BLOOD GAS ANALYSIS

Normal body pH is 7.357.45 /40Nmol/l H

Fall in pH is Acidemia, rise is Alkalaemia

Major buffer is
bicarbonate- carbonic acid pair

Other buffers
Haemoglobin
Phosphates
Proteins
Normal plasma HCO is 25mmol/L

Respiratory Acidosis

Due to retention of CO
PaCO & H+ rise. --- pH decrease
HCO3 is used-up for buffering

Compensation is by HCO retention by kidneys

In chronic conditions H+ has returned closer to normal due to HCO retention
Causes :
Clinical features of RAc
1) Ventilatory failure
Increases cerebral blood flow and raises intracranial
2) COPD (type 11 RF)
pressure
3) Emphysema
1) Impairs cardiac contractility
4) Polyneuropathy
2) Cardiac arrythmias
5) Drug-overdose
3) Confusion
4) Coma
5) Hyperkalaemia
6) ODC shifts to the right

Respiratory Alkalosis
H+ & PaCO fall. pH increase
Due to increased ventilation
Compensation is by slight decrease in HCO
Causes :
1) Mechanical ventilation

2)
3)
4)
5)
6)
7)

Hypoxaemia (type 1 RF)

Spontaneous hyperventilation
High altitudes
Septic shock
Pneumonia
Hyperkalaemia

Metabolic Acidosis
H+ increase. pH decrease
HCO is largely decreased

Is due to accumulation of acid otherthan HCO

Compensation is by decrease in PaCO by

hyperventilation

Causes : Acid administration

acid generation (Diabetic ketoacidosis, anaerobic
metabolism/ lactic acidosis (shock, cardiac arrest))
impaired acid excretion (chronic renal failure),
hyperkalaemia,
loss of HCO from gut or kidney (renal tubular
acidosis)

To see whether MAc is due to H Cl retention or other cause, need anion gap (plasma & urinary)

Normal anion gap acidosis

Normal AG with acidosis

When HCO3 is lost via the gut or kidney Cl is retained. (H CL is retained or Na HCO is lost)
E.g renal tubular acidosis plasma HCO < 21mmol/l, urinay pH > 5.3
Urinary anion gap (Urinary Na + K - Cl) is useful in distinguishing RTA1 (UAG +ve) & diarrhoea (UAG -ve)
Increased anion gap acidosis
Due to retention of unmeasured anions (organic acids)
HCO3 is utilized to maintain normal [H+] and therefore decreases. Cl is normal or low
E.g. Commonest is lactic acidosis:
type A- lack of O :cardiac arrest, sepsis, type B- metabolic ablormality :diabetes, metformin
Uraemic acidosis/ renal disease

Ketoacidosis : diabetes, alcohol excess, stravation

Exogenous acids : salicylates
Clinical features of MAc
1) Impairs cardiac contractility - -ve ionotrophic
2) Cardiac arrythmias
3) Arteriolar vasodilation
4) venoconstriction
5) Confusion

6) Coma
7) Hyperkalaemia if renal function is impaired or
hypokalaemia if normal
8) ODC shifts to the right
9) Air hunger / Kussmaul erspiration

Metabolic Alkalosis
H+ is decreased. pH increased
HCO is very much increased
PaCO is slightly increased as respiratory compensation
Causes : Hypochloraemia/Loss of acid ; gastric
Clinical features of MAl
(nasogastric suction, vomiting, intestinal obst)
Tetany
Chloruretic diuretics (furosemide),
Headache
Hypokalaemia/ mineralocorticoid excess (remove
Confusion
H+) ; aldosteronism
Seizures
Impaired cerebral
Hypercaicaemic states
Coma
Increased Rx with IV Na HCO , antacid abuse,
Hypokalaemia perfusion
Cardiac arrhythmias
Nueromuscular irritability
ODC shift to left

Arterial Blood Gas

pH

---

pCO2

---

pO2

----

Stand HCO3

----

Base Excess

---

SpO2

----

7.35 -7.45
40 42 mmHg
97 100 mmHg
24mmol/l
+/- 2
97 100%

Base Excess The concentration of acid or base in mEq/l to bring the pH back to normal when PCO & PO are
normal.HCO is the base. + BE means there are more HCO than H+
Standard HCO3 Plasma HCO3 after equilibrating with whole blood at pCO2 of 40mmHg at 37 C and fully
oxygenated. This totally eliminates the respiratory component and relates to the metabolic change.

How do you read an ABG ?

Disturbance of acid-base balance

Acidosis or Alkalosis - pH
Is it Respiratory or Metabolic - Look at the PaCO2 (resp) and BE (meta)
Is there any compensation ? - Look at the PaCO2 and BE

If acidotic is it a normal or increased anion gap

Alteration in oxygenation

What else do you need to interpret a Blood gas?

The concentration of O2 the patient is breathing
% ( FiO2 fractional inspired O )
20% (0.2), 50% (0.5) 100% (1.0)
Clinical history and examination

Relavant Rx - NaHCO administration

Why S electrolytes?

To determine the Anioin gap

 Anioin gap = (Na + K) (Cl + HCO3)

Usually 10 18 mmol/l
because of unmeasured albumin mainly & organic acids, phosphate
Reduced albumin cause reduction in anion gap