MLS115 Blood pH and Blood Gases CLINICAL CHEM 2

WILLIAM CHRISTOPHER SALAZAR, RMT | FEBRUARY 27, 2021 LE 02 TRANS 01

OUTLINE
I. Terminologies V. Oxygen Transport
II. Acid Base Balance VI. Measurement of Oxygen
III. Assessment of Acid- Saturation
Base Homeostasis VII. Blood Gas Analysis
IV. Compensation  Reference ranges at 37C
 pH - 7.35 – 7.45
LEGEND  PCO2 (mmhg) - 35 – 45
Remember Lecturer Book Previous Presentation  HCO3 (mmol/L) - 22 - 26
Trans
B. Organs in Acid – Base balance
 Lungs (Respiratory Mechanism)
I. TERMINOLOGIES
 Acid
 Substance that can yield H+ (hydronium ions) when dissolved in
water
 Base
 Kidney (Renal Mechanism)
 Substance that can yield OH- or hydroxyl ions
 Excretion of H
 pKa (a constant)
 pH in which protonated and unprotonated forms are equal in
concentration
 Example. Bicarbonate-carbonic acid system 6.1
 Buffer
 Combination of weak acid or weak base and its salt
 H2CO3  weak acid C. Acid – Base disorders: Acidosis and Alkalosis
 HCO3  weak / conjugate base I. Respiratory Origin = alterations in H2CO3 or CO2
Use to control the pH level of substances or solutions  Acidosis = Excess H2CO3 or CO2
 pH  Caused by:
 Power of hydrogen - Asthma, Emphysema
 Negative log of H concentration - Bronchoneumia
- Depression of Respiratory Center
 Inversely proportional to H concentration
- Hypoventilation due to drugs (Barbiturates)
 Venous blood pH = 7.35
- Congestive Heart Failure
 Arterial blood pH = 7.45 - OPD (Obstructive Pulmonary Disease)
CO2 cannot be release due to difficulty of
II. ACID BASE BALANCE breathing
A. MAINTENANCE OF H+ o Compensation
 H+ concentration: 36 – 44 nanomole/L  Na/H exchange
 pH 7.35 – 7.45 (normal range)  NH3 production
 H+ excess can lead to alteration in consciousness, tetany, coma  Reabsorption of HCO3
and death  Excretion of Acid H
 Acidosis pH of <7.35, alkalosis pH of >7.45
 Maintained by the lungs and the kidneys  Alkalosis = Excessive reduction of H2CO3 or CO2
 Caused by:
B. BUFFER SYSTEM - High fever
 The bicarbonate – carbonic acid system - Hysteria (Hyperventilation)
 Weak acid: carbonic acid (H2CO3) - Pulmonary emboli and fibrosis
 Conjugate base: bicarbonate (HCO 3) - Drugs (salicylates)
 H2CO3 dissociates into CO2 and H2O o Compensation
 CO2 – modify ventilation rate  Na/H exchange
 HCO3 can be altered by the kidneys  NH3 production
 Major extracellular buffer  Reabsorption of HCO3
 Hemoglobin buffer system  Excretion of Acid H
 Used hemoglobin in RBC to minimize pH changes in the
blood II. Metabolic Origin = alterations in HCO3
 Most important intracellular buffer  Acidosis = primary Bicarbonate deficit <24mmol/L
 Plasma protein buffer system  Caused by:
 Uses plasma proteins to minimize pH changes in the blood - Addition acidosis (diabetic ketoacidosis)
 Phosphate buffer system - Subtraction acidosis (diarrhea)
- Renal Tubular Acidosis
 Uses HPO4 and H2PO4 to minimize changes in the plasma
- Starvation, Lactic Acidosis
and erythrocytes
- Toxins
- Excessive loss of electrolytes and intestinal fluids
C. Regulation of Acid – Base balance: Lungs and Kidneys
o Compensation
 Hyperventilation
III. ASSESSMENT OF ACID – BASE HOMEOSTASIS
A. The bicarbonate buffering system and Henderson – Hasslebalch  Alkalosis = Bicarbonate excess (↑pH)
equation  Caused by:

