1 | CC2LEC WEEK 7
BLOOD GASES both the generation of bicarbonate irons and
Regulation of Acid-Base balance: lungs and
kidneys
• Most of the carbon dioxide (CO2) with water
(H2O) to form carbonic acid (h2co3), which
dissociates immediately into H+ and
bicarbonate (HCO3) – the reaction is
accelerated by carbonic anhydrase
• The dissociation of h2co3 increase hco3 in
RBC causing it to diffuse into the plasma
• HCO3 and H2CO3 are renewable – even
before renal mechanisms restore the
constituents, the lung alters the ration of
numerator (hco3) to denominator (h2co3) by
blowing off CO2
Lungs
• Respiratory control of carbon dioxide (co2)
excretion allows rapid and very sensitive
adjustment in blood pH
• as the lungs eliminate excess carbon dioxide
to resist accumulating hydrogen, the
proportion between bicarbonate (hco3) and
carbonic acid (h2co3) readjust to 20:1,
although the absolute concentration of each
can fall below normal
• by regulating the rate of carbon dioxide
excretion, the lungs can maintain the ratio at
or about 20:1, thereby minimizing pH
changes
• the carbon dioxide diffuses into the alveoli
and is eliminated through ventilation
• slow or non-removal of carbon dioxide by the
lungs results to increase in hydrogen ion
concentration -respiratory acidosis
• Rapid or fast elimination of carbon dioxide
results to decrease hydrogen ion
concentration – respiratory alkalosis
Kidneys
• The most important function of the kidney in
acid base homeostasis is excretion of acid
which is equivalent to generation of alkali or
reabsorption of bicarbonate from the
glomerular filtrate (proximal tubules of the
kidneys) and add it to the blood
• acid is excreted in the form of ammonia
(nh4+) and titratable acid
• Hydrogen ions are also excreted by the
kidney both by direct excretion and through
indirect disposal in the form of ammonium ion
• bicarbonate concentration (HCO3) is under
renal control, in that the kidneys regulate
they rate of urinary excretion
• 50-100 mmol/L of acid Must be excreted daily
by the kidneys resulting to urine pH of 4.5
Plasma and urine bicarbonate
• Increase bicarbonate ( HCO3): IV
Infusions of lactate, acetate and HCO3
• Decrease bicarbonate ( HCO3): use of
diuretics, reduced reabsorption and chronic
nephritis
• If bicarbonate is below 25mmol/L or if plasma
carbon dioxide rises above normal, the tubule
can reabsorb all the bicarbonate in the
glomerular filtrate, leaving none of the
excretion in urine
• A small amount of bicarbonate is normally
excreted in the urine (about 10 mEq/ Day)
• The kidneys excrete considerable amounts of
acid and base for acid-base regulation
• Urinary excretion of bicarbonate when
plasma reached 26-30 mmol/L
ACIDS
● Substance that can yield a hydrogen ion (H) or
hydronium ion when dissolved in water
● Representing the (+) charged molecule
o Positively charged molecule
BASE
● Substance that can yield hydroxyl ions (OH)
● Negatively (-) charged molecule
BUFFER
● Could be any compound which is a
combination of weak acid or weak base and
its salt, is a system that resist changes in pH
● Maintain normal body pH: 7.35 - 7.45
● Basically, its major function is to
maintain/prevent sudden fluctuations in the pH.
★ Effectiveness of buffer is determined based
on:
o pK of buffering system – ionization
constant (pKa)
o pH of the environment
● Plasma – (major buffer system) bicarbonate-
carbonic acid buffer system;
o pK of 6.1
● Bicarbonate-carbonic acid – major system
2 | CC2LEC WEEK 7
DIFFERENT BUFFER SYSTEM
★ BICARBONATE-CARBONIC ACID BUFFER
SYSTEM
● Principal mammalian buffer system
● Major extracellular blood buffer
● basis on how pH is determined
mathematically (Henderson-Hasselbalch
equation)
● made up of acids combine with
bicarbonates in the blood
○ conjugate base/ Neutral salts
(bicarbonate salts)
○ Carbonic acid (weak acid)
