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BLOOD GAS ANALYSIS

Apa yang dibaca ?

pH, PaCO2, BE
HCO3, PaO2

Hasanul-2003

STEPS IN ACIDS BASE CLASSIFICATION

1. pH Classification
2. PaCO2 Classification 3. Metabolic Classification

4. Compensation Evaluation
5. Complete Acid-Base Classification
Hasanul-2003

pH Classification
Classification
Normal Acidosis

pH
7.35-7.45 < 7.35

Alkalosis

>7.45
Hasanul-2003

Classification of Laboratory Respiratory Acid-Base Component


Classification Normal Resp.Component Respiratory Acidosis Respiratory Alkalosis PaCO2 (mmHg) 35-45 >45 <35
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Classification of Laboratory Metabolic Acid-Base Component


Classification Normal Metab.Component Metabolic Acidosis Metabolic Alkalosis BE 02 < -2 > +2 HCO3 242 <22 >26
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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-2003

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
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Classification of degree of Compensation


pH 7.35-7.45 Degree of compensation Complete

<7.35
>7.45

Partial
Partial
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ACIDOSIS

ALKALOSIS

7,35 45 -2 22

pH

7,45 35 +2 26
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PaCO2
BE HCO3

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-2003

pH : 7.28, PaCO2 : 40, BE : -10 ACIDOSIS ALKALOSIS

7.28 7,35
45 -10

pH
PaCO 40 2

7,45
35

-2
22

BE
HCO3

+2
26
Hasanul-2003

Acidosis metabolik tanpa kompensasi

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

7.32 7,35
55 45

pH
PaCO2

7,45
35

-2
22

BE +1
HCO3

+2
26
Hasanul-2003

Acidosis respiratorik tanpa kompensasi

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

ACIDOSIS

ALKALOSIS

7,35 45 -2

pH PaCO2 BE

7,45 7,50 35 +2

30

22

HCO3

26
Hasanul-2003

Alkalosis respiratorik tanpa kompensasi

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

ACIDOSIS

ALKALOSIS

7,35 45 -6 -2

pH PaCO2 BE

7,45 7,48 35 +2

30

22

HCO3

26
Hasanul-2003

Alkalosis respiratorik dgn kompensasi parsial

pH : 7,55 ; PaCO2 : 30 ; BE : -2 ;

ACIDOSIS

ALKALOSIS

7,35
45

pH PaCO2

7,45 7,55
35 30

-2
22

BE
HCO3

+2
26

+5
Hasanul-2003

Alkalosis respiratorik dan metabolik (proses ganda)

pH : 7.32, PaCO2 : 30, BE : -10 ACIDOSIS ALKALOSIS

7.32 7,35
45 -10

pH
PaCO2

7,45
35 30

-2
22

BE
HCO3

+2
26
Hasanul-2003

Acidosis metabolik dgn kompensasi parsial

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

pH 7,35 7,38
45 -10 PaCO2

7,45
35 30

-2
22

BE
HCO3

+2
26
Hasanul-2003

Acidosis metabolik dgn kompensasi penuh

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

ACIDOSIS

ALKALOSIS

7,35 45 -6 -2

pH 7,43 7,45 PaCO2 BE 35 +2

30

22

HCO3

26
Hasanul-2003

Alkalosis respiratorik dgn kompensasi penuh

CLASSIFICATION of PaO2
PaO2 (mmHg)
CLASSIFICATION Hyperoxemia Adult >100 Newborn >90

Normoxemia
Mild hypoxemia Moderate hypoxemia

80-100
60-79 45-59

60-90
50-59 40-49

Severe hypoxemia

<45

<40
Hasanul-2003

Severity of Generalized Acid-Base disturbances


pH Degree of Impairment

<7,20
7,20-7,29 7,30-7,34 7,35-7,45 7,46-7,50 7,51-7,55 >7,55

Severe Acidosis
Moderate Acidosis Mild Acidosis Normal pH Mild Alkalosis Moderate Alkalosis Severe Alkalosis
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Normal Arterial Gases


Parameter
pH PaCO2 PaO2 SaO2

Values
7,35-7,45 35-45 mmHg 80-100 mmHg 98-100%
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Normal mixed venous gases

Parameter
pH PaCO2 PaO2 SaO2

Values
7,38 48 mmHg 40 mmHg 75%
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No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

pH 7,58 7,44 7,21 7.44 7,60 7,50 7,41 7,52 7,44 7,44

PaCO2 20 52 66 31 28 50 42 41 28 35

HCO3 19 34 26 20 27 37 25 32 35 23

PaO2 63 28 47 111 59 75 229 49 87 97

Classification

Hasanul-2003

No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

pH 7.32 7.52 7.36 7.42 7.20 7.20 7.55 7.34 7.37 7.40

PaCO2 30 34 32 30 50 80 25 30 56 38

BE -10 +4 -4 -5 -9 +2 0 -9 +4 -2

PaO2 58 32 145 90 60 90 72 41 57 350

Classification

Hasanul-2003

Kam shia

Terima Kasih

Puncak Hoang Shan-China