ALS algorithm

- The respiratory-metabolic link

The body has two systems for ensuring a stable internal environment and preventing the development of an acidosis: the respiratory system and the kidneys.
The respiratory metabolic link equation: CO2 plus H20 reaction equilibrium symbol H2CO3 reaction equilibrium symbol H positive plus HCO3negative.

These two systems are linked by the presence of carbonic acid (H2CO[sub]3[/sub]) which is dependant on the presence of an enzyme called carbonic anhydrase present in red blood cells and kidneys. As is shown in this equation, the systems can compensate for derangements in each other.

Although this link exists, the ability for each system to compensate for the other is not instantaneous but becomes more significant when the initial disturbance in one system becomes prolonged.

There are examples demonstrating the links between the two systems in chapter 15 of the ALS manual.

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References

See chapter 15 of the ALS manual for further reading about arterial blood gas analysis.

Essentials: 5-step approach to ABG interpretation

Step 1 – how is the patient?

Step 2 – is the patient hypoxaemic?

Step 3 – is the patient acidaemic or alkalaemic?

Step 4 – what happened to the PaCO2?

Step 5 – what has happened to the base excess (BE) or bicarbonate?

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