pH & Blood Gas

Analysis
Dr. Farhan Javed Dar
 Introduction
 Arterial blood gas measurement is a blood
test that is performed to determine the
concentration of oxygen, carbon dioxide
and bicarbonate, as well as the pH, in the
blood.
 Its main use is in pulmonology, as many
lung diseases feature poor gas exchange,
but it is also used in nephrology (kidney
diseases) and electrolyte disturbances.
 As its nameimplies, the sample is taken
from an artery, which is more
uncomfortable and difficult than
venepuncture.
 The analyzer is use in the quantitative
determination of pH,PCO2,PO2,Oxygen
saturation and hematocrit. It also displays
hemoglobin.
 The 2-point calibration performed every
two hours gap & 1-point calibration after
every half an hour gap by machine
automatically.
 The PO & PCO2 electrode has a
2
membrane with a three months life,
change it after every three months.
 Two buffer solution having pH 6.840 and
7.382 are being used in the calibration of
pH electrode & are supplied with system
 Buffer solution, a solution which resists
change of pH upon addition of small
amounts of acid or base, or upon dilution
THE BUFFER SYSTEMS OF THE
BODY
 Proteins
 Phosphate
 HCO3-
 Instrument

Nova (STAT. Profile ultra analyzer).

 Procedure
 To initiate a sample sequence the
operator carefully watch the analyzer that
it must be calibrated, reagent pack are
perfectly installed & no error code is
blinking on the display screen
 Before introducing the sample, be sure
that sample is not clotted & mix the
syringe for few seconds to remove any air
bubble
 Press the analyze button after few
seconds probe comes out to pick the
sample, remove the needle then apply the
syringe into the probe & press the analyze
button so that probe pick the sample
 Give sample identify number in the data
screen of nova & other related information
so that the result can be transmitted
automatically to AKUH computer system
 Results also appears on the paper
inserted in the nova printer.
 pH
 The pH is a measure of hydrogen ion (H+)
in blood which indicates the acid or base
(alkaline) nature of blood
 A pH of less than 7 is acidic, and a pH
greater than 7 is called basic (alkaline).
 The normal blood pH range is 7.35 to
7.45
 Principle Of pH measurement
 pH is measured using a hydrogen ion
selective glass membrane.
 One side of the glass is in contact with a
solution of unknown pH.
 A change in potential develops which is
proportional to the pH difference of these
solutions.
 This change in the potential is measured
against a reference electrode of constant
potential.
 The magnitude of the potential difference
is then measure, the pH of unknown
solution.
 Partial Pressure Of CO2
 Definition
 The amount of carbon dioxide dissolved in
arterial blood.
 It’s level indicates how well carbon dioxide is
able to move out of the blood into the
airspace of the lungs and out with exhaled air.

The normal range is 35 to 45 mm Hg.
Principle Of PCO2 Measurement
 PCO is measured with a modified pH
2
electrode.
 CO in the unknown solution makes
2
contact with a gas permeable membrane
mounted on a combination
measuring/reference electrode.
 CO diffuses across the membrane into a
2
thin layer of electrolyte solution in
response to partial pressure difference.
 This solution then becomes equilibrated
with the external gas pressure.
 CO in the solution becomes hydrated
2
producing carbonic acid which results in a
change in hydrogen ion activity

CO2 + H2O ↔ H2CO3 ↔ H+ + [ HCO3]

 The electrolyte solution behind the
membrane is in contact with a glass
hydrogen ion selective electrode.
 The change in hydrogen ion activity in the
electrolyte solution produce a potential,
which is, measured against the internal
filling solution.
 This change in potential is measured
against the constant potential of the
reference electrode & is related to the
PCO2 of the unknown sample.
 Partial Pressure of Oxygen
 Definition
 the partial pressure of oxygen is the gas
phase in equilibrium with the blood.
 The partial pressure of oxygen that is
dissolved in arterial blood
 It indicates how well oxygen is able to move
from the airspace of the lungs into the blood.
 The normal range is 80 to 100 mm Hg.
 Principle of PO2 Measurement
 PO is measured amperometrically by the
2
generation of a current at the electrode
surface.
 As oxygen diffuses through a gas
permeable membrane, the oxygen
molecules are reduced at the cathode,
consuming 4 electrons for every molecule
of oxygen reduced.
 This flow of electrons is then measured by
the electrode & is directly proportional to
the PO2.
 Base Excess Of Blood
 Base excess of blood is defined as the
concentration of titrable base needed to
titrate blood to pH 7.40 at 370 C while the
PCO2 is held constant at 40 mm Hg.
 The base excess indicates the amount of
excess or insufficient level of bicarbonate
in the system.
 The normal range is –2 to +2 mEq/liter
 Oxygen Content
 Oxygen content is defined as the total
amount of oxygen contained in a given
volume of whole blood including dissolved
oxygen bound to hemoglobin.
 It is expressed in milliliters of oxygen per
100 ml of blood (vol. %) as calculated from
the oxygen saturation and the hemoglobin
concentration.
 The normal range is 95% to 100%.
 Controls
 Level I,II & III are available & one control
run in each 8 hours shift.
 These controls are formulated from a
buffered bicarbonate solution of pH &
sodium concentration.
 The solution are equilibrated with known
concentration of oxygen & carbon dioxide.
Acid Base Disorders
 There are four simple acid-base disorders
 Metabolic Acidosis
 Metabolic Alkalosis
 Respiratory Acidosis