● H2CO3 (Carbonic acid) unstable, changing to
H2O and CO2 in fluid
** in the blood circulation, bicarbonate and carbonic
exist in 2 different forms:
a. bicarbonate: exist in blood circulation as it
is; primary regulation is through the function
of kidneys (renal regulation)
b. Carbonic acid: unstable compound, readily
changes to water and carbon dioxide once
reaches the plasma
** the measurement of carbonic acid is
based on pCO2 (partial pressure of carbon
dioxide)
★ PHOSPHATE BUFFER SYSTEM→ also helps in
the maintenance of normal blood pH
● made up of 2,3-diphosphoglycerate →
primary phosphate form that act as a buffer
● it increases the amount of NaHCO3 (sodium
bicarbonate) in ECF (more alkaline)
● its function is to increase the amount of sodium
bicarbonate in the extracellular fluid making it
more alkaline because sodium bicarbonate is a
negatively charged molecule
● 16% of non-bicarbonate buffer value
utilization of RBC
→ RBCs would be the primary utilization
★ HEMOGLOBIN-OXYHEMOGLOBIN BUFFER
SYSTEM
● maintains pH level (venous and arterial
blood)
● 1 gram of hemoglobin carries 1.39 mL of
oxygen → (each mole of hemoglobin binds with
1 mol of oxygen, more than 95% of your
hemoglobin binds with oxygen)
○ 95% of hemoglobin binds in
oxygen
● Effective buffer because it holds or carries
oxygen, so it has the ability to uphold oxygen
and replace it with carbon dioxide
→ Hemoglobin is considered to be an effective buffer
primarily because it is the one responsible for carrying
oxygen and replace it with carbon dioxide
● Helps in the maintenance of carbon-dioxide,
in which it facilitates its diffusion across
different gradients
★ PROTEIN BUFFER SYSTEM
● Helps in maintaining the buffer due to the
charges which is present under surface
● Proteins are made up of amino acids. The
structure of an amino acid contains a carboxyl end
and amino end. (Positively charged and negatively
charged end)
● exist in 2 forms: H+ protein, B protein
● capability to bind or release excess hydrogen as
required within the blood circulation
● Protein tends to become more (+) in an
acidic environment and more (-) in basic
environment (alkaline)
○ Has the capability to act as a
minor buffer system
● plasma proteins (charges on their surface)
○ pH > pl → (-) charge
○ pH < pl → (+) charge
BICARBONATE(HCO3)
● The second largest fraction of the anions
in the plasma. It includes the ionized
bicarbonate (HCO3), carbonate and the
carbamino compounds.
○ Bicarbonate is also classified under
electrolytes
● Normal range is from 22-26 mmol/L (22-26
meq/L)
● Conjugate base representative of the
buffer major system
CARBONIC ACID (H2CO3)
● Weak acid
● This fraction of blood, plasma or serum
includes the undissociated carbonic acid
and the physically dissolved anhydrous
CO2. Since CO2 concentration is higher than
HCO3. (bicarbonate)
● Readily dissociated into water and carbon dioxide
once it reaches the blood circulation
3 | CC2LEC WEEK 7
● The symbol cdCO2 (conc. of dissolved CO2)
is frequently used is measured from pCO2
multiplied by the solubility coefficient of CO2
(0.03). → represents carbonic acid level
● 0.03 – solubility coefficient
● 0.0307 OR 0.0306 – complete solubility
coefficient.
● Normal range is from 1.05-1.45 mmol/L
● Weak acid representative of major buffer
system.
● Readily dissociated into H2O and CO2
when it reaches the blood circulation.
● Weak acid representative of major buffer
system.
PARTIAL PRESSURE OF CO2 (pCO2)
● The pressure or tension exerted by CO2 gas
dissolved in blood.
● It is a measurement of efficiency of gas exchange
happening within the lungs and blood.
● It is an index of efficiency of gas exchange in
the lungs and not a measure of CO2
concentration in the blood.
● Normal range is 35-45 mmHg.
● In pH determination, it is used to determine
carbonic acid level by multiplying it with
solubility coefficient.
