ABG Interpretation: A Grand Overview of Acid-Base Analysis (Lesson 13)

[@StrongMed]

sskfrey, I'm glad you have enjoyed the videos! There are some start-to-finish ABG examples in lecture 20, though these examples also cover analysis of oxygenation status. At some point, I hope to add 1-2 supplemental lectures that go through more examples, but unfortunately, that may be some time away.

[@BilalAntoine]

This is how lectures should be given!

[@WayneL-gh6hd]

Extremely amazing!! Very impressive for me, especially when organzing into the final diagnosis. Thanks a lot for this lecture!!

[@sixdeep126]

you are the amn Dr Eric!! great visuals, and explanations, your patients are getting spoiled with your vast knowledge and understanding... keep it up sir!!

[@campusEMS]

Wonderful review of the ABG lectures. Thanks for the great lessons.

[@СтаниславГоршков-щ9я]

Oh, now I begin to understand this acidosis-alcolosis puzzle. Thanks a lot.

[@sheronjk]

I just want to say, You are super awesome. Thank you

[@mohsinraza-dr2bj]

I am confused that why we didn't calculate anion gap in example no. 4. Thanks for these easy to comprehend lectures.

[@maryamjamal1870]

Do you get the answer why he didn't calculate anion gap

[@sunving]

Thank you Dr Eric Strong, This is an excellent lecture, possible ( still not easy for me) to understand and better understanding why this is a long series . I feel like rebirth .

[@marianahattar3550]

god bless you!! you're an amazing lecturer Dr. Eric :) . this video made things a lot easier for me.

[@TheBortezomib]

very very well summarized. Awesome lecture!

[@tesneemmuhammad279]

Amazing lecture. Thanks a lot

[@MissFussyNZ]

best explanation i hav ever come across! thanks dr eric! from nz

[@elissaschachter4385]

Dr. Strong, I have learned so much from this series!! I am managing a complicated case and have been using your series to navigate my patients acid/base status. To make a long story short, she is receiving bicarb as part of her IV fluids. As a result, her measured bicarb (BMP) is quite different than her derived bicarb (ABG). In this scenario, should I use the measured bicarb and factor or the derived when doing my calculations? Thanks!

[@jawairiakhan9995]

Genius approach!!

[@sskfrey]

Very nice. Exzellent solides. Could you make a video containing just examples, so one could see, how u apply your master algorithm. Thanks appreciate the work

[@abdullabedir4873]

After determining acidemia or alkalemia, what if the PCO2 level is normal? How do we determine if the primary derangement is respiratory or metabolic? Thank you so much for your lectures, extremely helpful and brilliantly put together!

[@StrongMed]

+Abdulla Bedir If the pH is abnormal, and the PCO2 is normal, then the "primary" process must be metabolic, and the patient has a second respiratory disorder in the same direction as the metabolic one. For example, if the pH is low and PCO2 normal, then the patient must have a metabolic acidosis with a low HCO3; and if you plug the HCO3 into Winters' formula you'll see that the patient has a concurrent respiratory acidosis. The converse holds true if the pH is high and PCO2 normal.

[@abdullabedir4873]

+Strong Medicine Makes sense, thank you!

[@maryamjamal1870]

Dr eric why didn't you calculate delta ratio in example 4? If we calculate delta ratio it would be nagma + hagma and not at all metabolic alkalosis

[@ayadoudin9338]

Excellent and informative

[@romeolhk1008]

Thank you very much Doctor Eric!!!!

[@larkest]

Dr Eric: Why do you not calculate the Delta Ratio in the final example despite of having an Anion Gap >20, becouse it is result below the range expected (for lactic acidosis or ketoacidosis), then acording to the chart it must be an additional Metabolic Acidosis with normal anion gap concurrent, thanks and i really enjoy watching and learning a lot from your videos, greetings from Mexico :)

[@srinivassri8521]

I have 2 question 1.how does metabolic alkalosis cause elevated anion gap ? (How does albumin increase in that case) 2.in example 3..in compensation how did u tell it's a chronic case ?... Confused

[@m7mdsmn]

very nice video Dr , thanks you , could you do a video on fluid and electrolytes(Na,K,Ca) and fluid resuscitation??? it would be very appreciated....thanks again!

[@ahmology]

I do have 2 Questions 1. What does one mean by measured S Osmolality? is that lab. measured value and if so why isnt it equal to the measure Osmolality? 2. Ketones here are refered to Ketones in Serum?

[@alexeuropapokal9116]

About compensation. My teachers and my book (Herold - internal medicine) are telling me that compensated means that pH is in normal range and decompensated that pH is out of the normal range. Is there maybe a different definition in acute or chronic settings? Thank you for your help!

[@StrongMed]

+Alexander Prinz I'm not familiar with Herold, but the published literature on acid-base compensation (which truthfully, is relatively modest) is all consistent with the fact that otherwise healthy individuals, when they develop an isolated, moderate-severe acid-base abnormality, will not normalize their pH. Although I have heard others claim the same as your teachers (i.e. any pH out of the normal range means that a person's acid-base derangement is not appropriately compensated), that is inconsistent with the literature I've read, the texts I'm familiar with, and my own personal experience. If you or any other viewers find primary literature to the contrary, please feel free to post it!

[@umgrandepino]

I don't think it matters at this point in time as UAG is still above 20, but the calculated UAG at minute 28 is 55 and not 35. It confused me a bit, but I believe the formula you wrote down on the slides is correct??? UAG=Na+K-Cl correct?

[@espinosa3059]

Great explanations tnx

[@ddshayoda]

Dr Eric : I Dont get what law of parsimony is Exactly ???

[@StrongMed]

shady abdelbari In medicine, the law of parsimony is defined in different ways, but most commonly states something like "When a patient has multiple pathologic or physiologic derangements occurring simultaneously, it is more likely for 1 disease to be causing all of them, than it is for each problem to be caused by a different disease". Or alternatively, "It's better to err on the side of invoking as few independent diagnoses as possible to explain multiple symptoms, physical signs, and test abnormalities".

[@songmasterization]

Sorry to be a besserwisser, it wont change outcome but Example 2. Your counting the adjusted AG and you put 132-(95+12) = 25, which is correct, but the HCO3 is 13 and not 12. ;)

[@agpdc]

sir when should we call it acute and chronic?

[@User-to7nb]

"I will summarize the first 12 lectures" me who just watched them: wha-

[@ddshayoda]

Example 3 : Urin gap = 60+10-15 = 55 not 35

[@StrongMed]

shady abdelbari Wow, that was some bad math! Thanks for pointing it out.

[@ddshayoda]

no .. But thank you for these Great Lectures Best Teaching ever seen for me at least : )

[@sixdeep126]

MAN