Penilaian Analisa Gas

Darah
dan
Keseimbangan Asam
Basa
Az Rifki, SpAn.KIC
Intensive Care Unit
RSI Siti Rahmah
Padang

Keseimbangan
asam basa
Who cares
about acid
base
balance?

Saya punya hasil

astrup, artinya
apa nich..?

Indikasi Pemeriksaan
AGD
1. Untuk mengetahui kelainan pertukaran gas pada
pasien-pasien sesak nafas akut.
2. Untuk
mengetahui
ada
tidaknya
hipoksemia,
hiperkapnia atau gangguan keseimbangan asam basa
pada pasien-pasien dengan perubahan kesadaran.
3. Untuk menentukan kelainan pertukaran gas pada
pasien-pasien tahipnu.
4. Untuk menilai ada tidaknya dan berat ringannya
gagal nafas pada pasien-pasien yang mengalami
kegagalan fungsi paru.
5. Untuk memantau pertukaran gas dan ventilasi pada
pasien-pasien
dalam
ventilator
serta
penatalaksanaan penyapihan dari ventilator.
6. Untuk penilaian preoperatif pada pasien-pasien
resiko tinggi yang memerlukan tindakan anestesi
umum.

ASAM BASA..

[H ]
+

pH

Terminology

Acid

Base

Notasi pH diciptakan oleh seorang ahli kimia dari

Denmark yaitu Soren Peter Sorensen pada thn 1909, yang
berarti log negatif dari konsentrasi ion hidrogen. Dalam
bahasa Jerman disebutWasserstoffionenexponent
(eksponen ion hidrogen) dan diberi simbol pH yang
berarti: potenz (power) of Hydrogen.

Normal = 7.40 (7.35-7.45)

Viable range = 6.80 - 7.80

Persamaan H2CO3

Hubungan antara sistem respirasi

(CO2) dan sistem metabolik (HCO3-)
c.a carbonic anhydrase
(mempercepat Rx)
CO2 + H2O <--> H2CO3 <--> H+ +
HCO3c.a.

PaO2

Tekanan oksigen arterial

(mmHg / Torr)
Jumlah oksigen yang larut dalam
darah
Normal :

dewasa, anak : 80 100 mmHg

newborn : 40 70 mmHg
60 90 tahun : 60 80 mmHg

PaCO2

Tekanan carbon dioksida arterial

(mmHg / Torr)
Merupakan carbon dioksida yang
larut dalam darah
Merupakan komponen respirasi
Normal : 35 45 mmHg

HCO3

Ion bikarbonat (mEq/l)

Komponen metabolik
Normal : 22 24 mEq/l

Base excess/defisit

Nilai menggambarkan hubungan

antara PaCO2 dan HCO3Lebih digunakan dibandingkan
HCO3Normal : - 2.5 s/d + 2.5

SO2

SaO2 : Saturasi oksigen darah arteri

SpO2 : Saturasi oksigen transkutaneus dg pulse
(pulse oxymetri)
Oksigen yang terikat dengan Hb
Dipertahankan > 90%
Tidak akurat pada :

Dyshemoglobinemia (COHb, MetHb, HbF)

Gangguan perfusi perifer
Anemia
Dyes
Pigmen (methylene blue, indocyanine green, bilirubin)
Sinar lampu

FiO2
Components of room air

Fraksi inspirasi
Oksigen
Nilai dalam
udara kamar

Desimal 0.21
Persen 21%

Oxygen

20.8% (or
21%)

Nitrogen

78.8%

Argon,
Helium and
0.4%
a few
others
Total

100.0%

Relationship Between FiO2 and PaO2

FiO2 predicted
(theoretical)

PaO2
(without shunt)

0.30

150 mmHg

0.40

200 mmHg

0.50

250 mmHg

0.60

300 mmHg

0.70

350 mmHg

0.80

400 mmHg

0.90

450 mmHg

1.0

500 mmHg

*Hint: multiply FiO2 by 5

PENILAIAN ANALISA GAS

DARAH DAN KESEIMBANGAN
ASAM BASA

MENGAPA PENGATURAN
pH SANGAT PENTING ?

