen ions contained in the blood.

Acidosis
Acidic-lemon

A pH of less than 7.35 is termed acidosis. Acidosis indicates a buildup of carbonic acid in the blood.

Alkalosis
Elk-loser

A pH higher than 7.45 is termed alkalosis. Alkalosis indicates a buildup of bicarbonate (bases) and/or a general decrease in carbonic acid in the blood.

STEP 2
pCO2
Partial-pressure-gauge CO2

The second step is to examine the partial pressure of carbon dioxide in the blood, pCO2.  pCO2 is normally 35-45 mmHg. pCO2 is regulated primarily through respiration.

Opposite Direction As pH
Showing the Opposite Direction on pH-strip

Opposite Respiratory and pH directions indicates a respiratory disorder. If the pCO2 is not in the opposite direction of the pH then check the HCO3 next.

Respiratory Acidosis
Respirator Acidic-lemon

Respiratory acidosis is often indicated by a pH of less than 7.35 and a pCO2 of higher than 45 mmHg.

Respiratory Alkalosis
Respirator Elk-loser

Respiratory Alkalosis is indicated by a pH of more than 7.45 and a pCO2 of less than 35 mmHg.

STEP 3
HCO3 (Bicarbonate)
Bi-car-bomb

The normal value of bicarbonate is 22-26 mmol/L. The amount of the base HCO3 and bicarbonate in the blood is regulated in the kidneys.

Same Direction As pH
Showing the Same Direction as pH-strip

If the HCO3 (bicarbonate) is going in the same direction as pH then the problem is most likely a metabolic problem. 

Metabolic Acidosis
Metal-ball Acidic-lemon

The patient with Metabolic acidosis can grossly be determined as Down, Down, Down (Decreased pH, Decreased pCO2, Decreased HCO3)

Metabolic Alkalosis
Metal-ball Elk-loser

Metabolic alkalosis can grossly be determined as UP, UP, UP (Increased pH, Increased pCO2, Increased HCO3)

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