SKILL STATION

Blood Gas Analysis

Zulkifli. Dr., SpAn., MKes Department of Anesthesiology and Reanimation FK Unsri/ RSMH

Definition
a technique to know the states of respiration and metabolic through measuring of blood gas tensions and pH. Evaluation of
Oxygenation Ventilation Acid-base balance

Normally arterial blood CVP Mixed venous

Measurement of Blood Gas Tensions & pH

Measuring
pH PO2 PCO2 HCO3 BEexcess SO2 Hb

Normal Value
7.35 7.45 60 100 mm Hg 35 45 mm Hg 19 -23 mmol/L 0 mmol/L > 90 %

Sample Source & Collection

Measurement of Blood Gas Tensions & pH

Acute Respiratory Acidosis

compensatory response limited [HCO3] increases only about 1 mEq/L For each 10 mm Hg increase in PaCO2 above 40 mm Hg

Chronic Respiratory Acidosis

[HCO3] increases approximately 4 mEq/L
for each 10 mm Hg increase in PaCO2 above 40 mm Hg

 Metabolic Acidosis
primary decrease in [HCO3]

Respiratory Alkalosis
primary decrease in PaCO2

Metabolic Alkalosis
primary increase in plasma [HCO3]

Interpretation of BGA Result

Normal pH or Acidosis or alkalosis Normally or Respiratory or metabolic disorder or both

Diagnosis of simple acidbase disorders.

Defining Acid-Based Disorders.

Disorder Respiratory
Acidosis Alkalosis PaCO2 PaCO2 HCO3HCO3-

Primary Change

Compensatory Response

Metabolic
Acidosis Alkalosis HCO3HCO3PaCO2 PaCO2

Base Excess
amount of acid or base that must be added for blood pH to return to 7.40 and PaCO2 to return to 40 mm Hg at full O2 saturation and 37C positive value indicates metabolic alkalosis negative value reveals metabolic acidosis

Correct a Base Deficit (BD)

BD x 30 % x BW in L In practice, only 50% of the calculated dose is usually given

Case Study 1
A 57 old man with post operative. craniotomy found to be tachypnea, somnolent. Initial blood gas analysis was :
pH 7.556 PCO2 31.3 mmHg PO2 142 mmHg HCO3 28.8 mmol/L BEecf 7 mmol/L SO2 100%

 What is the types of disorder ? How to manage this patients to improve BGA result?

Case Study 2
A 50 years old man, BGA post operative thoracotomi, founds :
pH 7.31 pCO2 50 mmHg pO2 72 mmHg HCO3- 25.2 mmol/L BEecf -1.1 mmol/L SO2 93%

 What is the types of disorder ? How to manage this patients to improve BGA result?

How patients compensate?

If there are respiratory disorder, body compensates with metabolic conditions If there are metabolic disorder, body compensates with respiratory conditions

Normal Compensatory Responses in AcidBase Disturbances

Disturbance Respiratory acidosis Acute Chronic Respiratory alkalosis Acute Chronic Metabolic acidosis Metabolic alkalosis ResponseExpected [HCO3] [HCO3] Change 1 mEq/L/10 mm Hg increase in PaCO2 4 mEq/L/10 mm Hg increase in PaCO2

[HCO3] [HCO3] PaCO2 PaCO2

2 mEq/L/10 mm Hg decrease in PaCO2 4 mEq/L/10 mm Hg decrease in PaCO2 1.2 x the decrease in [HCO3] 0.7 x the increase in [HCO3]

Case 3
Calculate the amount of NaHCO3 necessary to correct a base deficit (BD) of 10 mEq/L for a 70-kg man with an estimated HCO3 space of 30%:

 50% of the calculated dose =105 mEq