AKIBAT DARI ASIDOSIS BERAT

Kardiovaskular
Gangguan kontraksi otot jantung
Dilatasi Arteri,konstriksi vena, dan
sentralisasi volume darah
Peningkatan tahanan vaskular paru
Penurunan curah jantung, tekanan
darah arteri, dan aliran darah hati dan
ginjal
Sensitif thd reentrant arrhythmia dan
penurunan ambang fibrilasi ventrikel
Menghambat respon kardiovaskular
terhadap katekolamin

Respirasi
Hiperventilasi
Penurunan kekuatan otot nafas dan
menyebabkan kelelahan otot
Sesak

Metabolik
Peningkatan kebutuhan
metabolisme
Resistensi insulin
Menghambat glikolisis anaerob
Penurunan sintesis ATP
Hiperkalemia
Peningkatan degradasi protein

Otak
Penghambatan metabolisme dan
regulasi volume sel otak
Koma

Management of life-threatening Acid-Base Disorders, Horacio J.

Adrogue, And Nicolaos EM: Review Article;The New England Journal of
Medicine;1998

AKIBAT DARI ALKALOSIS BERAT

Kardiovaskular
Konstriksi arteri
Penurunan aliran darah koroner
Penurunan ambang angina
Predisposisi terjadinya supraventrikel dan ventrikel
aritmia yg refrakter

Respirasi
Hipoventilasi yang akan menjadi hiperkarbi dan
hipoksemia

Metabolic
Stimulasi glikolisis anaerob dan produksi asam organik
Hipokalemia
Penurunan konsentrasi Ca terionisasi plasma
Hipomagnesemia and hipophosphatemia

Otak
Penurunan aliran darah otak
Tetani, kejang, lemah delirium dan stupor
Management of life-threatening Acid-Base Disorders, Horacio J.
Adrogue, And Nicolaos EM: Review Article;The New England Journal of
Medicine;1998

Hendersen-Hasselbalch

The disadvantage of men not

knowing the past is that they do not
know the present.
G. K. Chesterton

Hendersen-Hasselbalch

Regulasi asam basa diatur melalui proses di:

1.

2.

Ginjal dengan cara mempertahankan [HCO 3-]

sebesar 22-24 mEq/L dan
Mekanisme respirasi dengan cara
mempertahankan tekanan parsial CO 2 arteri
(PaCO2) sebesar 40 mmHg.

Normal

pH = 6.1 + log
Normal

[HCO
GINJAL
BASA ]
3

HCO
HCO 3
3

Kompensasi

ASAM
pCO2
PARU

CO
CO22

pH = 6.1 + log

1. Change in
Metabolic disturbance
2. Change after
Renal compensation for
Respiratory disturbance

[ HCO3-]
0.03 pCO2
x

1. Change in
Respiratory disturbance

2. Change after
Respiratory compensation for
Renal disturbance

Acid Base Disorders:

Principles of
interpretation

Each primary (metabolic or respiratory)

disturbance is accompanied by a
secondary (opposing) response in the
other system (respiratory or metabolic)
pH is returned nearly but not
completely to normal
Overcompensation does not occur

Compensation for acid

base disturbances

Respiratory compensation for

metabolic disorders should be
complete in 24 hours

Acute is < 24-48 hrs

Chronic is > 24-48 hrs

Metabolic (renal) compensation for

respiratory disorders is slower and
requires 2 to 6 days

Nilai Dasar
Normal Ranges of Laboratory Values

Factor

Mean

Range

pH

7.40

7.35 7.45

PaO2 (mmHg)

80

60 100

PaCO2 (mmHg) 40

35 45

HCO3- (mEq/l)

22 - 24

24

Nomenclature
Physiologic condition Values
Acidosis
Alkalosis

pH
pH

<7.35
>7.45

Hypoxemia

PaO2 <80

Hyperoxia

PaO2>100

Alveolar Hyperventilation
(hipokarbia)

