Figure 2: Blood Gas Analysis

Respiratory Acidosis

The patient is critically unwell (senior support with

Give controlled oxygen using a venturi mask,
ICU involvement is recommended)
targeting oxygen saturations of 88 – 92% and
Are they tiring?
Risk factors for PaO2 8 – 10kPa.
Patients who have had persistently increased
work of breathing can begin to retain CO2 hypercapnic Optimise medical management.
and should be discussed with ITU. NO respiratory failure or YES If unable to maintain oxygen saturations at
Is their respiratory function suppressed? acute on chronic this level or worsening hypercapnia /
Check patients have not been taking opiates respiratory acidosis? acidosis, despite optimum therapy, then
or sedatives. discuss with a senior and/or ITU. Consider
Patients with acute severe asthma who have a non-invasive ventilation (if appropriate to the
normal or raised pCO2 need early discussion with clinical situation).
ITU.

This may represent increased work of breathing secondary to:

 V/Q mismatch in Pulmonary Embolism
Respiratory alkalosis  Severe asthma
 Hyperventilation
 Shunt

Common causes of raised anion gap metabolic acidosis include:

 Ketoacidosis – Diabetic Ketoacidosis, alcohol ingestion,
starvation
 Lactic acidosis
 Drugs
Consider calculating anion gap  Toxins
Metabolic acidosis (Na+ + K+) – (Cl- + HCO3)
Normal = 7-13mmol/L
Common causes of normal anion gap metabolic acidosis include:
 Diarrhoea
 Kidney injury or chronic kidney disease

Common causes include:

Metabolic alkalosis  Vomiting and diarrhoea
 Diuretics (especially loop and thiazide)
Diuret