Clinical Interpretation of Arterial Blood Gas, April 20 ,2018 | レリ

Clinical Interpretation of Arterial Blood Gas HCO3- is Remaining and sent out of the Cell
31B

Cesar M Ong, MD
1
Gas exchange
• Simple diffusion
3B

• Between lungs tissues

4B

o Dissolved into plasma

5B

o Binds to hemoglobin
6B

• Oxygenation
7B

o Oxygen added to pulmonary blood

8B

• Ventilation
9B

o Removal of carbon dioxide from alveoli

10B
And Compensated my Chloride
32B

• Respiration
1B

o Take in oxygen & give out carbon dioxide

12B

Factors affecting rate of diffusion Arterial Blood Gas

▪ Pressure difference
13B
• can document, specify & quantitate
3B

▪ Solubility
14B
• cardiopulmonary malfunction
34B

▪ Surface area of membrane

15B

• acid-base abnormalities
35B

▪ Thickness of the membrane

• absolute values should be
16B

36B

▪ Molecular weight
17B

interpreted in conjunction with the

▪ Temperature
18B
clinical picture
Carbon dioxide Physiological Considerations
▪ 70% as bicarbonate
19B
body tries to maintain a normal pH
37B

▪ with proteins -> carbamino compounds

20B

• ability to compensate:
38B

▪ dissolved in plasma
lungs – rapid, kidneys – slow
21B

39B

Oxygen
▪ 97% with hemoglobin
2B
• no overcompensation
40B

➢ H+23B
• consider underlying disease
41B

➢ PCO2
24B

• maintain adequate level of Hgb

42B

➢ temperature
25B

Why Arterial over Venous Blood?

328B

➢ 2,3-BPG
• represents mixture of blood
26B

43B

▪ 3% dissolved in plasma
coming from various parts of the
27B

Transport of Co2 body

Co2+H20 = H2Co3
28B

• gives information on how well the

4B

Degraded as H +
29B
+
HCO3- lungs are oxygenating the blood

H+ Combined to Hgb to HHgb

30B

© 2018 レリ

 Clinical Interpretation of Arterial Blood Gas, April 20 ,2018 | レリ

Normal Parameters of Blood

Assess the Oxygen Level
1B

2
Arterial Venous
Hypoxemia at Room Air for Patients < 60
329B

years
pH 7.35 – 7.45 7.30 – 7.40 • Mild
59B PO2 < 80 mm Hg

PCO2 35 – 45 30 – 50 • Moderate
60B PO2 < 60 mm Hg

• Severe
61B PO2 < 40 mm Hg
PO2 80 – 100 40 – 50
Hypoxemia on Oxygen Therapy
30B

HCO3 22 – 26 22 – 28
• Uncorrected
62B PO2 < 80 mm Hg

BE / BD -2 to +2 • Corrected
63B PO2 80 – 100 mm Hg

• Overcorrected PO2 > 100 mm Hg

SaO2 > 95% 60 – 85%
64B

FiO2 (Fraction of Inspired Oxygen

31B

Nomenclature Concentration)
• Acidosis –pathophysiologic state with significant base deficit
• measurable amount of oxygen received by
45B

(HCO3 < 22 meq / L)

65B

the patient
• Alkalosis – pathophysiologic state with significant base excess
• 21% = room air
46B

(HCO3 > 26 meq / L)

6B

• 21% = on oxygen therapy

67B

Assess the Ventilatory Status &Acid-Base Balance

0B

Assess the Tissue Oxygenation Status

2B

Classification of pCo2 Levels

< 35 mm Hg
47B alveolar hyperventilation Clinically assess:
68B

(respiratory alkalosis)
48B
1. Cardiac status
69B

35 – 45 mm Hg
49B acceptable alveolar ventilation 2. Peripheral perfusion
70B

> 45 mm Hg
50B ventilatory failure 3. Blood oxygen transport mechanism
71B

(respiratory acidosis)
51B
Assess 1 & 2 by the vital signs & PE.
72B

Nomenclature If 1 & 2 are adequate, then only 3 can be interfering

73B

1. What is the PCO2 level?

52B
with proper tissue oxygenation.

2. Is the pH explained by the PCO2?

53B

yes – respiratory
54B
Note:
74B

no – metabolic
5B
This Trans May Not be Accurate Since taken from
75B

Pictures.
3. What is the pH?
56B

The Samples Questions will be Uploaded Later

76B

abnormal – acute (uncompensated)

57B

normal – chronic (compensated)

58B

© 2018 レリ

 Clinical Interpretation of Arterial Blood Gas, April 20 ,2018 | レリ
12.
Clinical Interpretation of Arterial Blood Gas 154B

PCO2
15B <35
156B

(Questions) pH 157B <7.35

158B

3 HCO3 >26
By Dr. Cesar M. Ong
159B 160B

13.
16B

Correlate the pH and PCO2 with the HCO3 level.

