1. Interpretation of arterial blood gases Meera Ladwa

2. What it measures Measures acidity of arterial blood Measures partial pressure of oxygen and carbon dioxide in the blood Often measure Hb, electrolytes (Na, K), glucose, lactate Derives bicarbonate and base excess

5. Why measure? Tells you about acid-base balance Tells you about patient’s oxygenation and ventilation Therefore they are very useful in patient who are critically ill, deteriorating, have respiratory problems or are on invasive or non-invasive ventilation

6. Pathophysiology The function of crucial metabolic processes depends on a narrow range of pH (pH 7.35-7.45) H+ ions are normal products of cellular metabolism H+ ion concentration is INVERSELY PROPORTIONAL to pH Therefore the body must continually dispose of acid in order to keep pH within range

7. Pathophysiology BUFFERING (carbonic acid-bicarbonate system) H2O + CO2 ↔ H2CO3 ↔ HCO3 - + H+ Respiratory system (rapid change in pH) If pH falls, patient can increase respiratory rate to ‘blow off’ CO2

8. Pathophysiology BUFFERING (carbonic acid-bicarbonate system) H2O + CO2 ↔ H2CO3 ↔ HCO3 - + H+ Renal or metabolic system (slower change in pH) If pH falls, kidneys can increase reabsorption of bicarbonate (and increase secretion of H+)

9. Pathophysiology Henderson-Hassalbalch equation. Mathematical relationship between pH, pCo2 and HCO3 Ka = [H+][A-] [HA] pH = pKa + log [Base] [Acid]

10. Examples Respiratory acidosis e.g. opiate overdose pH 7.29(7.35-7.45) pCO2 8.6(4.7-6.0 kPa) pO2 9.0(9.3- 13.3 kPa) HCO3 22.4(22-26mmol/L) BE 1(-2 to +2)

11. Examples Metabolic acidosis (with partial respiratory compensation) e.g. DKA, lactic acidosis, AKI, diarrhea pH 6.90(7.35-7.45) pCO2 3.1(4.7-6.0 kPa) pO2 14.0(9.3- 13.3 kPa) HCO3 13.0(22 – 26mmol/L) BE -8(-2 to +2)

12. Examples Chronic CO2 retention with metabolic compensation e.g. COPD pH 7.36(7.35-7.45) pCO2 6.8(4.7 – 6.0 kPa) pO2 9.0(9.3 – 13.3 kPa) HCO3 31.0(22-26mmol/L) BE -1.0(-2 to +2)

13. Examples Mixed respiratory and metabolic acidosis (eg opiate o/d in renal failure) pH 7.16(7.35-7.45) pCO2 6.8(4.7 – 6.0 kPa) pO2 10.0(9.3 – 13.3 kPa) HCO3 14(22-26mmol/L) BE -7.0(-2 to +2)

14. Examples Respiratory alkalosis with metabolic acidosis (salicylate overdose) pH 7.47(7.35-7.45) pCO2 4.1(4.7 – 6.0 kPa) pO2 10.0(9.3 – 13.3 kPa) HCO3 17(22-26mmol/L) BE -6.0(-2 to +2)