Blood Gases
TERMS AND ABBREVIATIONS:
Acids
● substance that can yield a hydrogen ion (H)
or hydronium ion when dissolved in water
Base
● substance that can yield hydroxyl ions (OH)
Buffer
● combination of a weak acid or weak base
and its salt, is a system that resists changes
in pH
● effectiveness of a buffer:
- pK of the buffering system
- pH of the environment
● Plasma – bicarbonate-carbonic acid buffer
system; pK of 6.1
BICARBONATE-CARBONIC ACID BUFFER
SYSTEM
● Principal mammalian buffer system
● Acids combine with Bicarbonates in the
blood
- Neutral Salts (Bicarbonate Salts)
- Carbonic Acid (Weak Acid)
● H2CO3 unstable, changing to H2O and
CO2 in fluid
PHOSPHATE BUFFER SYSTEM
● 2,3-diphosphoglycerate – Phosphate form
that acts as a buffer
● It increases the amount of NaHCO3 in ECF
(more alkaline)
● 16% of the non-bicarbonate buffer value
of Erythrocytes
HEMOGLOBIN-OXYHEMOGLOBIN
BUFFER SYSTEM
● Maintains pH level (Venous and Arterial
Blood)
● 1 gram of Hemoglobin carries 1.39 mL of
Oxygen
PROTEIN BUFFER SYSTEM
● Proteins can exist in 2 forms: H+ protein, B
Protein
● Capability to bind or release excess
Hydrogen as required
● Plasma proteins (Charges on their surface)
- pH > pI – (-) charge
- pH < pI – (+) charge
BICARBONATE (HCO3)
● The second largest fraction of the anions
in the plasma. It includes the ionized
bicarbonate (HC03), carbonate and the
carbamino compounds. Normal range is
from 21 - 28 mmol/L (21 -- 28 meq/L)
CARBONIC ACID (H2CO3 )
● This fraction of blood, plasma or serum
Includes the undissociated carbonic acid
and the physically dissolved anhydrous
C02. Since CO2 concentration is higher
than HCO3. The symbol cdCO2 (conc. of
dissolved C02) is frequently used and is
measured from pCO2 multiplied by the
solubility coefficient of' CO2.
● Normal range is from 1.05 –1.45 mmol/L.
PARTIAL PRESSURE OF C02 (pC02)
● The pressure or tension exerted by C02 gas
dissolved in blood. It is an index of efficiency
of gas exchange in the lungs and not a
measure of C02 concentration in the blood.
● Normal range is 35 - 45 mmHg.
CARBON DIOXIDE COMBINING POWER (CO2
combining power)
● The value of the CO2 combining power Is
an index of the amount of CO2 that can be
bound by serum, plasma, or whole blood as
HCO3 at a pCO2 of 40 mmHg at 25
degrees Celcius.
● Normal range is 24 - 30 mmol/L.
TOTAL CARBON DIOXIDE CONCENTRATION
(ctCO2)
● Formerly known as C02 content, which
refers to the total concentration of C02 in
the blood consisting of ionized HC03, C03,
carbamino compound) and unionized
fraction (H2C03) and physically dissolved
C02.
● Normal range is 21 - 28 mmol/L.
pH
a. The negative logarithm of hydrogen ion
activity with a normal average range of
7.35-7.45
Major factors regulating blood pH:
1. Chemical buffers
2. Respiratory regulatory mechanism
3. Renal regulatory mechanism
Henderson-Hasselbalch Equation
BLOOD COLLECTION FOR BLOOD
GAS AND pH ANALYSIS
1. The pCO2 of air (0.2mmHg) Is much less
than that of the blood (38 mmHg) so that
when blood is exposed to air, the ctCO2 and
pCO2 decreases; and the pH increases,
thus it is a must to collect, transfer and
manipulate blood for blood gas analysis in
condition where air Is avoided or at least
kept at a minimum level.
a. Arterial blood is the more preferred
specimen for blood gas analysis because it
is of more uniform composition than venous
blood. This is due to the metabolic diversity
composing venous samples
● Venous and Capillary (Skin punctured)
Blood
- These specimens can also used for
blood gas analysis provided that they
undergo arterialization
Method of Determination
p02
● Clark p02 electrode
● Principle: Based on amperometric or
polarographic measurement of oxygen.
● Gasometric analysis
● Calculation from oxygen saturation, pH and
temperature by means of the standard 02
dissociation curve.