TRANS #1 Balilo, Candia, Roales, Villa EDITORS

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 3.03 Blood pH and Blood Gases LE 03 TRANS 03
- Additional alkalosis (ingestion of Alkali)
- Subtraction alkalosis (vomiting) 4 Parameters used to asses a patients oxygen status
- Diuretics, Excessive gastric suctioning 1. Oxygen Saturation (SO2)
- Intestinal obstructions  Represents the ratio of oxygen that is bound to its carrier
o Compensation protein, hemoglobin
 Hypoventilation 2. Fractional (percent) oxyhemoglobin (FO2Hb)
 Ratio of the concentration of oxyhemoglobin to the
IV. COMPENSATION concentration of total hemoglobin
 Goal: to maintain normal pH 3. Partial Pressure of Oxygen dissolved in plasma (PO 2)
 Organs: Lungs & Kidneys  Counts for the little of the body’s O 2 stores
 Henderson – Hasselbalch Equation 4. Pulse oximetry (SPO2)
 Uses a device to pass light to two or more wavelength
through the tissue in the capillary bed of toe, finger, or ear.

 Hemoglobin oxygen binding capacity

 Maximum amount of oxygen that can be carried by
pH Origin Affected Compensating Cause Compensation hemoglobin in a given quantity of blood
organ organ
↓ Respiratory Lungs Kidneys ↑PCO2 ↑HCO3  Oxygen content
 Total oxygen in blood ang is the sum of the oxygen bound to
↓ Metabolic Kidneys Lungs ↓HCO3 ↓PCO2 hemoglobin (O2Hb) and the amount dissolved in plasma
↑ Respiratory Lungs Kidneys ↓PCO2 ↓HCO3 (pO2)
↑ Metabolic Kidney Lungs ↑HCO3 ↑PCO2 VII. BLOOD GAS ANALYSIS
 pH, pCO2, pO2
Respiratory Opposite Metabolic Equal  Blood gas analyzers use electrodes (microelectrochemical or
microelectrochemical) as sensing device to pressure pO 2,
Compensation Mechanism pCO2, and pH
 Uncompensated  pO2 measurement is amperometric
 Abnormal pH (either acidic or basic alkaline)  pCO2 and pH measurement are potentiometric
 No action of compensating organ
 Cathode
 Partially Compensated
 Negative electrode
 Abnormal pH
 Site to which cations tent to travel
 Compensation takes place
 Site at which reduction occurs (reduction – gain of electron
 Fully compensated
by particle
 Normal pH
 Anode
V. OXYGEN TRANSPORT
 Positive electrode
 Oxygen is transported to the tissues by hemoglobin
 Site to which anions tends to travel
O2
External Environment  Site at which oxidation occurs (oxidation-loss of electron by
particle)
↓ ↑
Alveoli in Lungs
↓ ↑  pO2 electrodes (clark electrode)
Capillaries  Measure amounts of current flow in a circuit that is released
↓ ↑ to the amount of O2 being reduced at the cathode
Blood 
CO2  Continuous measurement of pO2
Variations in Hemoglobin  Made possible by using transcutaneous electrode (TC)
 Oxyhemoglobin placed directly in the skin
 O2 reversibly bound to hemoglobin  pH
 Bright red  Glass membrane coated placed around an internal Ag-AgCl
electrode (measuring electrode)
 Deoxyhemoglobin
 pCO2
 Reduced hemoglobin
 Serveringhaus electrode – an outer semipermeable
 Hgb not bound to O2
membrane that allows CO2 to diffuse into a layer of electrode
 Dark red

 Carboxyhemoglobin END OF TRANSCRIPTION

 Hgb bound to carbon monoxide (toxic)
 200x stronger affinity for Hgb than O 2
 Cherry Red appearance
 Methemoglobin
 Hgb unable to bind O2 because iron is oxidized
 Chocolate brown in appearance

VIII. MEASUREMENT OF OXYGEN SATURATION

 Dedicated spectrophotometer (cooximeter)
 Used to determine the relative concentration of each of the
forms of Hgb

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