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
Normal Acidosis

pH
7.35-7.45 < 7.35

Alkalosis

>7.45
Hasanul-2004

Classification of Laboratory Respiratory Acid-Base Component

Classification Normal Resp.Component Respiratory Acidosis Respiratory Alkalosis PaCO2 (mmHg) 35-45 >45 <35
Hasanul-2004

Classification of Laboratory Metabolic Acid-Base Component

Classification Normal Metab.Component Metabolic Acidosis Metabolic Alkalosis BE 02 < -2 > +2 HCO3 242 <22 >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 45 -2 22

pH

7,45 35 +2 26
Eddy Rahardjo1990/Hasanul-2004

PaCO2
BE HCO3

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-2004

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-2004

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-2004

Alkalosis respiratorik tanpa kompensasi

pH : 7,55 ; PaCO2 : 30 ; BE : +5 ;

ACIDOSIS

ALKALOSIS

7,35
45

pH PaCO2

7,45 7,55
35 30

-2
22

BE
HCO3

+2
26

+5
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 7.35-7.45 Degree of compensation Complete

<7.35
>7.45

Partial
Partial
Hasanul-2004

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-2004

Alkalosis respiratorik dgn kompensasi parsial

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-2004

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
Hasanul-2003

Normal Arterial Gases

Parameter
pH PaCO2 PaO2 SaO2

Values
7,35-7,45 35-45 mmHg 80-100 mmHg 98-100%
Hasanul-2003

Normal mixed venous gases

Parameter
pH PaCO2 PaO2 SaO2

Values
7,38 48 mmHg 40 mmHg 75%
Hasanul-2003

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

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