Patient Care and Monitoring

1. Every patient with a suspected acid-base disturbance should have an arterial blood gas and a serum chemistry panel drawn concurrently. The results of these tests should be reviewed using a systematic approach to ensure proper interpretation.

2. What is the primary disorder? Has compensation occurred?

3. Is the anion gap excessively large? If so, does calculation of the excess gap identify another acid-base disorder?

4. Continuous cardiovascular and hemodynamic monitoring should be used for significant pH disturbances, as the most serious sequelae of acid-base disorders include electrolyte abnormalities, cardiac dysrhythmias, and systemic hypotension.

5. All acid-base abnormalities result from underlying disease processes. Definitive therapy for these disturbances requires treatment of the illness that has disrupted the pH equilibrium.

6. Review each patient's history, physical exam, and current medication list for clues regarding potential causes of the observed acid-base disorder.

7. Serial arterial blood gases and serum chemistries should be compared, as every patient's acid-base status is continuously changing based on the underlying disease state and any therapy initiated.

Abbreviations Introduced in This Chapter

ABG

Arterial blood gas

bipap

Bilevel punitive airway pressure

ci-

Chloride ion

co2

Carbon dioxide

A(delta)

Change

H'

Hydrogen ion

HC1

Hydrochloric acid

HCO,

Bicarbonate

HCO;curr

Current bicarbonate

HC03posl

Post-therapy bicarbonate

Hg

Mercury

K'

Potassium ion

kg

Kilogram

kPa

Kilopascal

L

Liter

mEq

Milliequivalent

mm

Millimeter

m mol

Mi Hi mole

Na'

Sodium ion

NaHC03

Sodium bicarbonate

nh2

Terminal amine group

NH/

Ammonium

ph

Logarithm of the hydrogen ion concentration

PaCO,

Partial pressure of arterial carbon dioxide

tC02

Total venous carbon dioxide

UAG

^ Self-assessment questions and answers are available at ht-tp://www. mhpharmacotherapy. com/pp.html.

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