CARBON DIOXIDE COMBINING POWER (CO2
combining power)
● The value of 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°C.
● Normal range → 24-30 mmol/L
● Amount of CO2 that is maybe bound
within the blood circulation
TOTAL CARBON DIOXIDE CONCENTRATION
(ctCO2) → sum of all bicarbonate compounds as well as
carbonic acid
● Formerly known as CO2 content. (Carbon
dioxide content)
● Refers to the total concentration of CO2 in the
blood consisting of ionized HCO3, CO3,
carbamino compound) and unionized fraction
(H2CO3) and physically dissolved CO2.
● Normal range → 21-28 mmol/L
● Sum of major buffer system (HCO3 and
carbonic acid H2CO3)
pH
➢ The negative logarithm of hydrogen ion
activity
➢ Normal average range → 7.35-7.45
• In terms of clinical significance, pH inside the
body must be maintained between 7.35- 7.45
Major factors regulating blood pH:
1. Chemical buffers → Primary line in order
to prevent fluctuations in the pH.
➢ HCO3 and H2CO3 buffer system,
(bicarbonate and carbonate buffer
system) proteins, hemoglobin,
electrolytes
➢ With charges
2. Respiratory regulatory mechanism →
lungs (responsible for the respiratory
regulatory mechanism) and kidney (2
major organs)
➢ Secondary line/ second line of
defense
➢ Maintains/regulates the level of
carbonic acid
➢ Increase in the release of CO2
➢ Increases CO2 concentration by
decreasing exhalation or respiratory
rate to decrease release of CO2
➢ Lungs regulate the level of carbonic
acid
3. Renal regulatory mechanism → kidney
➢ Secondary line
➢ Excretion or reabsorption
➢ Regulates/maintain the level of
bicarbonate
HENDERSON-HASSELBALCH EQUATION
4 | CC2LEC WEEK 7
• It expresses acid-base relationship and
relates the pH of a solution to the dissociation
properties of the weak acid
• It indicates that pH depends on the ratio of
HCO3/pCO2
• When kidneys and the lungs are functioning
properly, a 20:1 ratio of HCO3 to H2CO3 will
be maintained, and it is expressed by the
Henderson-Hasselbalch equation.
BLOOD COLLECTION FOR BLOOD GAS AND pH
ANALYSIS
- Responsibility of respiratory therapist →
capable of collecting the sample and perform
blood gas analysis
- Always keep sample using anaerobic technique
in blood collection prevents too much exposure in
the ambient air (CO2 in air is less than those
present in blood) → when exposed, further
decreases because cells will be taking up
oxygen
1. The pCO2 of air (0.2 mmHg) is much less than in
blood (38 mmHg) so that when blood is exposed
to air, the ctCO2 and pCO2 decreases and the pH
increases.
a. Preferred sample is whole blood using
arterial blood collection (mainly because
venous blood sample oxygen level is
significantly lower as compared to arterial
blood)
i. The blood which is passing
through the vein is what we
called deoxygenated blood
ii. If mababa yung oxygen sa
venous blood mas mataas
naman ang kanyang PCO2
which is 2-8mmHg higher
compare to arterial blood
b. Ideally collected using glass syringe
(because glass is less porous) and
lyophilized heparin (powdered form) as
anticoagulant (liquid heparin results to
dilution of sample) → liquid heparin is not
advisable
c. Arterial blood sample is preferred because
Venous blood oxygen level is significantly
lower but higher pCO2 (2-8 mmHg higher)
→ acidic pH (0.02-0.05 pH lower)
d. 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
e. If venous and capillary blood: should
undergo arterialization (capillary is
preferred since it is a mixture of venous
and arterial blood)
i. Arterialization → inducing
vasodilation and maintain good blood
flow to get the nearest arterial
sample
ii. Warming up the area of extraction
using warming pad
iii. Not applicable to low blood pressure
(systole is <95mmHg), conditions
that induce vasoconstriction, patients
undergoing oxygen therapy,
newborns, newborns with respiratory
distress syndrome
METHOD OF DETERMINATION
