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Virgina D.S.

Mechanism of Acid-Base Balance Regulation

Buffer system only cope with acid-base

imbalances while
Kidney: regulate the balance of H + ions to
eliminate imbalances H + concentration is
slow; there is a phosphate buffer system and
Lungs: respond quickly to changes in the levels
of H + in the blood and maintain the levels to
kidney eliminating the imbalance

Respiratory regulation in Acid-Base Balance

CO2 levels increase the pH decreases
CO2 levels decreased pH increases
CO2 and pH stimulates chemoreceptors which will then

affect the respiratory center hypoventilation increase

CO2 level hyperventilation to reduce levels of CO2

The balance of ion H +

Respiratory regulation in Acid-Base Balance

Renal regulation in Acid-Base Balance

Secretion of H + into the filtrate and the reabsorption of

HCO3- to CES cause increases in extracellular pH

HCO3 hydrofoil filtrate absorbed
The rate of secretion of H + increases due to a decrease
in the pH of body fluids or increased levels of aldosterone
H + secretion is inhibited if the urine pH <4.5

Balance Acid-Base Disorders


Respiratory acidosis
Hypoventilation H2CO3H + CO2 retention


Respiratory alkalosis
Hyperventilation CO2 many missing H2CO3 H +


Metabolic acidosis
Diarrhea, DM HCO3- PCO2 H +


Metabolic alkalosis
Vomit H + HCO3- PCO2





Compensation Respiratory System for Metabolic



Kidney against Respiratory Acidosis Compensation


Nomogram Davenport


BGA Interpretation
pH < 7,35

< 40mmHg


pH > 7,45



see pCO2

see HCO3-

> 40 mmHg

< 24 mM


> 24 mM


BGA Defintion
Blood gas analysis (BGA) is one of the measures aimed

laboratory tests when necessary information related to the

patient's acid-base balance (Wilson, 1999).
Examination BGA also known as the examination
"Astrup", which is a blood gas examination conducted
through the arterial blood.

BGA Purpose
Assess respiratory function (ventilation)
Assess oxygenation capacity
Assess acid-base balance
Knowing the state of O2 and cell metabolism O2 and CO2

efficiency to determine the levels of CO2 in the body
Obtain arterial blood for blood gas analysis or other
diagnostic tests.

BGA Indication
Patients with chronic pulmonary obstructive disease
Patients with pulmonary edema
Patients acute respiratory distress syndrome (ARDS)
myocardial infarction
shock patients
Post surgery coronary artery baypass
Resuscitation from cardiac arrest

BGA Benefts
For the diagnosis and management: respiratory disease,

administration of oxygen, blood oxygen levels, CO2

levels, acid-base balance, ventilation
determine therapy
Determine the course of the disease after therapy
Assessing the acid-base balance disorders caused by
respiratory disorders and / or metabolic disorders in the

(1) the brachial artery

(2) the radial artery
(3) Femoral Artery
(4) the dorsalis pedis


BGA Procedure
dispossible syringe.
10 ml heparin, 1000 units / ml (multi-dose).
Needle number 22 G or 25 G for children), 20 G / 21 G

(for adults)
Alcohol swab.
sterile gauze
Write down label the patient's name, room number, the
temperature of the patient's temperature, date and time of
retrieval, the method of administration of oxygen, and the
name of the nurse in charge of the action.
Plaster and scissors

BGA Procedure
1. Preparation appliance.
2. Inform patients about the purpose and the procedure
3. Choosing arteries:
a. radial artery;
b. dorsalis pedis artery;
c. brachial artery;
d. femoral artery

4. Prepare the patient's position:

a. Radial artery:
patient bed semi-Fowler and hands straightened
Hand fouled or elevated, the artery should really palpable.
b. Dorsalis pedis artery:
patients should be flat / Fowler.
c. Brachial artery:
patients semi-Fowler position, hands propped on one elbow.
d. Femoral artery:
Patient position : flat.

