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Analyzing of Blood Gas &

Assessment
Antonius Freddy -
A&E Dept Saiful Anwar General Hospital
School of Medicine Brawijaya University
Malang East Java Indonesia.
Objective

• Evaluation of ABGs will tell you how well you


ventilated your patient

• Learning ABGs will teach you about acid/base


balance
Acid/Base Balance
• A correct acid/base balance is required for virtually all
metabolic processes
• Narrow operating range means that abnormalities
rapidly lead to cellular dysfunction and potentially death.
• The body uses three mechanisms to maintain acid/base
balance:
– buffers
– respiratory system
– kidneys
What the heck is pH???

pH is simply a mathematical calculation of the


hydrogen ion (the pre-eminent acid)
concentration in the body. Specifically, the pH
is the inverse logarithm of the hydrogen ion
concentration.
pH Regulation

Buffer System: instant, ongoing response


• Buffer: weak acid or base which combines
with stronger opposites to create a weaker
acid/base and water
• Body has 20:1 buffer ratio, acids/bases. So,
we can cope with acid conditions better than
base
• Buffers work instantly and continuously
pH Regulation
Respiratory System: fast response
• Activated instantly when the buffer system fails
– Respirations = CO2, H+ pH (for conditions of excess
acid)
– Respirations =  CO2, H+, pH (for conditions of excess
base). But, how slow can we breathe???
– Again, the body copes with excess acid more effectively than
excess base.
pH Regulation

Metabolic System: if all else fails


• Kidneys selectively reabsorb/secrete acids or
bases
– In acidosis, reabsorb HCO3 and secrete H
– In alkalosis, reabsorb H and secrete HCO3
• The Problem: it is slow!! Requires 10-20
hours to respond. But, when it does, it is very
precise.
Five Step ABG Interpretation

• But first, why evaluate ABGs?


– To determine acid/base status (pH)
– To evaluate adequacy of ventilation (PaCO2)
– To evaluate adequacy of oxygenation (PaO2)
– To understand whether the abnormality is long-
standing or extremely acute (HCO3)
Arterial Blood Gas Values

Normal values (room air, sea level)


• pH 7.35 - 7.45
• paCO2 35 - 45 torr
• paO2 75 - 100 torr
-
• HCO3 22 - 26 mEq/L
Five Step ABG Interpretation

• Step 1: Acid/Base Status


– Look at the pH. Is it normal or abnormal?
– If abnormal, is it acid or base?
• < 7.35: acid
• > 7.45: base
– Write it down!

– Note: an abnormal pH is always an acute event.


No one has a chronically abnormal pH!
Five Step ABG Interpretation

• Step 2: Respiratory Component


– Look at the PaCO2. Is it normal or abnormal?
– If abnormal, is it tending toward acid or base?
• < 35: base
• > 45: acid
– Write it down!
Five Step ABG Interpretation

• Step 2: Respiratory Component


– Note: the PaCO2 also tells us about ventilation. If
it is below normal, in most cases minute
ventilation should be decreased (slow rate, reduce
tidal volume). If it is too high, increase minute
ventilation.
Five Step ABG Interpretation

• Step 3: Metabolic Component


– Look at the HCO3. Is it normal or abnormal?
– If abnormal, is it tending toward acid or base?
• < 22: acid
• > 26: base
– Write it down!
Five Step ABG Interpretation

• Step 3: Metabolic Component


– Note: HCO3 also tells us about chronic vs. acute.
Acute episodes don’t have time to activate the
kidneys, so the HCO3 is normal. Long-standing
conditions alter kidney function, and will change
HCO3.
Five Step ABG Interpretation

• Step 4: Oxygenation
– Look at the PaO2. Is it normal or abnormal?
– If the PaO2 is below normal (<80 at sea level, <65
at 5,280 ft), increase FiO2.
– Note: PaO2 has no direct relationship to
acid/base status. So, don’t get PaO2 values mixed
up with your evaluation of acid/base. Just adjust
the oxygen and move on to Step 5…..
Five Step ABG Interpretation

• Step 5: Put it all together


– Look at the pH, PaCO2, and HCO3.
– Identify any changes which are consistent with
the pH abnormality. They are the cause.
– You’ve now identified the problem as either:
• Respiratory (PaCO2 change is consistent with pH)
• Metabolic (HCO3 change is consistent with pH)
• Mixed (Both are consistent with pH)
Five Step ABG Interpretation

• A Final Rule:
– If it isn’t respiratory, it’s metabolic…..
• Remember, metabolic changes are slow. So, an acute
metabolic acid/base problem won’t have a chance to
change the serum HCO3; it will be normal.
• So, if the CO2 change isn’t consistent with the pH
change, the problem must be metabolic (no matter
what theHCO3 is)
Acid-Base Disturbance
Simple :
• Respiratory acidosis: PaCO2 high / HCO3- normal or
slightly high
• Respiratory alkalosis: PaCO2 low /HCO3- normal or low
• Metabolic acidosis: HCO3- low / PaCO2 normal or low
• Metabolic alkalosis: HCO3- high / PaCO2 normal or high
Mixed / Combination:
• (Respiratory + Metabolic)
Exercise
• pH = 7.33 • pH = 7.55
• PaCO2 = 50 mmHg • PaCO2 = 30 mmHg
• HCO3- =25.8 mEq/L • HCO3- = 23.4 mEq/L
Answer: Answer:
• Acidemia • Alkalemia
• Primary respiratory • Primary respiratory
• Acute • Acute
Exercise
• pH = 7.31 • pH = 7.59
• PaCO2 = 29.5 mmHg • PaCO2 = 46.5 mmHg
• HCO3- = 14.5 mEq/L • HCO3- = 45 mEq/L
Answer: Answer:
• Acidemia • Alkalemia
• Primary metabolic • Primary metabolic
• Respiratory • Respiratory
compensation compensation