Measurement of pO2 (oxygen)
● ISE: Clarke pO2 electrode (clark)
○ principle: based on amperometric or
polarographic measurement of oxygen
○ oxygen is equivalent to Clarke
electrode
● Gasometric analysis
● Calculation from oxygen saturation, pH and
temperature by means of the standard O2
dissociation curve → like in hematology (shift to
left, right..)
● Transcutaneous monitoring → non-invasive
method where electrode with gel casing to
maintain the temperature of the skin between
43-44 C is placed on the patient
**@ 43-44 C will cause arterialization of
capillaries and can somehow measure oxygen
through diffusion of oxygen through skin
** method is different from using pulse
oximeter
Measurement of pCO2 (carbon dioxide)
● Severinghaus electrode: pCO2 electrode
○ principle: based on pH measurement of a
stationary NaHCO3 (SODIUM
BICARBONATE) solution which is in
equilibrium with the test solution and the
test via CO2 permeable membrane
● gasometric analysis
● Henderson Hasselbach equation from pH and
total CO2
5 | CC2LEC WEEK 7
● CO2 equilibrium curve from a measured pH
value interpolated
Measurement of pH
● pH electrode
○ Principle: based on polarographic
principle
● Typically measured using pH meters or
electrodes
● Henderson-Hasselbalch equation derivation
→ Derivation of pH using the HendersonHasselbalch
equation – used as a mathematical derivation for
determining pH based on partial pressure of carbon
dioxide and bicarbonate level.
● Nomogram and slide rule → used for plotting
of data
● Siggard- Anderson Alignment nomogram
Measurement of Ct CO2 (total concentration of
CO2)
● Gasometric Analysis
2 types: would vary depending on the volume
of blood
a. Macro gasometric method – utilizes more
than 1mL of sample
b. micro gasometric method – utilizes less
than 1mL of sample
2 types of Gasometric Analysis
a. Van Slyke Gasometric Analysis
b. Manometric Method using Natelson
Microgasometer
○ Principle: carbon dioxide is released
front HCO3 by the addition of lactic acid.
The CO2 and other gases are extracted
under a partial vacuum. The pressure
difference at constant value before and
after absorption of CO2 by NaOH is the
amount of CO2 present in the sample
- chemicals will be used in order to liberate
the different blood gasses and specific
chemicals which will be used to
differentiate oxygen and carbon dioxide
Reagents in Natelson Microgasometer
● 10% lactic acid → releases CO2 from HCO3
(bicarbonate ion)
● 12% NaOH → for total reabsorption of CO2
gas as Na2CO3
● NaHSO3 → for reabsorption of O2
● Caprylic alcohol → prevents foaming/ air
bubble formation
● Mercury → separates the sample and other
reagents, prevents introduction of air and
seals gasometer because the process should
be anaerobic
● Distilled water → washes the sample and
reagent into the reaction chamber
** Gasometric analysis is a continuous flow
type of analyzer – all reagents and samples will
be passing through a single analytic pathway
using a peristaltic pump
**Do not use air bubble as separator in
analyzer → will cause false results due to
production of air → we use mercury
● Alternative Method
- replacing lactic acid with sulfuric acid for the
release of carbon dioxide; methodology is still
the same
○ principle: involves the release of CO2
carbon dioxide gas when the sample is
added to H2SO4 (sulfuric acid) 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 electrode is a
measure of the concentration of its CO2 in
the sample
→measurement is done through electrochemical
analysis
CRITERIA & CONDITIONS for BLOOD GAS
ANALYSIS – conditions for analysis
1. All procedures should be considered “STAT”
procedure
- specimen turnaround time must be short →
within an hour after extraction should be
processed
**introduction of POTC (point of care_ –
performed on bedside, if none keep sample
in ice
a. if delayed 20-30 mins: pH lowers by