PaCO2 <35

Ventilatory Failure
(Hiperkarbia)

PaCO2 >50

Diagnosis menggunakan nilai asam basa serum:

50

Davenport Diagram

PCO = 80

40

Henderson- Hasselbalch:

[ HCO3- ]

40

pH = pK + log [HCO3-]
s PCO2

Asidosis
Respiratori

Alkalosis
Metabolik

30

20

pH = 6.1 + Ginjal
Paru

Normal
20
Asidosis
Metabolik

Alkalosis
Respiratori

10

7.0

7.2

7.4

pH

atau,

7.6

7.8

Alkalosis Respiratori
50

PCO = 80
2

40
Penyebab:
Acute alveolar

[ HCO3- ]

40

hyperventilation

20

30

a.

Anxiety

b.

Hypoxia

c.

drugs (aspirin,
catecholamines,

Normal
Alkalosis
Respiratori

20

7.2

d.

Sepsis

e.

hepatic
encephalopathy

kompensasi = [HCO3-]

10
7.0

progesterone)

Alkalosis
Respiratori
terkompensasi

7.4

pH

7.6

7.8

Asidosis Respiratori
50

PCO = 80

40

Penyebab:
Acute ventilatory

[HCO3-]

kompensasi
= [HCO3-]
40

failure
1.

Asidosis
Respiratori
terkompensasi

acute airway
obstruction

2.

20

30

severe pneumonia
/ pulmonary edema

3.

neuromuscular
disorders

Asidosis
Respiratori

4.

CNS depression
(drugs, CNS event)

20

5.

ventilator
dysfunction

10
7.0

Chronic ventilatory

7.2

7.4

pH

7.6

7.8 1.

failure
chronic lung
diseases

Metabolic Alkalosis
50

PCO = 80

40

Penyebab:
Metabolic alkalosis

[ HCO3- ]

40
kompensasi
= PCO2

Alkalosis
Metabolik
terkompensasi

a.

suctioning

Alkalosis
Metabolik

30

vomiting/ NG

20

b.

diuretic therapy

c.

mineralocorticoid
activity
(Cushing's

20

syndrome,
exogenous
steroids)

10
7.0

7.2

7.4

pH

7.6

7.8

Metabolic Asidosis
50

PCO = 80
2

40

Penyebab:
Metabolic acidosis
a.

[ HCO3- ]

40

ketoacidoses
(diabetic/alcoholic
)

20

30

20

renal failure

c.

lactic acidosis

d.

Rhabdomyolysis

e.

toxins (methanol,
ethylene glycol,

Asidosis
Metabolik

salicylates,
paraldehyde)
Asidosis
Metabolik
terkompensasi

kompensasi = PCO2

10
7.0

b.

7.2

7.4

pH

7.6

7.8

f.

Diarrhea

g.

HCl administration

BE = (1 - 0.014Hgb) (HCO3 24 + (1.43Hgb + 7.7) (pH 7.4)`

50

PCO = 80

40

[HCO3-]

40
Alkalosis
Metabolik

30

Base Excess

20

Base
Excess/
Base Deficit

Normal

20

Base Defisit

10
7.0

Asidosis
Metabolik

7.2

7.4

pH

7.6

7.8

Oxyhemoglobin Dissociation Curve

Hub. antara SatO2

dl Hb dan PO2
Tergantung afinitas
Hb thd O2

Meningkat : sukar
melepaskan O2 ke
jaringan (bergeser ke
kiri)
Menurun : mudah
melepaskan O2 ke
jaringan (bergeser ke
kanan)
the basic OHDC

Oxyhemoglobin Dissociation Curve

what happens when the curve is shifted

Interpretation Guidelines

Step 1: Look at pH - this is the starting point.

1.

2.

3.

If within normal range, a normal or compensated

state exists.
If outside normal limits, assess whether acidosis
or alkalosis is present.
The body never overcompensates. Whichever
state exists on the pH scale is the primary
abnormality.

Interpretation Guidelines

Step 2: Assess hypoxemic state.

1.
2.

