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 Ⅰ or type Ⅱ

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-(age×0.33) ±5mmHg
 Hypoxia

Mild: 80-60mmHg
Mediate: 60-40mmHg
Severe: <40mmHg
 Respiratory Failure

PaO2<60mmHg respiratory failure

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
Type Ⅰ TypeⅡ
PaO2 (mmHg) <60 <60
PaCO2 (mmHg) ≤50 >50
Parameters in acid-basic disorder evaluation

PH: negative logarithm of Hydrogen ion

concentration.
Normal: 7.35-7.45
mean: 7.4
〔HCO3- 〕
PH=Pka+log
0.03PaCO2

20
＝6.1+log
1
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: HCO3-
hemoglobin
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: 0±2.3 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 acid-basic disorder evaluation.
 Classification of Acid-basic Disorder
PH PaCO2 HCO3-

Resp. acidosis
Resp. alkalosis
Meta. acidosis
Meta. alkalosis
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 PaCO2 HCO3
Resp Acid.

Resp Alk.

Metab Acid

Metab Alk
 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 ABG’s
• 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 ABG’s
• 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 ABG’s

• 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 ABG’s
• 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 ABG’s
• pH < 7.35 (acidosis) and the HCO3 is
< 22mEq/L, the primary disturbance is
metabolic acidosis. This situation occurs when
the body’s 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