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Few Questions from the Chapter –
Acid Base Balance
of the book
FirsTest Series – Biochemistry
Author –
Dr.M.Amali Bruno
Publisher
Kalam Books
.Book Available Online atwww.first-test-series.comandwww.targetpg.com
Question 107
Which of the following is more appropriate for a 17 year old Female suffering from IDDMpH: 7.05PO2 : 108PCO2 : 12HCO3 : 5Base Excess : -30
Choices
A)
Metabolic AcidosisB)
Respiratory AcidosisC)
Metabolic AlkalosisD)
None of the above
Answer
A) Metabolic Acidosis
Reference:
Harrison
Discussion Arterial Blood Gas (ABG)
, an investigation which plays an important role in therapeutic decision making requires proper interpretation. A proper understanding of various components that are analysed is vital. As adetailed discussion of acid base disturbances is out of scope of this article; few basic facts are discussed in thefollowing paragraph.
Drawing blood for ABG:
A plastic / glass syringe is used.
0.1ml of Heparin is used for 1ml of blood drawn, as an anticoagulant. (Heparin is withdrawn into thesyringe and pushed back, thus allowing heparin to just coat the syringe)
The safest place to draw blood for ABG
is radial artery
at the wrist. Femoral artery also can be used.
The syringe should be sealed immediately with cap (or needle tip inserted to a cork) to avoid air bubbles.
Blood drawn should be analysed within 10mts. Otherwise it should be cooled to
4
o
C
with ice slush whena delay of up to one hour is acceptable. (Usually the syringe is sent in a flask with ice).
Routine practice of temperature correction for blood gas measurements is not required.
Analysis :
The parameters analysed are
PO
2
,
PCO
2
HCO
3-
PO
2
Accepted
Arterial O
2
tension
at room are as below.Criteria mmHg Normal 97 Adults &Children Acceptable >80New born 40-70
Few Questions from the Chapter –
Acid Base Balance
of the book
FirsTest Series – Biochemistry
Author –
Dr.M.Amali Bruno
Publisher
Kalam Books
.Book Available Online atwww.first-test-series.comandwww.targetpg.com
60 > 8070 > 7080 > 60Oldindividuals(Age inyrs)90 > 50 The relationship between PaO
2
and SaO
2
are
PaO
2
O
2
Saturation
Hypoxemia < 80 <95Mild 60-79 90-94Moderate 40-59 75-89Severe < 40 <75
pH:
The first step in an ABG interpretation is to look whether there is acidemic or alkalemicNormal : 7:4 (7.35 to 7.45) Acidemia : <7.35 Alkalemia : >7.45
Acidemic, Alkalemic refer to the pH change only
Acidosis, Alkalosis refer to the entire clinical & Biochemical picture.
HCO
3-
The second step is to look into HCO3. The primary change in HCO3 is called as
Metabolic'
Normal : 24 mmol/L. (22-26)Metabolic acidosis : < 22 mEq/LMetabolic alkalosis : > 26 mEq/L
PCO
2
The third step in an ABG interpretation is to look into the PCO2.The primary change is PCO2 is refered to as
'Respiratory'
Normal : 40 mmHg (35-45)Respiratory acidosis : > 45mm Hg Respiratory alkalosis : < 35mm Hg Wherever there is a change in PH, compensation occurs. Respiratory Compensation occurs for a metabolic acid-base disturbance and vice versa and in such cases
PCO2 & HCO3 move in the same direction
o
If HCO3 decreases (Metabolic acidosis) then PCO2 also decreases (Respiratory compensation)
o
If PCO2 increases (Respiratory acidosis), HCO3 also increases (Metabolic compensation)
Few Questions from the Chapter –
Acid Base Balance
of the book
FirsTest Series – Biochemistry
Author –
Dr.M.Amali Bruno
Publisher
Kalam Books
.Book Available Online atwww.first-test-series.comandwww.targetpg.com
The normal expected rates of compensation are as follows: Please note that the unit of HCO
3-
is mEq/L(milliequivalent per litre) and the unit of PaCO
2
is mm Hg (millimeter of Mercury)
Primary Disorder Defect Effect onpHCompensatoryResponseExpected Response Limit of Compensation
Metabolic Acidosis
HCO
3-
DecreasedGain in H
+
or loss of HCO
3-
Decrease Respiratory AlkalosisPaCO
2
Decreased
Δ
PaCO
2
=
Δ
HCO
3-
x 1.2 (1 to1.5)PCO
2
= 12mmHg
Metabolic Alkalosis
HCO
3-
IncreasedGain in HCO
3-
or loss of H
+
Increase Respiratory AcidosisPaCO
2
Increased
Δ
PaCO
2
=
Δ
HCO
3-
x 0.7(0.25 to 1.0)PCO
2
= 55mmHg
Acute:
Δ
HCO
3-
=
Δ
PaCO
2
x 1.0 (0.7to 1.3)HCO
3-
= 32 mmol/L
Respiratory Acidosis
PaCO
2
IncreasedCO
2
Retention Decrease Metabolic AlkalosisHCO
3-
Increased
Chronic:
Δ
HCO
3-
=
Δ
PaCO
2
x 0.35(0.1 to 0.8)HCO
3-
= 45 mmol/L
Acute:
Δ
HCO
3-
=
Δ
PaCO
2
x 0.2 (0.1to 0.3)HCO
3-
= 12-20 mmol/L
Respiratory Alkalosis
PaCO
2
DecreasedCO
2
Washout Increase Metabolic AcidosisHCO
3-
Decreased
Chronic:
Δ
HCO
3-
=
Δ
PaCO
2
x 0.4 (0.3to 0.5)HCO
3-
= 12-15 mmol/L
If the compensation does not match, then a mixed acid base disorder is to be suspected.Base Excess / Deficit is another parameter seen is any ABG report. The concept of base excess / deficit isfound on the premise that the degree of deviation from the normal total buffer base availability can be calculatedindependent of compensatory CO2 changes. A negative base excess is refered to as deficit. An abnormal pH with a base excess within 5mmol./L denotes a relatively normal and balanced metabolic acid base status. Anabnormal pH with a base excess outside 10mmol/L signifies significant metabolic acid base disturbance. A few examples of acid base disturbances are interpreted below.
1. 17 yrs old F, IDDM
pH: 7.05 PCO2 : 12 PO2: 108HCO3 : 5 BE: -30
Solution:
pH: 7.05 - Acidemic.HCO3 : 5 Primary metabolic disturbance.HCO3 deficit = 24 - 5 = 19Expected PCO2 = 40-(19X1.2) = 40-22.8 = 17.2 Actual PCO2 >12
Interpretation:
Metabolic acidosis with respiratory alkalosis.
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