3.

If PaO2 is <60 mmHg, hypoxic state exists.

If PaO2 is between 80 -100 mmHg, a
normal condition exists.
If PaO2 is >100 mmHg, a hyperoxic state
exists.

Interpretation Guidelines

Step 3: Assess ventilatory status.

1.

2.

3.

4.

If PaCO2 is <35 mmHg, it is termed "alkalosis"

(alveolar hyperventilation or hypocarbia).
If PaCO2 is between 35-45 mmHg, it is within
normal limits.
If PaCO2 is >45 mmHg, it is termed "acidosis"
(ventilatory failure or hypercarbia).
If possible, determine whether this is an acute or
chronic state (see the compensation explanation).

Interpretation Guidelines
Step 4: Assess metabolic component.
1. If bicarbonate (HCO3-) is <22 mEq/l, it is termed
"acidosis".
2. If bicarbonate is between 22-28 mEq/l, it is within
normal limits.
3. If bicarbonate is >28 mEq/l, it is termed "alkalosis".
4. If possible, determine whether this is an acute or
chronic state (see the compensation explanation).

Eight Primary Blood Gas

Classifications
Classification

pH

PaCO2

HCO3-

Acute ventilatory failure

(acute respiratory
acidosis)

vN

^N

vN

^N

Chronic ventilatory
failure (compensated
respiratory acidosis)
Acute alveolar
hyperventilation
(acute respiratory
alkalosis)
Chronic alveolar
hyperventilation
(compensated
respiratory alkalosis)
Acute metabolic acidosis
Chronic metabolic
acidosis
Acute metabolic
alkalosis
Chronic metabolic
alkalosis

Hint: in compensated states, the PaCO2 and HCO3- have matching arrows (directions).

Some Basic Interpretations

1. pH - normal, acidosis or
alkalosis?
Condition (choose)
pH

7.37

alkalosis

7.61

alkalosis

7.19

alkalosis

7.49

alkalosis

7.30

alkalosis

Interpretation Answers
pH

Normal

7.37

Acidosis

7.61
7.19

X
X

7.49
7.30

Alkalosis

X
X

2. In this exercise, identify whether the respiratory situation is normal,

acute, chronic, acidotic or alkalotic. Choose the appropriate categories,
then check your answers.

PaCO2
75
27

pH
7.20
7.54

Condition (choose)
normal
respiratory alkalosis

normal
respiratory alkalosis
normal

50

7.35

respiratory alkalosis
normal

30

7.46

respiratory alkalosis

normal

41

7.38

respiratory acidosis

Interpretation Answers
pH

PaCO2 Norma Acute Chroni Resp

l
c
acidosis

7.20

75

7.54

27

7.35

50

7.46

30

7.38

41

Resp
alkalosis

X
X
X
X

3. Identify whether the metabolic situation is normal, acute,

chronic, acidotic or alkalotic. Choose the appropriate
categories, then check your answers.

HCO3-

pH

Condition (choose)

19

7.25

metabolic alkalosis

19

7.25

metabolic acidosis

36

7.60

metabolic alkalosis

42

7.38

metabolic alkalosis

18

7.35

metabolic alkalosis

26

7.44

metabolic alkalosis

normal

normal

normal
normal

normal

normal

Interpretation Answers
Norma Acut
l
e

Chroni
c

pH

HCO3-

7.25

19

7.60

36

7.38

42

7.35

18

7.44

26

Met
acidosis

Met
alkalosi
s

X
X
X
X

4. Identify the primary disturbance (acidosis/alkalosis). This might be

just slightly off normal. Note whether the situation is of respiratory or
metabolic in origin. Then note if compensation exists (partial or
complete).

pH

PaCO2

HCO3-

Condition (choose)
acidosis

7.50

32

26

metabolic

partial compensation
acidosis

7.38

32

19

metabolic

partial compensation

7.24
7.41
7.50

60
30
42

32
18
33

acidosis

metabolic
complete compensation
alkalosis
respiratory
complete compensation
acidosis
respiratory
complete compensation