0.01
b. avoid glycolysis – conversion of
Glucose to acetyl coenzyme A to
produce ATP leading to the liberation of
CO2 and water
** blood continuous its metabolic
process even on lyophilized heparin of
arterial sample
6 | CC2LEC WEEK 7
** increased pCO2 = increase H2CO3
(carbonic acid) = decreased pH
2. Specimen must be kept at anaerobic
condition
- if not, blood will take up oxygen –
increase O2 = decreased pCO2 =
decreased H2CO3 = increased pH
- how to maintain the anaerobic: empty
air in syringe ang bend the needle with
cork; do not use winged blood collection
- remove air bubble
3. Specimen w/c cannot be analyzed
immediately →must be placed in an ice slurry –
not advisable due to thermal equilibrium
• Decrease in pH
• Blood is still metabolically active and capable
of undergoing glycolysis
ACID-BASE DISTURBANCES
Acidosis→ decrease in pH, lower than 7.35
- general term applied for any condition where
the pH of the blood and the bicarbonate
concentration of the blood are below
normal
- compensation is alkalosis
Alkalosis→ increase in Ph, above 7.45
- 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
(UCO3) and a reduction in the H+ ion
substances (H2CO3)
- compensation is acidosis
Metabolic
- the affected is bicarbonate (HCO3)
concentration
- compensation is respiratory
Respiratory
- the affected is carbonic acid (H2CO3)
concentration
- compensation is metabolic
** whenever there is an imbalance with 1 of the
regulatory mechanism, the other regulatory
mechanism will try to compensate through different
compensatory mechanisms
If metabolic: either excretion or reabsorption
If respiratory: either retention by decreasing the
exhalation of CO2 or increasing the exhalation of
CO2 (hyperventilation and hypoventilation
METABOLIC ACIDOSIS→ will occur if there is a
decrease in bicarbonate
● caused by bicarbonate deficiency
● production of increased amount of acid
○ diabetic ketoacidosis
○ lactic acidosis (alcoholism)
○ renal failure
○ diarrhea
** common involving the excretion of
bicarbonate (HCO3- bicarbonate ion)
● Compensation: hyperventilation → will
decrease the pCO2/ excrete carbon dioxide
● Acidosis: increased in H+ concentration
○ (+) hyperkalemia and hyperchloremia
● Normochloremic in DKA (diabetic
ketoacidosis)
● pCO2 drops 1 to 1.3 mmHg per mEq/L fall in
HCO3
METABOLIC ALKALOSIS → will occur if there is an
increase in bicarbonate
● caused by bicarbonate excess
● conditions
○ vomiting with loss of chloride form
the stomach
● Compensation: hypoventilation → will
increased pCO2 concentration → increase
carbonic acid
● (+) hypokalemia, hypochloremia
● For every 10mEq/L rise in bicarbonates, the
pCO2 rises by 6 mmHg
RESPIRATORY ACIDOSIS →increase in carbonic
acid
● Excessive accumulation of CO2 (carbon
dioxide)
● Conditions
○ chronic obstructive pulmonary
disease (COPD)
○ myasthenia gravis
○ CNS disease
○ drug overdose (morphine,
barbiturates and opiates)
○ pneumonia
** common in the decreased release of
CO2 causing accumulation
● compensation: retention of bicarbonates →
reabsorb/ retain HCO3
7 | CC2LEC WEEK 7
● Bicarbonate rises 1 mEq/L for each 10 ● HCO3 (22-26 mEq/L) → evaluate the
mmHg rise in pCO2 metabolic process (kidney)
○ <22 – metabolic acidosis
RESPIRATORY ALKALOSIS→ decrease in carbonic ○ >26 – metabolic alkalosis
acid ● determine which is the primary and
● excessive carbon dioxide loss compensating disorder
● Conditions ○ pH
○ Anxiety ● Determine the degree of compensation
○ severe pain ○ non-compensatory
○ aspirin overdose ○ partial compensatory
○ hepatic cirrhosis ○ complete compensatory
● Compensation: decreased reabsorption of ● pO2 (81-100 mmHg) → adequate
bicarbonate in blood circulation by excreting oxygenation
more ○ pO2 hypoxia
● (+) hypokalemia ■ mild (61-80)
● Bicarbonate falls 2 mEq/L for each 10 mmHg ■ moderate (41-60)
fall in pCO2 ■ severe (40 or less)

