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Blood gas analysis and

acid-basic disorder
stefanus lembar

ABG analysis
Why do we care ?

Critical care requires a good understanding


Helps in the differential and final diagnosis
Helps in determining treatment plan
Treating acid/base disorders helps medications
work better (i.e. antibiotics, vasopressors, etc.)
Helps in ventilator management
Severe acid/base disorders may need dialysis
Changes in electrolyte levels in acidosis
(increased K+ and Na+, and decreases in HCO3)

Clinical Significance
To evaluate respiratory
failure
type or type
To evaluate acid-basic
disorder

How to evaluate respiratory


failure?
PaO2:
Arterial blood oxygenic partial
pressure.
Normal: 95-100mmHg (12.6-13.3kPa)
Estimate formula of age:
PaO2=100mmHg-(age0.33)
5mmHg

Hypoxia
Mild: 80-60mmHg
Mediate: 6040mmHg
Severe: <40mmHg

Respiratory Failure
PaO2<60mmHg
failure

respiratory

Notice: sea level, quiet, inspire air


rule off other causes ( heart
disease)

Classification of Respiratory
Failure
PaCO2: The carbon dioxide partial
pressure
of arterial blood
Normal: 35-45mmHg (4.7-6.0kPa)
mean: 40mmHg

Classification of Respiratory
Failure
PaO2 (mmHg)
<60
PaCO2 (mmHg)
>50

Type
<60

50

Type

Parameters in acid-basic disorder


evaluation

PH: negative logarithm of


Hydrogen ion concentration.
Normal: 7.35-7.45
mean: 7.4
HCO3-

PH=Pka+l 0.03PaCO
og
20

1
6.1+lo

HCO3- (bicarbonate):
SB (standard bicarbonate)
AB (actual bicarbonate)
SB: the contents of HCO3- of serum of
arterial
blood in 38, PaCO2 40mmHg, SaO2
100%.
Normal: 22-27mmol/L
mean: 24mmol/L
AB: The contents of HCO3- in actual
condition.
In normal person: AB=SB

AB and SB are parameters to reflect


metabolism, regulated by kidney.
Difference of AB-SB can reflect the
respiratory affection on serum
HCO3- .

Respiratory acidosis: AB>SB


Respiratory alkalosis: AB<SB
Metabolic acidosis: AB SB<Normal
Metabolic alkalosis: AB=SB>Normal

Buffer bases BB)


is the total of buffer negative
ion of blood.
BB: HCO3hemoglobin
plasma proteins
HPO42- (phosphate)
Normal: 45-55mmol/L
mean: 50mmol/L
Significance: Metabolic acidosis: BB
Metabolic alkalosis: BB

Bases excess BE):


the acid or bases used to
regulate blood PH 7.4 . ( in 38
PaCO2 40mmHg, SaO2 100%)
Normal: 02.3 mmol/L
Significance:
add acid: BE(+), BB
add base: BE(-), BB

Anion gap (AG):


the difference of undetermined
anion and undetermined cation in
serum.
AG=Na+ (Cl-+ HCO3- )
Normal: 8-16mmol/L
Significance:
AG
acidosis: ketoacidosis, kidney
failure
AG normal acidosis: Cl
, diarrhea, fixed
acid decrease
to evaluate mix acid-basic disorder

Classification of Acid-basic
Disorder

Complementary: PH is normal
Dis-complementary: PH is
abnormal.

PH, PaCO2, HCO3- are three


important parameters in acidbasic disorder evaluation.