5. Wash your hands before and after the action.

6. Feel back arterial pulsation to ensure the area after
cleaning with alcohol swab circularly and wait for it to dry.
7. Localization of arteries that have been cleared, fixed by the
left hand, the skin is stretched by the index finger and middle
finger so that the artery to be pricked located between two
8. Syringes (with heparin inside) hold as holding a pencil in
the right hand,than the needle is inserted into the artery that
has been fixed earlier.
- In the radial artery needle position 45o;
- The brachial artery needle position 60o;
- In the femoral artery needle position 90o.

10. After blood was obtained 2 cc needle is removed, and try to

position the syringe pump fixed to prevent inhaling air into the syringe.
11. The tip of the needle immediately closed with a cork / rubber.
12. Former press arterial puncture puncture with alcohol cotton mixed
with bethadine.
- In the radial and dorsalis pedis artery for 5 minutes;
- The brachial artery for 7-10 minutes;
- In the femoral artery for 10 minutes;
- If patients received anticoagulation press for 15 minutes.
13. Localization puncture closed with sterile gauze + bethadine.
14. Giving etiquette laboratory (patient name, room, date, and clockmaking, temperature, and type of examination).
15. If the delivery / examination far, blood put into a plastic bag filled
with ice.
16. Wash hands after completing the action.
17. Perform measurement using a blood gas analyzer

BGA interpretation

BGA Interpretation
1. pH -> describe the acid-base balance in
the body. Normal values of serum pH:
Normal Value: 7:35 to 7:45
Critical value: <7:25 to 7:55
Clinical implications:
- Decreased: acidemia
- Rising: alkalemia
When evaluating the value of pH, PaCO2 and
HCO3 should be known also to estimate
the components that affect the respiratory
or metabolic acid-base status.

2. PaCO2: describe the pressure generated by the

CO2 dissolved in the plasma.
Normal values: 35-45 mmHg
SI: 4.7 - 6.0 kPa
Clinical Implications:
- Decrease: hypoxia, anxiety / nervousness and
pulmonary embolism. Value of less than 20
mmHg needs special attention.
- Improved: pulmonary disorders / decreasing
function of the respiratory center. Value PaCO2>
60 mmHg should receive special attention.
- Generally, an increase in PaCO2 occurs in
hypoventilation and hyperventilation decrease
- Usually, a decrease of 1 mEq HCO3 will reduce the
pressure by 1.3 mmHg PaCO2.

3. PaO 2: measure the partial pressure

generated by the amount of oxygen
dissolved in the plasma.
Normal values: 75-100 mmHg
SI: 10 - 13.3 kPa
Clinical Implications:
- Impairment: chronic obstructive pulmonary
(COPD), pulmonary obstructive disease,
anemia, hypoventilation due to physical
impairment or neoromuskular and cardiac
dysfunction. PaO2 less than 40 mmHg needs
special attention.
- Improved: increase O2 delivery by the tools
(eg, nasal prongs, appliance mechanical

4. SaO2: the amount of oxygen carried

by hemoglobin.
Normal values: 95-99% O2
Clinical Implications:
- Oxygen saturation is used to evaluate
the levels of hemoglobin oxygenation
and oxygen kecakupan on the
- Partial pressure of oxygen dissolved
in plasma describes the amount of
oxygen bound to hemoglobin as
bicarbonate ion

5. tCO2: the amount of CO2 present in the

blood and include acid bicarbonate,
bicarbonate ions and dissolved CO2 gas.
Normal values: 22-32 mEq / L
SI: 22-32 mmol / L.
Clinical Implications:
- Improved: severe vomiting, emphysema,
and aldosteronism
- Decrease: acute renal failure, diabetic
acidosis and hyperventilation
- The increase and decrease may occur in
the use of nitrofurantoin

6. HCO3: describe what has happened

metabolic disorders, such as
Low values describe metabolic acidosis
and vice versa.
HCO3- can also be abnormal when the
kidneys compensate for respiratory
problems that the pH back into the
normal range.
Normal values: 22-26 mmol / l

7. Base Excess: describe the amount of

strong acid or base to be added in
mmol / l to make the blood has a pH
of 7.4 in condition PCO2 = 40 mmHg
with Hb 5.5 g / dl and a temperature
of 370C.
BE positive value indicates the
condition of metabolic alkalosis and
BE negative value indicates the
condition of metabolic acidosis.
Normal values: -2 to 2 mmol / l