BLOOD GAS ANALYSIS

 Normal body pH is 7.35–7.45 /40Nmol/l H  Other buffers

 Fall in pH is Acidemia, rise is Alkalaemia  Haemoglobin
 Major buffer is  Phosphates
 bicarbonate- carbonic acid pair Proteins
 Normal plasma HCO is 25mmol/L

Respiratory Acidosis
 Due to retention of CO
 PaCO & H+ rise. --- pH decrease
 HCO3 is used-up for buffering
 Compensation is by HCO retention by kidneys
 In chronic conditions H+ has returned closer to normal due to HCO retention
Causes : Clinical features of RAc
1) Ventilatory failure Increases cerebral blood flow and raises intracranial pressure
2) COPD (type 11 RF) 1) Impairs cardiac contractility
3) Emphysema 2) Cardiac arrythmias
4) Polyneuropathy
3) Confusion
5) Drug-overdose
4) Coma
5) Hyperkalaemia
6) ODC shifts to the right

Respiratory Alkalosis
 H+ & PaCO fall. pH increase 2) Hypoxaemia (type 1 RF)
 Due to increased ventilation 3) Spontaneous hyperventilation
 Compensation is by slight decrease in HCO 4) High altitudes
5) Septic shock
Causes :
6) Pneumonia
1) Mechanical ventilation 7) Hyperkalaemia

Metabolic Acidosis
 H+ increase. pH decrease Causes : Acid administration
 HCO is largely decreased acid generation (Diabetic ketoacidosis, anaerobic metabolism/
 Is due to accumulation of acid otherthan HCO lactic acidosis (shock, cardiac arrest)) impaired acid excretion
 Compensation is by decrease in PaCO by hyperventilation (chronic renal failure),
hyperkalaemia,
loss of HCO from gut or kidney (renal tubular acidosis)
To see whether MAc is due to H Cl retention or other cause, need anion gap (plasma & urinary)
Normal anion gap acidosis
 Normal AG with acidosis
 When HCO3 is lost via the gut or kidney Cl is retained. (H CL is retained or Na HCO is lost)
E.g renal tubular acidosis – plasma HCO < 21mmol/l, urinay pH > 5.3
 Urinary anion gap (Urinary Na + K - Cl) is useful in distinguishing RTA1 (UAG +ve) & diarrhoea (UAG -ve)
Increased anion gap acidosis
 Due to retention of unmeasured anions (organic acids)
 HCO3 is utilized to maintain normal [H+] and therefore decreases. Cl is normal or low
E.g. Commonest is lactic acidosis:
type A- lack of O :cardiac arrest, sepsis, type B- metabolic ablormality :diabetes, metformin
Uraemic acidosis/ renal disease
Ketoacidosis : diabetes, alcohol excess, stravation
Exogenous acids : salicylates
Clinical features of MAc 6) Coma
1) Impairs cardiac contractility - -ve ionotrophic 7) Hyperkalaemia if renal function is impaired or
2) Cardiac arrythmias hypokalaemia if normal
3) Arteriolar vasodilation 8) ODC shifts to the right
4) venoconstriction 9) Air hunger / Kussmaul erspiration
5) Confusion

Metabolic Alkalosis
 H+ is decreased. pH increased
 HCO is very much increased
 PaCO is slightly increased as respiratory compensation
Causes : Hypochloraemia/Loss of acid ; gastric (nasogastric suction, Clinical features of MAl
vomiting, intestinal obst) Tetany
Chloruretic diuretics (furosemide), Headache
Hypokalaemia/ mineralocorticoid excess (remove H+) ; Confusion
aldosteronism Seizures
Impaired cerebral perfusion
Hypercaicaemic states Coma
Increased Rx with IV Na HCO , antacid abuse, Hypokalaemia
Cardiac arrhythmias
Nueromuscular irritability
ODC shift to left

 Arterial Blood Gas

 pH --- 7.35 -7.45
 pCO2 --- 40 – 42 mmHg
 pO2 ---- 97 100 mmHg
 Stand HCO3 ---- 24mmol/l
 Base Excess --- +/- 2
 SpO2 ---- 97 – 100%

Base Excess – The concentration of acid or base in mEq/l to bring the pH back to normal when PCO & PO are normal.HCO is the base. ‘+’ BE
means there are more HCO than H+
Standard HCO3 – Plasma HCO3 after equilibrating with whole blood at pCO2 of 40mmHg at 37 C and fully oxygenated. This totally eliminates the
respiratory component and relates to the metabolic change.

How do you read an ABG ?

 Disturbance of acid-base balance
 Acidosis or Alkalosis - pH
 Is it Respiratory or Metabolic - Look at the PaCO2 (resp) and BE (meta)
 Is there any compensation ? - Look at the PaCO2 and BE
 If acidotic is it a normal or increased anion gap
Alteration in oxygenation

What else do you need to interpret a Blood gas?

 The concentration of O2 the patient is breathing
% ( FiO2 – fractional inspired O )
20% (0.2), 50% (0.5) 100% (1.0)
Clinical history and examination
 Relavant Rx - NaHCO administration

Why S electrolytes?
 To determine the Anioin gap
 Anioin gap = (Na + K) – (Cl + HCO3)
 Usually 10 – 18 mmol/l
because of unmeasured albumin mainly & organic acids, phosphate
 Reduced albumin cause reduction in anion gap