Classification of Acid-basic
Disorder
PH

HCO3Resp. acidosis
Resp. alkalosis
Meta. acidosis
Meta. alkalosis

PaCO2

Arterial Blood Gas


Interpretation

Blood Gas Components

Oxygen level
Carbon Dioxide Level
pH
Bicarbonate level

ABG Analysis

pH: 7.35-7.45
PaCO2: 35-45mmHg
HCO3: 22-26/28 mEq/L
PaO2: > 80mmHg
Oxygen Saturation >95%

Analysis
pH

=Alkalosis

pH

=Acidosis

Normal values 7.35-7.45

Analysis
PaCO2

= Respiratory

PaCO2

= Respiratory

Normal value 35-45mmHg

Comparison
Chart
pH
Resp
Acid.
Resp Alk.
Metab
Acid
Metab
Alk

PaCO2

HCO3

Respiratory Acidosis
Any disease process which decreases
the
ability of the lungs to exchange CO2 for
oxygen.
Increased K+
Pneumonia
Asthma
CHF

Respiratory Acidosis
pH

PaCO2

Respiratory Alkalosis
Anything which greatly increases
respiratory rate.
Fever
Pain
Anxiety
Overvenitilation with a mechanical
venitalator
Decreased K+

Respiratory Alkalosis

pH

PaCO2

Metabolic Acidosis
Anything which increases the
accumulation of acids or decreases the
amount of bicarbonate in the body.
Renal failure
Loss of bases from diarrhea
Increased K+
Diuretic therapy which causes HCO3 loss

Metabolic Acidosis
pH

HCO3

Metabolic Alkalosis
Anything which decreases H ions in
The body or increases bicarbonate.
Prolonged vomiting

Metabolic Alkalosis
pH

HCO3

Determining ABGs

First, Look at the pH.


It can be high >7.45 (alkalosis)
It can be low <7.35 (acidosis)
It can be normal 7.35- 7.45 (normal)

Determining ABGs
A normal pH may indicate perfectly
normal blood gases, or it may be an
indication of a compensated
imbalance.
A compensated imbalance is one in
which the body has been able to
correct the pH by either respiratory or
metabolic changes (depending on the
primary problem)

Example of
compensation
Pt. With primary metabolic acidosis
starts out with a low bicarbonate
level but a normal carbon dioxide
level. Soon afterward, the lungs try
to compensate for the imbalance by
exhaling large amounts of carbon
dioxide. (hyperventilation)

Determine Primary Cause


of Disturbance
Evaluate the PaCo2 & HCO3 in
relation to the pH.
PaCo2 35-45mmHg
HCO3 22-26 mEq/L

Interpreting ABGs
pH > 7.45 (alkalosis) and the PaCO2 is,
< 35 mmHg, the primary disturbance is
respiratory alkalosis. This occurs when a pt.
hyperventilates and blows off too much
carbon dioxide.
pH > 7.45 (alkalosis) and the HCO2 is > 26
mEq/L, the primary disturbance is metabolic
alkalosis. This situation occurs when the body
gains too much bicarbonate, an alkaline
substance.

Interpreting ABGs
pH <7.35 (acidosis) and the PaCO2 is
> 40mmHg, the primary disturbance
is respiratory acidosis. This situation
occurs when a patient hypoventilates
and thus retains too much carbon
dioxide, an acidic substance.

Interpreting ABGs
pH < 7.35 (acidosis) and the HCO3 is
< 22mEq/L, the primary disturbance
is metabolic acidosis. This situation
occurs when the bodys bicarbonate
level drops , either because of direct
bicarbonate loss or because of gains
of acids such as lactic acid or
ketones.

Determine if compensation
has begun
This is done by looking at the value
other than the primary disorder. If it
is moving in the same direction as
the primary value, compensation is
underway.

Examples
Consider the following gases:
pH
PaCO2
HCO3
1)7.20
60mmHg 24mEq/L
2)7.33
60mmHg 37mEq/L
1) indicates acute respiratory acidosis without
compensation (the PaCO2 is high, the
HCO3 is normal).
2) Indicates chronic respiratory acidosis,
compensation has taken place; that is
HCO3 has elevated to an appropriate level
to balance the high PaCo2 ands produce a
normal pH.

Example of
compensation
A patient with primary respiratory
acidosis starts out with a high carbon
dioxide level; soon afterward, the
kidneys attempt to compensate by
retaining bicarbonate. If the
compensatory maneuver is able to
restore the bicarbonate to carbonic acid
ratio back to 20:1, full compensation
(and thus normal pH) will be achieved.

Thank you