CONSEQUENCES OF ACID-BASE IMBALANCE BLOOD GAS CALCULATION

● In alkalosis, tetany ensues due to Henderson- Hasselbalch Equation

hypocalcemia, which can lead to death
because of respiratory muscle spasm - equation in determination of pH
● In acidosis, there is an inhibition of the - primary source of equation of pH
neural mechanism which will then lead to
pH = pKa + log [conjugate base/ weak acid]
coma. A blood pH of 6.9 has proven fatal
pH = 6.1 + log [HCO3- / H2CO3+]
ARTERIAL BLOOD GAS REFERENCE RANGE
AT 37 DEGREE CELCIUS ● pKa → ionization constant of buffer
pH 7.35-7.45
system
pCO2 (mm Hg) 35-45
HCO3- (mmol/L) 22-26 ○ bicarbonate-carbonic acid system
Total CO2 content 23-27 = 6.1 pKa
(mmol/L) ● bicarbonate (HCO3-) → representative
pCO2 (mmol/L) 80-100 conjugate base
SO2 (%) >95 ● carbonic acid (H2CO3) → weak acid;
O2Hb (%) >95 called weak acid because upon entering
the blood circulation/ during gas
PARAMETERS OF INTEREST exchange, bicarbonate? readily
dissociates into water and carbon dioxide
● pH (7.35-7.45)
→ means of measuring carbonic acid is
○ <7.35 – acidosis
○ >7.45 – alkalosis through liberation of products
● pCO2 (35-45 mmHg) → Evaluate the ● partial pressure of CO2 (pCO2) – basis
ventilation (lungs) of carbonic acid/ representative of
○ <35 respiratory alkalosis carbonic acid
○ >45 respiratory acidosis ● total CO2 concentration (tCO2) – sum of
the bicarbonate and carbonic acid
Primary disturbance
22-29 mmol/L →metabolic alkalosis (tCO2 = HCO3- + H2CO3+)
HCO3 →metabolic acidosis
35-45 mmHg →respiratory alkalosis ** carbonic acid is not directly determined but is
pCO2 →respiratory acidosis known through pCO2
● H2CO3 = pCO2 (0.003)
0.03 → solubility coefficient
8 | CC2LEC WEEK 7
pH = 6.1 + log [HCO3 / pCO2 x 0.03] compensatio pH pCO2 HCO3
n
if tCO2 & pCO2 is only given:
Non abn abn N
pH = 6.1 + log [tCO2 - (pCO2x0.03) / pCO2
x0.03] N Abn
** in our body we have different buffer system Partial abn abn abn
responsible in maintaining the pH) at normal
level Complete N abn abn
PARAMETERS ** non compensatory → one buffer system
(pCO2 or HCO3) did not compensate for any
1. pH = 7.35 - 7.45 deviation with the other buffer system
○ acidosis – <7.35
○ alkalosis – >7.45 ** partial/ complete compensatory →
2. Primary Disturbance characterized by abnormal concentration on
○ HCO3 = 22-29 mmol/L both buffer systems. compensation on the buffer
■ metabolic acidosis – decreased with one another
HCO3 (bicarbonate ion) = <22 ~ Partial → condition where in bicarbonate
■ metabolic alkalosis – increased and carbonic acid did its compensatory
HCO3 = >29
mechanism but not sufficient enough to
** metabolic conditions are named as normalize the pH
such because bicarbonate is primarily ~ Complete → condition where in
regulated by kidney (renal regulatory bicarbonate and carbonic acid did its
mechanism) → absorbed or excreted
compensatory mechanism, normalizing the
○ pCO2 (representative of H2CO3- pH concentration
sulfurous acid) = 35-45 mmHg 4. Degree of Oxygenation
■ respiratory acidosis – increased
in acid → >45 pO2 = 85-105 mmHg or mmol/L
■ respiratory alkalosis – decreased
** pO2 → not included in the equation; just
in pCo2 → <35
evaluate based on the given
** respiratory because the means to
** clinically significant – below normal → find
regulate CO2 is through gas exchange
the category of condition with hypoxemia (low