Respiratory Alkalosis
 A pt. can also suffer from
two simple
disorders simultaneously which is termed
a mixed acid base disturbance
 METABOLIC ACIDOSIS
 Characterized by :

 A low HCO3 - less than 22 mEq/L

 A low pH - less than 7.35

 And if compensation has occurred ,a low Pco2

 Causes of Metabolic Acidosis
 Addition of H+
 Increased production
• Ketoacidosis
• Lactic acidosis
• Toxins
• Ingestion/infusion( HCl,NH4Cl )
 Decreased Renal Excretion
• Renal failure
• Obstructive uropathy
• Renal tubular acidosis Type 1
• Mineralcorticoid deficiency
 Loss of HCO3

Extrarenal losses
• Acute Diarrhea
• Drianage from pancreatic fistulae
• Diversion of urine to gut

 Renal Losses
• Renal Tubular Acidosis
 Consequences of Metabolic
Acidosis
 Cardiac Failure
 Hyperkalemia e.g diabetic ketoacidosis
 Hypokalemia in in renal tubular acidosis
 Mobilization of calcium from bone. Renal
reabsorption of calcium producing
hypercalciuria, leads to nephrocalcinosis &
urolithiasis
 METABOLIC ALKALOSIS
 Characterized by :

 a high pH-greater
pH- than 7.45

 A high bicarbonate-greater
bicarbonate- than 26 mEq/liter

 If compensation has occurred a High Pco2

 Causes of Metabolic Alkalosis
 Increased exogenous bicarbonate

Oral/IV. Bicarbonate
 Antacid therapy, e.g, magnesium carbonate
 Organic acid salts e.g , lactate ,citrate
 Loss of hydrogen ions
 Gastrointestinal tract losses
• Stomach : vomitting, gastric suction
• Bowel : diarrhea

Kidney losses
• Diuretic therapy
• Mineralcorticoid excess
 Consequences Of Metabolic
Alkalosis
 Alkalemia enhances binding of calcium ions
to protein which results in increased
neuromuscular activity & Characteristic
Chvostek & Trousseaue signs may occur
 Hypokalemia
 Increased calcium reabsorption
 Enhanced glycolysis ( stimulation of
phosphpfructokinase by a high intracellular
pH )
 RESPIRATORY ACIDOSIS
 Characterized by :
 Increased Pco2
 pH less than 7.35 with a PCO2 greater than 45
mm Hg.

 It is always due to decreased excretion of

CO2 by the lungs
 Causes of Respiratory Acidosis
 Thoracic Disease
 Restrictive defects
• Hydrothorax
• Pneumothorax
• Flail Chest
 Obstructive disease
• Bronchitis
• Emphysema
• Pneumonia
• Infiltrations
• Edema
• Pneumonia
• Foreign body obstruction
 Neuromuscular disease
 Poliomyletiis
 GB syndrome
 Multiple sclerosis

Myopathies

 Central Depression
 Trauma
 Cerebrovascular accidents
 CNS infections

CNS tumors
 Drug overdose
 Consequences Of Respiratory Acidosis
 On Brain
 Hypercapnia induces cerebral vasodilation &
increased cerebral blood flow which in turn
increses intracerebral pressure producing :
• Drowsiness
• Headaches
• Stupor
• Coma
 On Potassium
 Release of potassium from cells (exchange for
H+

But not a constant feature
 RESPIRATORY ALKALOSIS

 Characterized by :
 Hypocapnia ( low Pco2 ) due to increased
ventilation.
 pH greater than 7.45 with a PCO2 less than 35
mm Hg
Causes Of Respiratory Alkalosis
 Central Stimulation
 Anxiety

Pregnancy
 Hypoxemia
 Hepatic Encephalopathy
 Gram –ve septicaemia
 Salicylate overdose

Infection, trauma

Tumour
 Pulmonary Pathology
 Embolism
 Congestive cardiac failure

Asthma,Pneumonia
 Consequences Of Respiratory Alkalosis
 On Calcium Metabolism
 Tetany as alkalemia causes increased binding
of calcium ions to protein.
 On Potassium

Initially mild hypokalemia but generally plasma
potassium remains normal
 On Phosphate
 Transient severe hypophosphataemia
 On Glucose Metabolism
 Increased lactate production
 On Brain
 Cerebral vasoconstriction, which may results in
light headedness
 pH PCO2 HCO-3

Respiratory ↓ ↑ N
Acidosis

Respiratory ↑ ↓ N
Alkalosis

Metabolic ↓ N ↓
Acidosis

Metabolic ↑ N ↑
Alkalosis
THANK YOU