ARTERIAL BLOOD

GAS AND PH

imarponrmt
INCREASE IN (H+) NEUTRAL DECREASE IN (H+)

ACIDEMIA ALKALEMIA
NORMAL pH
pH: <7.35 7.35 7.45 pH: >7.45
 CA
CO2 + H2O H2CO3 HCO3- + H+
BICARBONATE - BASE

pH =

CARBON DIOXIDE - ACID

CALCULATE THE ANION GAP
AG = Na+ - (Cl- + HCO3-)

NV: 6-12 mmol/L

AVERAGE: 10 mmol/L
INCREASED ANION GAP
Increased in Anion Gap
✔Increased in unmeasured
anions
✔Decrease in unmeasured
cations (calcium,
magnesium, potassium)
✔Increase in anionic albumin

“HAGMA”
 NORMAL/DECREASED ANION GAP
• Hyperchloridemia Decrease in Anion Gap
• Acedozolamide ✔ Increase in unmeasured cations
✔ Addition to the blood of abnormal cations such
• Renal tubular acidosis as lithium or cationic immunoglobulins
• Diarrhea ✔ Reduction in the plasma anion albumin
• Urethral dilation concentration
✔ Hyperviscosity and severe hyperlipidemia
• Pancreatic fistula

“NAGMA”
 NORMAL VALUES:
pH 7.35-7.45
pCO2 35-45 mmHg
pO2 80-100 mmHg
HCO3 22-26 mEq/L
O2 saturation >94%
 SIMPLE ACID-BASE DISORDERS
ACIDOSIS ALKALOSIS
pH
<7.35 >7.45
HCO3 <22 HCO3 >26
HCO3 METABOLIC METABOLIC

pCO2 >45 pCO2 <35

pCO3 RESPIRATORY RESPIRATORY
 pH 7.35-7.45

SIMPLE ACID-BASE DISORDERS

pCO2 35-45 mmHg

pO2 80-100 mmHg

EXAMPLES HCO3

O2 saturation
22-26 mEq/L

>94%

pH 7.29 pH 7.48 pH 7.20 pH 7.49

pCO2 40 pCO2 36 pCO2 48 pCO2 29

HCO3 19 HCO3 32 HCO3 24 HCO3 25

SIMPLE ACID-BASE DISORDERS pH

pCO2
7.35-7.45

35-45 mmHg

EXAMPLES pO2

HCO3
80-100 mmHg

22-26 mEq/L

O2 saturation >94%

pH 7.43 7.40
pCO2: |40-28| /40 = 0.3
pCO2 28 40 0.3 > 0.2
HCO3: |24-19| /24 = 0.2
HCO3 19 24
RESPIRATORY ALKALOSIS
 Is there an on-going
PHYSIOLOGIC
COMPENSATION?
FULL PARTIAL
OR
 CA
CO2 + H2O H2CO3 HCO3- + H+
 pH 7.35-7.45

pCO2 35-45 mmHg

pO2 80-100 mmHg

HCO3 22-26 mEq/L

O2 saturation >94%

✓ Check pH if acidemia or alkalemia

✓ Check if metabolic or respiratory AG = Na - (Cl- + HCO3-)
+
”SMORE”
✓ If disorder metabolic acidosis, determine the ANION GAP.
✓ If HAGMA detected, determine Delta ratio
 Ph pCo2 HCO3 Na Cl
1. 7.44 56 37 ---- ----
2. 7.22 55 22 ---- ----
3. 7.36 58 29
4. 7.32 34 14 135 109
5. 7.25 25 10 140 77
6. 7.28 26 11 129 100
O2 loaded onto
hemoglobin depends
a. Availability of O2
b. Concentration and Type(s) of Hb
c. Interfering substances ( eg. CO)
d. pH
e. Temperature
f. Pco2 level
g. 2,3-diphosphoglycerate (2,3-
DPG).
STRUCTURE OF HEMOGLOBIN
 OXYGEN
SATURATION
NV: > 95%
 PULSE
OXIMETRY
FRACTIONAL OXYHEMOGLOBIN
PARTIAL PRESSURE OF OXYGEN
NV: 90-95mmHg
• Tetramer of Hb mw: 64,458 g/mol
• Mole of Perfect gas: 22,414 ml

Each gram of Hb carries 1.39 mL of O2

Example:
GIVEN:
Total Hb: 15g/dl O2 Sat: 100%

What is the O2 Capacity?

SOLUTION:
15g/100mL x 1.39 ml/g
=20.8 ml O2 ml of blood

20XX Pitch deck title 39

 OXYGEN
DISSOCIATION
CURVE
 Source of error:
1. Protein buildup on membrane
surface
2. Bacterial contamination
CLARKE ELECTRODES
3. Incorrect calibration
- reference method
4. Room air exposure
PRINCIPLE: AMPEROMETRIC
5. Skin thickness & tissue
- measure the amount of current flow
in a circuit that is related to the perfusion w./ arterial blood
amount of O2 being reduced at the
cathode.
POTENTIOMETRIC MEASUREMENT
- reference method
pH: Ag-AgCl or Hg-HgCl Electrode

Principle:
potential that develops at glass membrane → H from unknown solution diffusing membrane
surface → difference in cH between unknown sample & buffer solution

pCO2: Severinghaus Electrode

- semipermeable membrane allows CO2 to diffuse in a layer of electrode
CALCULATED PARAMETERS:

HCO3
- based on Henderson Hasselbalch equation
- Can be calculated if pH & PCO2 is known
- Bicarbonate buffer system (pka: 6.1)

Carbonic acid
- Solubility coefficient of CO2 in plasma at 37C
- pCO2 conversion factor: 0.0307
ctCO (Total Carbon dioxide)
2

ctCO2= cHCO3 + (0.0307 X Pc02)

Use of BASE EXCESS

- Assess non-respiratory component
- Should not be used alone
 CALIBRATION:
1. pH ELECTRODE
- 2 buffer solution traceable to
standards prepared by NIST
- Do not expose to room air
- Has 2 gas mixtures

2. Self calibrating
 QUALITY
ASSURANCE
PRE-ANALYTIC
1. Patient Hyperventilation
2. pH & Blood gas studies
✓ Arterial blood
✓ Venous sample
✓ Capillary blood
✓ Central venous
(pulmonary artery)
BLOOD SAMPLE:
1.Heparinized
2.Anaerobic
3.Fresh!
4.Transport with Ice
COLLECTION AND HANDLING:
SOURCE OF ERROR
1. Collection device
2. Form or concentration of Heparin
3. Syringe speed filling
4. Maintenance of anaerobic environment
5. Sample mixing
6. Transport
7. Storage time
COLLECTION:
✓ Ideal volume: 1-3ml
✓ Evacuated tube= NOT RECOMMENDED!
✓ Dry (lyophilized)/Liquid Heparin: ACCEPTABLE!
Liquid form: Not recommended
Lithium salts or heparin: Recommended
✓ Ammonium, Zinc, Electrolyte balanced and calcium
titrated
✓ Small needles
✓ Transport fast!
✓ ICE
ANALYTICAL ASSESMENT
1. Surrogate Liquid Control material
2. Aqueous base controls
3. Hb containing emulsion based
controls
4. Non surrogate QC
END

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