Interpretation Answers
pH

PaCO2 HCO3-

Disturbanc
e

Cause

Acute/
chronic

7.50

32

26

alkalosis

respirator
y

acute

7.38

32

19

acidosis

metabolic

chronic

7.24

60

32

acidosis

respirator
y

chronic

7.41

30

18

alkalosis

respirator
y

chronic

7.50

42

33

alkalosis

metabolic

acute

Case Studies

Evaluate the ABG results. Select the disturbance, whether the situation is
respiratory or metabolic and whether an acute or chronic state exists,
then check your answers)

1. 64 year old male with advanced Chronic Obstructive

Pulmonary Disease (COPD).

pH

7.238

PaCO2

78.0

PaO2

28.3

HCO3-

32.5

SaO2

49.7

COHb
FiO2

10.6
0.21

alkalosis

metabolic
chronic

uncompensated

acute metabolic acidosis

Case Studies

Evaluate the ABG results. Select the disturbance, whether the situation is
respiratory or metabolic and whether an acute or chronic state exists,
then check your answers)

2. 60 year old male with metastatic lung

cancer
pH
7.492
alkalosis
PaCO2

46.4

PaO2

64.8

HCO3-

34.8

SaO2

94.2

COHb

0.6

FiO2
(nasal cannula 3
liters)

32.0

respiratory

acute

compensated

hypoxemia

Case Studies

Evaluate the ABG results. Select the disturbance, whether the situation is
respiratory or metabolic and whether an acute or chronic state exists,
then check your answers)

3. 80 year old female with COPD

pH

7.058

PaCO2

129.4

PaO2

64.8

HCO3-

alkalosis

respiratory

acute

36.4

SaO2

59.9

COHb

0.1

FiO2(6 liter
mask)

0.40

partially compensated

hypoxemia

Case Studies

Evaluate the ABG results. Select the disturbance, whether the situation is
respiratory or metabolic and whether an acute or chronic state exists,
then check your answers)

4. This is a series of two ABG's run about 2 hours apart. 30

year old male who ran a gas powered paint compressor in his
home.

pH

7.423

7.423

PaCO2

38.8

38.6

alkalosis

respiratory

PaO2

73.1

89.2

HCO3-

24.9

24.7

SaO2

97.7

98.4

COHb

30.3

acute

compensated

6.7
normal

FiO2 (100%
by mask)

0.21

1.0

Case Studies

Evaluate the ABG results. Select the disturbance, whether the situation is
respiratory or metabolic and whether an acute or chronic state exists,
then check your answers)

5. 79 year old female with arthritis and a cardiac

history.

pH

7.387

alkalosis

PaCO2

15.5

respiratory

PaO2

114.7

acute

HCO3-

10.1

SaO2

98.3

COHb

0.3

FiO2

21.0

compensated

hypoxemia

Case Studies

Evaluate the ABG results. Select the disturbance, whether the situation is
respiratory or metabolic and whether an acute or chronic state exists,
then check your answers)
6. 21 year old male with an altered level of consciousness. (This
memorable patient went home the next day.)

pH

6.979

PaCO2

6.9

PaO2

148.3

HCO3-

1.6

SaO2

95.9

COHb

0.4

FiO2

0.21

alkalosis
respiratory

acute

compensated

hypoxemia

Case Studies

Evaluate the ABG results. Select the disturbance, whether the situation is
respiratory or metabolic and whether an acute or chronic state exists,
then check your answers)

7. 69 year old female with long standing COPD. She

endearingly called herself the "old tattooed biker chick".

pH

7.388

PaCO2

39.3

PaO2

52.5

HCO3-

acidosis

respiratory

acute

23.7

SaO2

87.4

COHb

4.8

FiO2

0.21

compensated

hypoxemia

Case Studies

Evaluate the ABG results. Select the disturbance, whether the situation is
respiratory or metabolic and whether an acute or chronic state exists,
then check your answers)

8. 69 year old male with COPD. This was just prior to

intubation.

