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Gas Analysis
Ram E. Rajagopalan,
MBBS, AB (Int. Med & Crit. Care)
Consultant & Head, Dept. of Critical Care Medicine
SUNDARAM MEDICAL FOUNDATION, Chennai
Goals of this talk:
Not:
To teach physiology of respiratory gas exchange
To discuss theories on acid-base regulation
To debate alternative approaches to
interpretation
A Systematic Approach
As required for ECG
interpretation,
a systematic approach to
ABGs enhances accuracy.
Corrected 38.6 C
o
Temperature Correction:
pH 7.439 Is there any value to it?
pCO2 47.6 mm Hg
pO2 123.5 mm Hg
ct Hb 10.5 g/dl
FiO2 30.0 %
Traditional Measurements
pH electrode
Measured 37.0 C
o Bicarbonate is calculated on the
pH
pCO2
7.463
44.4 mm Hg
basis of the
pO2 113.2 mm Hg
Henderson equation:
o
Corrected 38.6 C
+ -
[H ] = 24 pCO2 / [HCO3 ]
Calculated Data or
HCO3 act 31.1 mmol / L
HCO3 std 30.5 mmol / L for the mathematically inclined…
BE 6.6 mmol / L
O2 CT 14.7 mL / dl
O2 Sat 98.3 % Henderson-Hasselbach equation:
t CO2 32.4 mmol / L
pO2 (A - a) 32.2 mm Hg
pO2 (a / A) 0.79
pH = pKc + Log [HCO3-]
Entered
Temp 38.6
Data
oC a pCO2
ct Hb 10.5 g/dl
FiO2 30.0 %
----- XXXX Diagnostics ------ Standard Bicarbonate:
Blood Gas Report Plasma HCO3 after equilibration
to a PCO2 of 40 mm Hg
o
Measured 37.0 C
pH 7.463
: reflects non-respiratory acid base change
pCO2 44.4 mm Hg : does not quantify the extent of the buffer
pO2 113.2 mm Hg
o
base abnormality
Corrected 38.6 C : does not consider actual buffering
capacity of blood
Calculated
HCO3 act 31.1
Data
mmol / L
Base Excess:
HCO3 std
BE
30.5
6.6
mmol / L
mmol / L D base to normalise HCO3 (to 24)
O2 CT 14.7 mL / dl
O2 Sat 98.3 % with PCO2 at 40 mm Hg
t CO2 32.4 mmol / L (Sigaard-Andersen)
pO2 (A - a) 32.2 mm Hg : reflects metabolic part of acid base D
pO2 (a / A) 0.79
: no info. over that derived from pH,
Entered Data pCO2 and HCO3
Temp 38.6 oC
Entered Data
Temp 38.6 oC Arterial / alveolar ratio:
ct Hb 10.5 g/dl
FiO2 30.0 %
Oxygen Saturation
100% Most blood gas
machines estimate
Saturation
saturation from an
idealized dissociation
curve
Gold standard is
0 60 120 co-oximetry
pO2
Errors may occur with abnormal haemoglobins.
partO2 = 90 mmHg
pCO2 = 40 pCO2 = 80
pO2 = 45 pO2 = 45
D = 100-45 = 55 D = 50-45 = 5
Arterial-alveolar Difference
B
Moderate
C Mild
D Normal
% Inspired Oxygen
----- XXXX Diagnostics ------
O2 Sat 98.3 %
pO2 (A - a) 32.2 mm Hg
HCO3 24 + 4 mmol/L
Step 2
Is it a metabolic or respiratory disturbance ?
Acidemia: With HCO3 < 20 mmol/L = metabolic
With PCO2 >45 mm hg = respiratory
Step 4
For a respiratory disorder is renal compensation OK?
If not:
actual PCO2 > expected : hidden respiratory acidosis
actual PCO2 < expected : hidden respiratory alkalosis
Step 6
If there is metabolic acidosis, is there an anion gap?
Measured
o
37.0 C pCO2 >45; respiratory acidemia
pH 7.301 D CO2 =76-40=36
pCO2 76.2 mm Hg Expected D pH = 36/10 x0.08=0.29
pO2 45.5 mm Hg Expected pH = 7.40-0.29=7.11
Calculated Data Chronic resp. acidosis
HCO3 act 35.1 mmol / L 60 year old male smoker
Limits:
with progressive
O2 Sat 78 % DHCO3 = 3/10 of D pCO2
pO2 (A - a) 9.5 mm Hg D respiratory distress
=3/10x36=10.8
pO2 (a / A) 0.83 and somnolence.
Limits of HCO3 = 24+11=35
Entered Data Pure Resp Acidosis
FiO2 21 %
Hypoxia
Normal A-a gradient
Due to hypoventilation
Blood
----- XXXX Diagnostics ------
Gas Report
Case 4
pH <7.35 ; acidemia
Measured
o
37.0 C pCO2 >45; respiratory male
18-year-old acidemia
asthmatic;
pH 7. 24
D3COdays of cough, dyspnea
2 = 49 - 40 = 9
pCO2 49.1 mm Hg
pO2 66.3 mm Hg
Expected D pH = 9/10 not
and orthopnea x 0.08 = 0.072
Expected pH = 7.40
responding to -usual
0.072 = 7.328
Calculated Data Acute resp. acidosis
HCO3 act 18.0 mmol / L bronchodilators.
Limits:
O2 Sat 92 %
DHCO3
O/E:= 1/10 of D pCO2
Respiratory distress;
pO2 (A - a) 153-66= 87 mm Hg D
=1/10x9=0.9
pO2 (a / A) suprasternal and
Limits of HCO3 = 24+1=25
Entered Data Respintercostal retraction;
Acidosis + Metabolic Acidosis
FiO2 30 % tired looking; on 4 L NC.
Hypoxia
piO2 = 715x.3=214.5 / palvO2 = 214-49/.8=153
----- XXXX Diagnostics ------
pH <7.35 ; acidemia
Blood
Measured
Gas Report
o
37.0 C Limits:
Case 5
pH 7.23 Expected pCO2 = (1.5 x HCO3)+8 + 2
pCO2 23 mm Hg = (1.5 x 14)+ 8 + 2
pO2 110.5 mm Hg = 29 + 2 = 27 to 31
Calculated Data Met. Acidosis
28 year+ Resp.
old alkalosis
diabetic with
HCO3 act 14 mmol / L
respiratory distress
HCO3 <22; metabolic acidemia
O2 Sat %
fatigue and
pO2 (A - a) mm Hg D
pO2 (a / A) loss of appetite.
Entered Data If Na = 130,
FiO2 21.0 % Cl = 100
Anion Gap = 130 - (100 + 14)
Normal AG= 12; D Gap = 16 - 12 = 4 = 130 - 114= 16
DHCO3 = 24 - 14 = 10, 2.5 accounted for by resp. alkalosis;
D/D 3.5 indicates additional non-gap acidosis
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