Arterial Blood Gas Analysis

Chairperson

Dr. H.N Dr. MD. Fakhrul islam khaled

Phase B
Presenter Ashiqur BSMMU
Resident
Rahman
Associate professor

BSMMU
3
 ABG component
• PH:
measures hydrogen ion concentration in the blood, it
shows blood’ acidity or alkalinity.

• PCO2 :
It is the partial pressure of CO2 that is carried by the blood for
excretion by the lungs, known as respiratory parameter.

• PO2:
It is the partial pressure of O2 that is dissolved in the blood , it
reflects the body ability to pick up oxygen from the lungs.

• HCO3 :
known as the metabolic parameter, it reflects the kidney’s ability
to retain and excrete bicarbonate.
4
A.Y.T 8
Step 1: Check pH.
- normal/ acidemia/alkalemia

Step 2: Check PaCO2 .

-is respiratory primary cause
-If PaCO2 changes from normal in the opposite direction of PH, then
respiratory is primary cause

Step 3: Check HCO3-

-is metabolic is primary cause
-If HCO3 changes from normal in the same direction as PH, then
imetabolic is primary cause

A.Y.T 9
 Acid Base Disorder
Metabolic Acidosis Metabolic Alkalosis

pH HCO3 PCO2 pH HCO3 PCO2

↓ ↓ -------- ↑ ↑ ----------

Respratory Alkalosis
Respiratory Acidosis

pH HCO3 PCO2
pH HCO3 PCO2
↑ --------- ↓
↓ ---------- ↑

A.Y.T 10
Step 4: Is body compensating?.
-if both PaCO2 & HCO3 are abnormal in same direction ,then yes
body is compensating

A.Y.T 11
 Compensation
• The respiratory and metabolic system works together to
keep the body’s acid-base balance within normal limits.
• The respiratory system responds to metabolic based PH
imbalances in the following manner:
* metabolic acidosis: ↑ respiratory rate and depth (↓PaCO2)
* metabolic alkalosis: ↓ respiratory rate and depth (↑PaCO2)
• The metabolic system responds to respiratory based PH
imbalances in the following manner:
*respiratory acidosis: ↑ HCO3 reabsorption
*respiratory alkalosis: ↓HCO3 reabsorption

12
Step 5: Determine if compensation is appropiate :are
there other primary cause?.

A.Y.T 13
Step 6: If metabolic acidosis present , resolve
whether it is anion or non-anion gap acidosis.

A.Y.T 14
A.Y.T 15
 Asima mitu 24yrs old, HTN, CKD on MHD, presented with ALVF

Step 1: Check pH.

pH =7.262 (↓)

Step 2: Check PaCO2.

PCO2=63.7mmhg (↑)

Step 3: Check HCO3

HCO3=28.7 (↑)

Primary disorder-Respiratory acidosis

A.Y.T 16
Step 4: Is body compensating?.
HCO3 = 24+(PCO2-40)x.1=26.3
Step 5: Determine if compensation
is appropiate :are there other
primary cause?.
HCO3 is more than expected level

Respiratory acidosis+ metabolic

Alkalosis

A.Y.T 17
Mrs Fatema ,67yrs DM, HTN CKD,OSA , H/O STEMI 1month back , septicemia
developed impaired conciousness GCS 5/15

Step 1: Check pH.

pH =7.481 (↑)

Step 2: Check PCO2.

PCO2=50mmhg (↑)

Step 3: Check HCO3

HCO3=37.3 (↑)

Primary disorder-Metabolic
alkalosis

A.Y.T 18
Step 4: Is body
compensating?.
PCO2 = (HCO3+15) ±2=52.3 ± 2
Step 5: Determine if
compensation is appropiate
:are there other primary
cause?.
PCO2 is with in expected level

Partial compensated
metabolic Alkalosis

A.Y.T 19
 Nadira, 35yrs CKD on MHD, Peripartum
cardiomyopathy,,septicemia

Step 1: Check pH.

pH =7.392 (↓)

Step 2: Check PCO2.

PCO2=31.9mmhg (↓)

Step 3: Check HCO3

HCO3=19.4 (↓)

Primary disorder-Metabolic
acidosis

A.Y.T 20
Step 4: Is body
compensating?.
PCO2 = (HCO3+15) ±2=34.4 ±2
Step 5: Determine if
compensation is appropiate
:are there other primary
cause?.
PCO2 is with in expected level

Partial compensated
metabolic Acidosis

A.Y.T 21
Anion GAP=Na- (HCO3+Cl)
=136.4-(19.4+101.8)
=15.2
Normal anion Gap Metabolic acidosis

A.Y.T 22
 Mrs Lovely 52yrs during intraabdominal surgery, patient
developed cardiac arrest now in mecanical ventilation

Step 1: Check pH.

pH =7.499 (↑)

Step 2: Check PCO2.

PCO2=37.1mmhg (↓)

Step 3: Check HCO3

HCO3=28.9 (↑)

Primary disorder-Metabolic
alkalosis

A.Y.T 23
Step 4: Is body compensating?.
PCO2 = (HCO3+15) ± 2=43.9 ± 2
Step 5: Determine if
compensation is appropiate
:are there other primary
cause?.
PCO2 is less than expected level

metabolic Alkalosis+
Respiratory alkalosis

A.Y.T 24
 Mrs rokeya 90 yrs , STEMI , HTN, BP-80/50 SPO2-89%

Step 1: Check pH. PH-7.1

pH =7.1 (↓) PCO2-40mmHg
PO2-47.6mmHg
Step 2: Check PCO2. Na-137mmol/l
PCO2=40mmhg(n) K-3.15mmol/l
HCO3-14mmol/l
Step 3: Check HCO3 Cl-89 mmol/l
HCO3=14 (↓) BE=-9.5 mmol/l

Primary disorder-Metabolic
acidosis

A.Y.T 25
Step 4: Is body PH-7.1
compensating?. PCO2-40mmHg
PCO2 = (HCO3+15) ±2=29 ± 2 PO2-47.6mmHg
Step 5: Determine if Na-137mmol/l
compensation is appropiate
K-3.15mmol/l
:are there other primary
cause?. HCO3-14mmol/l
PCO2 is more than expected Cl-89 mmol/l
level BE=-9.5 mmol/l

metabolic
Acidosis+respiratory acidosis

A.Y.T 26
Anion GAP=Na- (HCO3+Cl) PH-7.1
=137-(14+89) PCO2-40mmHg
=34 PO2-47.6mmHg
High anion Gap Metabolic acidosis Na-137mmol/l
Bicarbonate Gap= pts HCO3+ ∆AG K-3.15mmol/l
=14+(34-16) HCO3-14mmol/l
=32 (BG >28) Cl-89 mmol/l
So metabolic alkalosis is present BE=-9.5 mmol/l
Final- High anion gap metabolic
Acidosis,respiratory acidosis, metabolic
alkalosis

A.Y.T 27
HCO3 ( mEq) required = 0.5 x weight (kg )x
[24-serum HCO3 (meq)]

In this pt…TBW=56Kg…………=0.5x56x (24-

14)
= 280 meq NaHCO3
in 7.5% solution 75mg= 0.893meq
1 bottle=22.325 meq
For correction need 12 bottle
Half is coorrected stat dose
Next half acording ABG within 24 hours

A.Y.T 28
A.Y.T 31