pH

7.143

alkalosis

PaCO2

83.3

respiratory

PaO2

278.8

HCO3-

26.2

SaO2

95.9

COHb

2.4

acute

compensated

hypoxemia

FiO2 (via bag/

valve/mask
ventilation)

~0.90

Case Studies

Evaluate the ABG results. Select the disturbance, whether the situation is
respiratory or metabolic and whether an acute or chronic state exists,
then check your answers)

9. 68 year old male brought in by medics for an altered

level of consciousness.

pH

7.295

acidosis

PaCO2

36.1

respiratory

PaO2

59.8

acute

HCO3-

17.7

SaO2

89.9

COHb

0.8

FiO2 (by nonrebreather

mask)

~0.95

compensated

corrected hypoxemia

Acid Base Disorders

Simple Primary disturbance and

expected adaptive (secondary)
response
Mixed Two separate primary
disturbances present simultaneously in
the same individual
Must know expected adaptive
(compensatory) response to recognize
mixed disturbances

Acid Base Disorders

Primary disorder

Compensatory response

Metabolic acidosis

0.7-1.2 mmHg pCO2 per 1.0 mEq/L

HCO3-

Metabolic alkalosis

0.7 mmHg pCO2 per 1.0 mEq/L HCO3-

Acute respiratory acidosis

0.15 mEq/L HCO3- per 1.0 mmHg pCO2

Chronic respiratory
acidosis

0.35 mEq/L HCO3- per 1.0 mmHg pCO2

Acute respiratory
alkalosis

0.25 mEq/L HCO3- per 1.0 mmHg pCO2

Chronic respiratory
alkalosis

0.55 mEq/L HCO3- per 1.0 mmHg pCO2

Acid Base Disorders:

Interpretation

Is an acid base disturbance

present?
What is the primary disturbance?
Is the secondary (adaptive)
response as expected?
What underlying disease process is
responsible for the acid base
disturbance?

Acid Base Disorders:

Interpretation

Arterial blood gas from a dog: pH 7.27, HCO312 mEq/L, pCO2 27 mmHg (normal: pH 7.39,
HCO3- 22 mEq/L, pCO2 37 mmHg)

Is an acid base disturbance present?

Of what general type?

YES (look at the pH)

ACIDOSIS (pH 7.27 < 7.39)

Metabolic or respiratory?

pCO2 is LOW (cant be respiratory acidosis)

HCO3- is LOW (must be METABOLIC ACIDOSIS)

Acid Base Disorders:

Interpretation

Arterial blood gas from a dog: pH 7.27, HCO 312 mEq/L, pCO2 27 mmHg (normal: pH 7.39,
HCO3- 22 mEq/L, pCO2 37 mmHg)

Is secondary (adaptive) response as expected?

Observed HCO3- is 10 mEq/L lower than normal

(22-12)
Normal dog can lower pCO2 1 mmHg for every
0.7-1.2 mEq/L decrement in HCO3- (use 1.0 mEq/L
as average)
Expected pCO2 = 37-10 = 27 mmHg
Observed pCO2 = 27 mmHg
Conclusion: YES, adaptive response is as expected.
This is a simple metabolic acidosis with respiratory
compensation

Acid Base Disorders:

Interpretation

Arterial blood gas from a dog sick for 1 week:

pH 7.33, HCO3- 29 mEq/L, pCO2 57 mmHg
(normal: pH 7.39, HCO3- 22 mEq/L, pCO2 37
mmHg)

Is an acid base disturbance present?

Of what general type?

YES (look at the pH)

ACIDOSIS (pH 7.33 < 7.39)

Metabolic or respiratory?

HCO3- is HIGH (cant be metabolic acidosis)

pCO2 is HIGH (must be RESPIRATORY ACIDOSIS)

Acid Base Disorders:

Interpretation

Arterial blood gas from a dog sick for 1 week: pH

7.33, HCO3- 29 mEq/L, pCO2 57 mmHg (normal: pH
7.39, HCO3- 22 mEq/L, pCO2 37 mmHg)

Is secondary (adaptive) response as expected?