● Transcutaneous monitoring
pC02
● Use of pCO2 electrode
- Principle: Based on pH
measurement of a stationary
NaHCO3 solution which is in
equilibrium with the test solution and
the test via a CO2 permeable
membrane.
● Use of Henderson Hasselbach equation
from pH and total carbon dioxide.
● From a measured pH value interpolated in
the C02 equilibrium curve.
pH
● PH electrode
● Principle: Based on polarographic principle
● Use of PH meters
● Henderson - Hasselbach equation
● Nomogram and Slide Rule
● Siggard -Anderson Alignment nomogram
ct C02:
● Manometric Method Using Natelson
Microgasometer
● Principle:
- Carbon dioxide is released front
HC03 by the addition of lactic add.
The C02 and other gases are,
extracted under a partial vacuum.
The pressure difference at constant
value before and after absorption of
C02 by NaOH Is the amount of C02
present in the sample.
Alternative Method
● Principle
- Involves the release of C02 gas when
the sample is added to H2S04 with
subsequent monitoring of this release
with a pair of pCO2 electrodes
(reference and sample electrodes).
The rate of change in pH of the buffer
inside the pCO2 electrodes is a
measure of the concentration of its
CO2 In the Sample
Conditions for analysis:
1. All procedures should be considered “STAT”
- If delayed 20-30 mins: pH lowers by
0.01
- Avoid glycolysis
2. Specimen must be kept at anaerobic
condition
3. Specimen w/c cannot be analyzed
immediately must be placed in an ice slurry
ACID-BASE DISTURBANCES
Acidosis - General term applied for any condition
where the pH of the blood and the bicarbonate
concentration of the blood are below normal.
Alkalosis
● General term applied for any condition with
an increase in blood pH (above normal
range) characterized by an elevation in the
H+ ion accepting buffer of the plasma
(UC03) and a reduction in the H+ ion
substances (H2CO3)
Classification of Acid-Base Imbalance
● Metabolic Alkalosis
● Metabolic Acidosis
● Respiratory Alkalosis
● Respiratory Acidosis
Metabolic Acidosis
● Caused by bicarbonate deficiency
● Production of increased amount of acid –
diabetic ketoacidosis, lactic acidosis
(alcoholism), renal failure and diarrhea
● Compensation: Hyperventilation
● (+) Hyperkalemia and hyperchloremia
*In DKA→normochloremic
Metabolic Alkalosis
● Caused by bicarbonate excess
● Conditions: Vomiting with the loss of
chloride from the stomach
● Compensation: Hypoventilation
● For every 10 meq/L rise in bicarbonates, the
pCO2 rises by 6 mmHg
● (+) hypokalemia, hypochloremia
● pCO2 drops 1-1.3 mmHg per mEq/L fall in
HCO3-
Respiratory Acidosis
● Excessive CO2 accumulation
● Conditions: Chronic obstructive pulmonic
disease (COPD), myasthenia gravis, CNS
disease, drug overdose (morphine,
barbiturates and opiates), pneumonia
● Compensation: retention of bicarbonates
● Bicarbonate rises 1 meq/L for each 10
mmHg rise in pCO2
Respiratory Alkalosis
● Due to excessive carbon dioxide loss
● Conditions: Anxiety, severe pain, aspirin
overdose, hepatic cirrhosis
● Compensation: decreased reabsorption
● Bicarbonate falls 2 meq/L for each 10
mmHg fall in pCO2
● (+) Hypokalemia
Consequences of Acid- Base Imbalance:
● In Alkalosis, tetany ensues due to.
hypocalcemia, which can lead to death
because of respiratory muscle spasm.
● In Acidosis, there is an inhibition of the
neural mechanisms which will then lead to
coma. A blood pH of 6.9 has been proven
fatal
PARAMETERS OF INTEREST
Evaluate (normal pH - 7.35-7.45)
● <7.35 - acidosis
● >7.45 – alkalosis
Evaluate the ventilation (Lungs)
● pC02 - 35 - 45 mm Hg
● < 35 respiratory alkalosis
● > 45 respiratory acidosis
Evaluate the metabolic Process (kidneys)
● HC03 = 22-26 meq/L
● < 22 - metabolic acidosis
● >26 – metabolic alkalosis
● Determine which is the Primary (1°) and
compensating disorder
- pH
● Determine the degree of compensation
- non- compensatory
- partial compensatory
- complete compensation
● pO2 = 81 - 100 mmHg (adequate
oxygenation)
● p02 Hypoxemia:
- mild = 61 - 80
- moderate = 41 - 60
- severe = 40 or less