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Blood Gas Analysis
Blood Gas Analysis
Q. What are the principles of Gas analysis ? Q. What is the difference between electrode &
optode ?
Ans : Ans :
•Chemical (Haldane, Orsat-Henderson & Van Slyke) •Electrode : Sensor that operates via electrochemical
•Physical (Magnetic, infrared, gas chromatography) properties
•Specific electrodes •Optode : Sensor that operates via optical detection
of altered light
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Prof. A K Sethi’s EORCAPS 2008 Prof. A K Sethi’s EORCAPS 2008
Ans :
•Usually from peripheral art. (Radial, Brachial,
Femoral or Dorsalis pedis)
•Arterialised capillary sample
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Prof. A K Sethi’s EORCAPS 2008 Prof. A K Sethi’s EORCAPS 2008
Q. How Allen’s test is performed ? What precautions
should be taken while taking the sample ? Q. How arterialised capillary sample is taken ?
Ans : Allen E.V. (1929) Ans :
•Pt. closes hand as tightly as possible for 1 minute in order to squeeze out
blood
•Site – Finger, toe, heel or ear lobe
•Compress radial art. at wrist •Wrapping in warm pad (40-430 C) for 10 minutes
•Open the hand (extend fingers)
•Or
•Note the return of colour
•Full blushing – 7 seconds •Massage ear lobe for 2-3 minutes
•Borderline – 8 – 14 seconds •Heparinised capillary tube should be sealed after
•Abnormal (-ve test) - > 14 seconds
•LA – prevents arterial spasm, softens skin, increases subcutaneous space
collecting sample with clay at one end
(working room),
•Short steel wire is inserted then other end is sealed
•Ringe syringe with Heparin 1 in 1000
•Steel wire is moved with magnet to mix the sample
Q. What values are returned from ABGs ? Q. What is the actual bicarbonate and what is
standard bicarbonate ?
Ans :
•Actual bicarbonate (ABC) is calculated from
Ans : 3-5 values are actually measured (pH, PaO2, measured pH and PCO2 of whole blood sample
PaCO2, Hb & O2 saturation) all remaining values are
calculated like •Standard bicarbonate (SBC) is simply a measure of
bicarbonate concentration under standard conditions
ABC, TCO2, SBC, BE, SBE i.e., bicarbonate concentration in plasma of fully
oxygenated blood which has been equilibrated to a
PaCO2 of 40 mm of Hg at 370 C
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Prof. A K Sethi’s EORCAPS 2008 Prof. A K Sethi’s EORCAPS 2008
Q. What are primary and secondary acid base Q. What are the changes in actual HCO3- in levels in
derangements ? acute and chronic respiratory acidosis ?
Ans : Primary is the cause of acid-base drangement
where is the secondary is the compensatory change. Ans :
The end point is constant if compensation is in
range. PaCO2/ HCO3- is constant. •Acute respiratory acidosis : 1 mm of Hg rise in
Acid Base Disorder Primary Change Secondary Change
PaCO2 = 0.1 mmol/L rise in actual HCO3-
Respiratory Acidosis ↑ PaCO2 ↑ HCO3- •Chronic respiratory acidosis : 1 mm of Hg rise in
Alkalosis ↓ PCO2 ↓ HCO3-
PaCO2 = 0.4 mmol/L rise in HCO3-
Metabolic Acidosis ↓ HCO3- ↓ PCO2
Q. What are the changes in actual HCO3- levels in Q. What are the changes in PaCO2 in metabolic
acute and chronic respiratory alkalosis ? acidosis and alkalosis ?
Ans : Ans :
•Acute : 1 mm of Hg fall in PaCO2 = 0.2 mmol/L •Metabolic acidosis : 1 mmol/L fall in HCO3- = 1-
fall in HCO3- 1.3 mm of Hg fall in PaCO2
•Chronic 1 mm of Hg fall in PaCO2= 0.5 mmol/L •Metabolic alkalosis : 1 mmol/L rise in HCO3- = 0.6
fall in HCO3- mm of Hg rise in PaCO2
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Prof. A K Sethi’s EORCAPS 2008 Prof. A K Sethi’s EORCAPS 2008
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Prof. A K Sethi’s EORCAPS 2008 Prof. A K Sethi’s EORCAPS 2008
Q.
FURTHER ANALYSIS OF METABOLIC ACIDOSIS
pH = 7.4 Q. What is Anion Gap?
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Prof. A K Sethi’s EORCAPS 2008 pH 7.5
Q. A patient admitted in surgical ward was on Q.
PaCO2 50 mm of Hg
gastric aspiration through Ryle’s tube because of
persistent vomitings: ABC 35 mmol/L
Arterial blood gases shows:
SBC 32 mmol/L
pH 7.5 z INTERPRETATION –
z pH high – alkalaemia BE +8 mmol/L
PaCO2 50 mm of Hg z Both pH and PCO2 moving in same direction
(Rule 1) metabolic alkalaemia
ABC 35 mmol/L
z ABC – 35 - ↑ of 11 mmol/l
SBC 32 mmol/L z 1 mmol ↑ HCO3- - ↑ PaCO2 0.6 mm of Hg
z 11 mmol – ↑ 6.6 mm of Hg expected rise
BE +8 mmol/L
(Rule 2)
INTERPRETATION - z ∆ metabolic alkalemia with poor resp
compensation
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pH 7.2
Q. A 19 years old boy brought in emergency Q.
with history of injecting some drug. O/E PaCO2 72 mm of Hg
respiration shallow 8/mt, responded to painful
stimuli. ABC 26.5 mmol/L
pH 7.36
Q. A 67 years old male with H/O cough and Q.
PaCO2 60 mm of Hg
respiratory distress and chronic smoking came in
emergency : ABC 32 mmol/L
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pH 7.52
Q. A 52 years old man brought in emergency Q.
with history of cough and pleuritic chest pain for PaCO2 14.0 mm of Hg
few days increasingly becoming breathless: ABC 11 mmol/L