Arterial Blood Gas Analysis

Presenter : dr. Nivedita R Shetty dr. Rollando Erric Manibuy Supervisor : dr. Tatang SpB-KBD, KIC

What Is An ABG?
pH [H+] PCO2 Partial pressure CO2

PO2

Partial pressure O2

HCO3 Bicarbonate BE Base excess

SaO2 Oxygen Saturation

The normal range

Desired Ranges
pH - 7.35 - 7.45 PaCO2 - 35-45 mmHg PaO2 - 80-100 mmHg HCO3 - 21-27 O2sat - 95-100% Base Excess - +/-2 mEq/L

Why Order an ABG?

Helps in establishing a diagnosis Helps guide treatment plan Helps in ventilator management Improvement in acid/base management allows for optimal function of medications Acid/base status may alter electrolyte levels critical to patient status/care

From where is the sample taken

Radial artery Femoral artery Brachial artery Dorsalis Pedis artery Axillary artery

Acid Base Balance

The body produces acids daily
15,000 mmol CO2 50-100 mEq Nonvolatile acids

The lungs and kidneys attempt to maintain balance

Acid Base Balance

Assessment of status via bicarbonatecarbon dioxide buffer system
CO2 + H2O <--> H2CO3 <--> HCO3- + H+
ph = 6.10 + log ([HCO3] / [0.03 x PCO2])

The Terms
ACIDS
Acidosis
Respiratory CO2 Metabolic HCO3

BASES
Alkalosis
Respiratory CO2 Metabolic HCO3

Respiratory Acidosis
ph, CO2, Ventilation Causes
CNS depression Pleural disease COPD/ARDS Musculoskeletal disorders

Respiratory Acidosis
Acute vs Chronic
Acute - little kidney involvement. Buffering via titration via Hb for example
pH by 0.08 for 10mmHg in CO2

Chronic - Renal compensation via synthesis and retention of HCO3 (Cl to balance charges hypochloremia)
pH by 0.03 for 10mmHg in CO2

Respiratory Alkalosis
pH, CO2, Ventilation CO2 HCO3 (Cl to balance charges hyperchloremia) Causes
Intracerebral hemorrhage Salicylate and Progesterone drug usage Anxiety lung compliance Cirrhosis of the liver Sepsis

Respiratory Alkalosis
Acute vs. Chronic
Acute - HCO3 by 2 mEq/L for every 10mmHg in PCO2 Chronic - Ratio increases to 4 mEq/L of HCO3 for every 10mmHg in PCO2 Decreased bicarb reabsorption and decreased ammonium excretion to normalize pH

Metabolic Acidosis
pH, HCO3 12-24 hours for complete activation of respiratory compensation PCO2 by 1.2mmHg for every 1 mEq/L HCO3 The degree of compensation is assessed via the Winters Formula
PCO2 = 1.5(HCO3) +8 2

Metabolic Alkalosis
pH, HCO3 PCO2 by 0.7 for every 1mEq/L in HCO3 Causes
Vomiting Diuretics Chronic diarrhea Hypokalemia Renal Failure

 THANK YOU....