Observed pCO2 is 20 mmHg higher than normal (5737)

Normal dog can increase HCO3- 3.5 mEq/L for every
10 mmHg increment in pCO2 (in chronic disturbance)
Expected HCO3- = 22+7 = 29 mEq/L
Observed HCO3- = 29 mEq/L
Conclusion: YES, adaptive response is as expected.
This is a simple respiratory acidosis with metabolic
compensation

Acid Base Disorders:

Interpretation

Even in simple disturbances,

calculated compensatory pCO2 and
HCO3- values usually wont match
observed values because calculations
are based on average values
Do not diagnose a mixed disturbance
unless calculated value is > 2 to 3
mmHg (pCO2) or mEq/L (HCO3-)
different from observed value

Acid Base Disorders:

Interpretation

Arterial blood gas from a dog: pH 7.05, HCO312 mEq/L, pCO2 44 mmHg (normal: pH 7.39,
HCO3- 22 mEq/L, pCO2 37 mmHg)

Is an acid base disturbance present?

Of what general type?

ABSOLUTELY! (look at the pH)

ACIDOSIS (pH 7.05 << 7.39)

Metabolic or respiratory?

pCO2 is HIGH (could be respiratory acidosis)

HCO3- is LOW (could be metabolic acidosis)

Acid Base Disorders:

Interpretation

Is secondary (adaptive) response as expected?

NO

If simple metabolic acidosis, pCO2 should

be low in response

If simple respiratory acidosis, HCO3should be high in response

Conclusion: This is a mixed metabolic and

respiratory acidosis. The extremely low pH
alerts you to the possibility of a mixed
disturbance

Acid Base Disorders:

Interpretation

Arterial blood gas from a dog with sudden onset of

gastric dilatation/volvulus: pH 7.38, HCO3- 12 mEq/L,
pCO2 21 mmHg (normal: pH 7.39, HCO3- 22 mEq/L,
pCO2 37 mmHg)

Is an acid base disturbance present?

If so, its not obvious from pH

Of what general type?

From pCO2 could be respiratory alkalosis or from

HCO3- could be metabolic acidosis

Metabolic or respiratory?

pCO2 is LOW (could be respiratory alkalosis)

HCO3- is LOW (could be metabolic acidosis)

Acid Base Disorders:

Interpretation

Arterial blood gas from a dog with sudden onset of

gastric dilatation/volvulus: pH 7.38, HCO3- 12 mEq/L,
pCO2 21 mmHg (normal: pH 7.39, HCO3- 22 mEq/L, pCO2
37 mmHg)

Is secondary (adaptive) response as expected?

If primary metabolic acidosis
10 mEq/L decrement in HCO3- (22-12)
Expected pCO2 = 27 mmHg (37-10)
Observed pCO2 = 21 mmHg
If primary acute respiratory alkalosis
16 mmHg decrement in pCO2 (37-21)
Expected HCO3- = 18 mEq/L (22-4)
Observed HCO3- = 12 mEq/L
Conclusion: Mixed metabolic acidosis and respiratory
alkalosis

Acid Base Disorders:

Interpretation

Is mixed metabolic acidosis and

respiratory alkalosis compatible
with acute gastric
dilatation/volvulus?

YES
Metabolic acidosis due to shock and
decreased tissue perfusion
Respiratory alkalosis due to
hyperventilation induced by pain or
septicemia

Acid Base Disorders:

Interpretation

Arterial blood gas from a dog with sudden

onset of gastric dilatation/volvulus: pH 7.38,
HCO3- 12 mEq/L, pCO2 21 mmHg (normal: pH
7.39, HCO3- 22 mEq/L, pCO2 37 mmHg)

What if dog had been sick with some

other disorder for 1 week?

If primary chronic respiratory alkalosis

16 mmHg decrement in pCO 2 (37-21)
Expected HCO3- = 13.2 mEq/L (22-8.8)
Observed HCO3- = 12 mEq/L
Difference is < 2 mEq/L
Conclusion of simple chronic respiratory
alkalosis would be justified