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BLOOD GAS

ANALYSIS

Hasanul Arifin
Departemen Anestesiologi dan Reanimasi

FKUSU RSUP. H. Adam Malik Medan


Apa yang dibaca ?

pH, PaCO2, BE
HCO3, PaO2,
SaO2

Hasanul-2004
STEPS IN ACIDS BASE
CLASSIFICATION

1. pH Classification
2. PaCO2 Classification
3. Metabolic Classification
4. Compensation Evaluation
5. Complete Acid-Base Classification
Hasanul-2004
pH Classification

Classification pH
Normal 7.35-7.45
Acidosis < 7.35
Alkalosis >7.45
Hasanul-2004
Classification of Laboratory
Respiratory Acid-Base Component

Classification PaCO2 (mmHg)


Normal Resp.Component 35-45
Respiratory Acidosis >45
Respiratory Alkalosis <35

Hasanul-2004
Classification of Laboratory
Metabolic Acid-Base Component

Classification BE HCO3
Normal Metab.Component 02 242
Metabolic Acidosis < -2 <22
Metabolic Alkalosis > +2 >26
Hasanul-2004
Langkah Langkah
Baca pH normal, acidosis, alkalosis
Lihat PaCO2 atau BE, mana yg searah dengan pH
Bila PaCO2 yang searah respiratorik sebagai
proses primer
Bila BE yang searah metabolik sebagai proses
primer
Bila proses primer sudah diketahui, lihat dimana
posisi komponen yg lain :
Bila berlawanan proses kompensasi
Bila searah proses ganda
Bila posisi normal belum atau tidak ada proses
kompensasi

hasanul-2004
ACIDOSIS ALKALOSIS
7,35 pH 7,45
45 PaCO2 35
-2 BE +2
22 HCO3 26
Eddy Rahardjo1990/Hasanul-2004
pH : 7.28, PaCO2 : 40, BE : -10

ACIDOSIS ALKALOSIS
7.28 7,35 pH 7,45
45 40 2
PaCO 35
-10 -2 BE +2
22 HCO3 26
hasanul-2004

Acidosis metabolik tanpa kompensasi


pH : 7.32, PaCO2 : 55, BE : +1

ACIDOSIS ALKALOSIS
7.32 7,35 pH 7,45
55 45 PaCO2 35
-2 +1
BE +2
22 HCO3 26
hasanul-2004

Acidosis respiratorik tanpa kompensasi


pH : 7,50 ; PaCO2 : 30 ; BE : -2 ;

ACIDOSIS ALKALOSIS
7,35 pH 7,45 7,50
45 PaCO2 35 30
-2 BE +2
22 HCO3 26
Alkalosis respiratorik tanpa kompensasi
hasanul-2004
pH : 7,55 ; PaCO2 : 30 ; BE : +5 ;
ACIDOSIS ALKALOSIS
7,35 pH 7,45 7,55
45 PaCO2 35 30
-2 BE +2 +5
22 HCO3 26
Hasanul-2004

Alkalosis respiratorik dan metabolik


(proses ganda)
Steps in Evaluation and Classification of
Acid-Base Compensation

1. Evaluate for the presence of compensation


2. Determine the probable primary problem
3. Classify the degree of compensation

Hasanul-2004
Determination of the
primary problem

pH 7.40-7.45 Alkalosis is primary


Acidosis is compensatory

pH 7.35-7.40 Acidosis is primary,


Alkalosis is compensatory

Hasanul-2004
Classification of degree of
Compensation

pH Degree of compensation
7.35-7.45 Complete
<7.35 Partial
>7.45 Partial

Hasanul-2004
pH : 7,48 ; PaCO2 : 30 ; BE : -6 ;

ACIDOSIS ALKALOSIS
7,35 pH 7,45 7,48
45 PaCO2 35 30
-6 -2 BE +2
22 HCO3 26
Alkalosis respiratorik dgn kompensasi parsial
hasanul-2004
pH : 7.32, PaCO2 : 30, BE : -10

ACIDOSIS ALKALOSIS
7.32 7,35 pH 7,45
45 PaCO2 35 30
-10 -2 BE +2
22 HCO3 26
hasanul-2004

Acidosis metabolik dgn kompensasi parsial


pH : 7.38, PaCO2 : 30, BE : -10

ACIDOSIS ALKALOSIS
7,35 7,38
pH 7,45
45 PaCO2 35 30
-10 -2 BE +2
22 HCO3 26
Hasanul-2003

Acidosis metabolik dgn kompensasi penuh


pH : 7,43 ; PaCO2 : 30 ; BE : -6 ;

ACIDOSIS ALKALOSIS
7,35 pH7,43 7,45
45 PaCO2 35 30
-6 -2 BE +2
22 HCO3 26
Alkalosis respiratorik dgn kompensasi penuh
Hasanul-2003
CLASSIFICATION of PaO2
PaO2 (mmHg)
CLASSIFICATION Adult Newborn
Hyperoxemia >100 >90
Normoxemia 80-100 60-90
Mild hypoxemia 60-79 50-59
Moderate hypoxemia 45-59 40-49
Severe hypoxemia <45 <40
Hasanul-2003
Severity of Generalized Acid-Base
disturbances
pH Degree of Impairment
<7,20 Severe Acidosis
7,20-7,29 Moderate Acidosis
7,30-7,34 Mild Acidosis
7,35-7,45 Normal pH
7,46-7,50 Mild Alkalosis
7,51-7,55 Moderate Alkalosis
>7,55 Severe Alkalosis
Hasanul-2003
Normal Arterial Gases
Parameter Values
pH 7,35-7,45
PaCO2 35-45 mmHg
PaO2 80-100 mmHg
SaO2 98-100%
Hasanul-2003
Normal mixed venous gases

Parameter Values
pH 7,38
PaCO2 48 mmHg
PaO2 40 mmHg
SaO2 75%
Hasanul-2003
No. pH PaCO2 HCO3 PaO2 Classification
1. 7,58 20 19 63
2. 7,44 52 34 28
3. 7,21 66 26 47
4. 7.44 31 20 111
5. 7,60 28 27 59
6. 7,50 50 37 75
7. 7,41 42 25 229
8. 7,52 41 32 49
9. 7,44 28 35 87
10. 7,44 35 23 97
Hasanul-2003
No. pH PaCO2 BE PaO2 Classification

1. 7.32 30 -10 58
2. 7.52 34 +4 32
3. 7.36 32 -4 145
4. 7.42 30 -5 90
5. 7.20 50 -9 60
6. 7.20 80 +2 90
7. 7.55 25 0 72
8. 7.34 30 -9 41
9. 7.37 56 +4 57
10. 7.40 38 -2 350
Hasanul-2003
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