with O2 (respiratory regulatory
oxygen in the blood) – not detected by oximeter
mechanism). Primary organ to lungs.
3. Degree of Compensation – mechanism of Degree of hypoxemia mmHg
body to revert back to normal pH level.
- mechanism involving 1 buffer system
mild >61; <84 (61-84)
adjusting for the other buffer system
which has a primary disturbance moderate >41: <60 (41-60)
- example: respiratory acidosis →
kidney (HCO2) will compensate by severe <40
inducing metabolic alkalosis
NORMAL >90
OXYGENATION
9 | CC2LEC WEEK 7
Sample Problem 1:
pH = ? 7.31 → abn = acidosis
pCO2 = 47 mmHg → abn = acidosis
HCO3 = 23 mmol/L → N
pO2 = 65 mmHg → mild hypoxemia
Degree of compensation → non compensatory
primary disturbance (base is on the pH) →
respiratory acidosis
interpretation: patient has non-compensatory
respiratory acidosis with mild hypoxemia
** primary disturbance should correlate with the
pH if no, repeat
Sample problem 2:
pH = ? 7.42 → N
pCO2 = 49 mmHg → abn = respiratory acidosis
HCO3 = 31 mmol/L → abn = metabolic alkalosis
pO2 = 90 → N
evaluate:
complete compensated – can determine primary
disturbance or proceed without it
** how to know the disturbance: buffer system
with biggest deviation from the normal range
Interpretation/ evaluation: complete
compensatory with normal oxygenation /
complete compensatory, respiratory acidosis
with normal oxygenation
Sample problem 3:
pH = ? 7.46 → abn = alkalosis
pCO2 = 29 mmHg –. abn = respiratory alkalosis
HCO3 = 20 mmol/L → abn = metabolic acidosis
pO2 = 55 mmHg → moderate hypoxemia
Interpretation/ evaluation: partial
compensatory, respiratory alkalosis with
moderate hypoxemia
Note:
In looking for primary disturbance:
** pH normal → biggest deviation from normal
range
** pH is abnormal → base on the pH
1. Which of the following represents the Henderson–
Hasselbalch equation as applied to blood pH?
A. pH = 6.1 + log HCO3–/PCO2
B. pH = 6.1 + log HCO3–/(0.03 × PCO2)
C. pH = 6.1 + log dCO2/HCO3–
D. pH = 6.1 + log (0.03 × PCO2)/HCO3–
2. What is the PO2 of calibration gas containing
20.0% O2, when the barometric pressure is 30 in.?
A. 60 mm Hg
B. 86 mm Hg
C. 143 mm Hg
D. 152 mm Hg
3. What is the blood pH when the partial pressure of
carbon dioxide (PCO2) is 60 mm Hg and the
bicarbonate concentration is 18 mmol/L?
A. 6.89
B. 7.00
C. 7.10
D. 7.30
What is the PCO2 if the dCO2 is 1.8 mmol/L?
A. 24 mm Hg
B. 35 mm Hg
C. 60 mm Hg
D. 72 mm Hg
What is the maximum recommended storage time
and temperature for an arterial blood gas sample
drawn in a plastic syringe
D. 30 min 22 degree Celsius
10 | C C 2 L E C W E E K 7
Which condition results in metabolic acidosis with
severe hypokalemia and chronic alkaline urine?

A. Diabetic ketoacidosis

B. Phenformin-induced acidosis

C. Renal tubular acidosis

D. Acidosis caused by starvation

Which of the following mechanisms is responsible

for metabolic acidosis?

A. Bicarbonate deficiency

B. Excessive retention of dissolved CO2

C. Accumulation of volatile acids

D. Hyperaldosteronism

6. Which of the following disorders is associated with

lactate acidosis?

A. Diarrhea

B. Renal tubular acidosis

C. Hypoaldosteronism

D. Alcoholism

Which of the following conditions is classified as

normochloremic acidosis?

A. Diabetic ketoacidosis

B. Chronic pulmonary obstruction

C. Uremic acidosis

D. Diarrhea