7B

PCO2
162B <35
163B

pH 7.35-7.45
1.
164B 165B

78B

HCO3 <22
PCO2 35-45
16B 167B

79B 80B

pH < 7.35
14.
81B 82B

168B

HCO3
83B < 22 84B

PCO2
169B <35
170B

pH 7.35-7.45
2.
17B 172B

85B

PCO2 86B 35-45 87B

HCO3
173B 22-26 174B

pH 8B < 7.35
89B

HCO3
90B 22-26 91B
15.
175B

PCO2
176B <35
17B

3.
92B
pH 178B 7.35-7.45
179B

PCO2
93B 35-45
94B
HCO3
180B >26 18B

pH 95B < 7.35

96B

HCO3
97B >26 98B
16.
182B

PCO2
183B <35
184B

4.
9B
pH 185B >7.45
186B

PCO2
10B 35-45
10B
HCO3
187B <22 18B

pH 102B < 7.35

103B

HCO3
104B >26 105B
17.
189B

PCO2
190B <35
19B

5.
106B
pH 192B >7.45
193B

PCO2
107B 35-45
108B
HCO3
194B 22-26 195B

pH 109B 7.35 -7.45

10B

HCO3
1B 22-26 12B
18.
196B

PCO2
197B <35
198B

6.
13B
pH 19B >7.45
20B

PCO2
14B 35-45
15B
HCO3
201B >26 20B

pH 16B 7.35-7.45
17B

HCO3
18B > 26 19B
19.
203B

PCO2
204B >45
205B

7.
120B
pH 206B <7.35
207B

PCO2
12B 35-45
12B
HCO3
208B <22 209B

pH 123B >7.45
124B
20.
210B

HCO3
125B <22 126B
PCO2
21B >45
21B

pH 213B <7.35
214B

8.
127B

HCO3
215B 22-26 216B

PCO2
128B 35-45
129B

pH
130B >7.45
13B
21.
217B

22-26
132B
PCO2
218B >45
219B

9.
13B
pH 20B <7.35
21B

PCO2
134B 35-45
135B
HCO3
2B >26 23B

pH 136B >7.45
137B

22.
24B

HCO3 >26
PCO2 >45
138B 139B

25B 26B

10.
140B
pH 27B 7.35-7.45
28B

PCO2
14B <35
142B
HCO3
29B <22 230B

pH 143B <7.35
14B

23.
231B

HCO3 <22
PCO2 >45
145B 146B

23B 23B

11.
147B
pH 234B 7.35-7.45
235B

PCO2
148B <35
149B
HCO3
236B 22-26 237B

pH 150B <7.35
15B

24.
238B

HCO3 22-26
PCO2 >45
152B 153B

239B 240B

pH 241B 7.35-7.45
24B

HCO3
243B >26 24B

© 2018 レリ

 Clinical Interpretation of Arterial Blood Gas, April 20 ,2018 | レリ

25.
245B

PCO2
246B >45
247B

4 pH 248B >7.45
249B

HCO3
250B <22 251B

26.
25B

PCO2
253B >45
254B

pH 25B >7.45
256B

HCO3
257B 22-26 258B

27.
ANSWERS:
259B

PCO2
260B >45
261B

pH 26B >7.45
263B
1. Acute metabolic acidosis
HCO3
264B >26 265B
2. ?
3. ?
4. ?
28.
26B

5. Normal acid base balance

PCO2
267B 7.39
268B

6. ?
pH
269B 42
270B
7. ?
pO2 271B 95 27B
8. ?
9. Acute metabolic alkalosis
HCO3 22
10. Partly compensated metabolic acidosis
273B 274B

BE +1
11. ?
275B 276B

SaO2 95%
12. ?
27B 278B

FiO2 279B 21%

280B

13. Compensated respiratory alkalosis/ compensated metabolic acidosis

14. ?
29.
281B

15. ?
16. Partly compensated respiratory alkalosis
PCO2
28B 7.30
283B

17. Acute respiratory alkalosis

pH
284B 52
285B
18. Combined respiratory and metabolic alkalosis
19. Combined respiratory and metabolic acidosis
pO2 286B 75
287B
20. Acute respiratory acidosis
HCO3
28B 24 289B
21. Partly compensated respiratory acidosis
BE 290B -4 291B
22. ?
23. ?
SaO2 29B 97%
293B

24. Compensated respiratory alkalosis/Compensated metabolic acidosis

FiO2 294B 21%
295B

25. ?
26. ?
30.
27. Partly compensated metabolic alkalosis
296B

PCO2
297B 7.60
298B

28. Normal acid base balance with adequate oxygenation

pH
29B 45
30B 29. Acute respiratory acidosis with mild hypoxemia
pO2 301B 75 302B
30. Acute metabolic alkalosis with uncorrected hypoxemia
31. Compensated respiratory alkalosis with overcorrected hypoxemia
HCO3
30B 34
304B

BE 305B +5
306B

SaO2 307B 95%

308B

FiO2 309B 50%

310B

31.
31B

PCO2
312B 7.44
31B

pH
314B 30
315B

pO2 316B 110 317B

HCO3
318B 16
319B

BE 320B +4
321B

SaO2 32B 95%

32B

FiO2 324B 50%

325B

Transcribed by: レリ
326B

This May not be Accurate, Transcribed from Pics

327B

© 2018 レリ
