Arterial blood gases Normal PaO2 80 - 100 mmHg

Normal pH 7.35 - 7.45 pH

The University of Manchester | W.L. Gan | 2012 Normal PaCO2 Normal HCO3 35 - 45 mmHg 22 - 26 mEq/L PaCO2 normal normal HCO3 normal normal

Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis ** same direction - metabolic ** opposite direction - respiratory Partially compensated states Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis Fully compensated states Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

pH

PaCO2

HCO3

pH normal but < 7.40 normal but > 7.40 normal but < 7.40 normal but > 7.40

PaCO2

HCO3

Respiratory buffer response CO2 is carried in the blood to the lung where excess CO2 combines with water to form carbonic acid. The blood pH changes with carbonic acid level. This triggers the lung to increase or decrease the rate and depth of ventilation until the appropriate amount of CO2 has been re established. The correction starts within 1 to 3 minutes. Renal buffer response As the blood pH decreases, the kidney will compensate by retaining HCO3 and as pH rises, the kidney will excrete HCO3 through urine. It takes days to hours to correct. Mixed respiratory and metabolic acidosis - cardiac arrest pH Type I respiratory failure PaO2 < 8kPa with normal or low PaCO2 Pneumonia, pulmonary edema, PE, asthma, emphysema, fibrosing alveolitis, ARDS Treat underlying cause. Oxygen (35-60%) Assisted ventilation if PaO2 <8kPa on 60% O2

PaCO2

HCO3

Type II respiratory failure PaO2 < 8kPa with PaCO2 > 6.0kPa COPD, asthma, fibrosis, sleep apnea, sedative drugs, CNS trauma, MG, GBS, flail chest, kyphoscoliosis Treat underlying cause. Controlled oxygen. Assisted ventilation ( NIPPV )