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ATERIAL BLOOD GAS
ANALYSIS
DR. ANERI PATWARI
INTRODUCTION
 Blood gas analysis is crucial
to the assessment of
problems related to
1. acid–base balance
2. Ventilation
3. and oxygenation.
09-04-2024 2
A LOOK AT ACIDS AND BASES
The body constantly works to maintain a balance (homeostasis) between acids
and bases. Without that balance, cells can’t function properly. As cells use
nutrient to produce the energy, two by-products are formed H+ & CO2.
Acid-base balance depends on the regulation of the free hydrogen ions
Even slight imbalance can affect metabolism and essential body functions.
Several conditions as infection or trauma and medications can affect acid-base
balance
09-04-2024 3
09-04-2024 4
WHY ABG
The major function of the pulmonary system (lungs and pulmonary
circulation) is to deliver oxygen to cells and remove carbon dioxide
from the cells.
If the patient’s history and physical examination reveal evidence of
respiratory dysfunction, diagnostic test will help identify and evaluate
the dysfunction.
An ABG test can measure how well the person's lungs and kidneys are
working.
09-04-2024 5
09-04-2024 6
INDICATION
To obtain
information
about patient
ventilation
(PCO2) ,
oxygenation
(PO2) and acid
base balance
Monitor gas
exchange and
acid base
abnormalities
for patient on
mechanical
ventilator or not
To evaluate
response to
clinical
intervention
and diagnostic
evaluation
( oxygen
therapy )
are frequently
used to monitor
the condition of
patients in the
critical care
setting and to
help modify
respiratory
interventions
09-04-2024 7
SITES FOR OBTAINING ABG
 Radial artery ( most common )
 Brachial artery
 Femoral artery
Radial is the most preferable site used because:
 It is easy to access
 It is not a deep artery which facilitate palpation, stabilization and
puncturing
 The artery has a collateral blood circulation
09-04-2024 8
COMPONENETS
• Measures hydrogen ion concentration in the blood, it
shows blood’ acidity or alkalinity
Ph
• It is the partial pressure of CO2 that is carried by the
blood for excretion by the lungs, known as respiratory
parameter
Pco2
• It is the partial pressure of O2 that is dissolved in the
blood , it reflects the body’s ability to pick up oxygen
from the lungs
Po2
• Known as the metabolic parameter, it reflects the
kidney’s ability to retain and excrete bicarbonate
Hco3
09-04-2024 9
NORMATIVE DATA
09-04-2024 10
09-04-2024 11
HENDERSON-HASSELBALCH EQUATION
(H-H eq)
 The H-H eq is specific for calculation of pH of bicarbonate buffer system of the blood.
 pH=6.1 + log {[HCO3-]/PaCO2*0.03}
 Can be conceptually written as
pH ≈ Kidney control of [HCO3-]
Lung control of PCO2
09-04-2024 12
ACID-BASE DISORDERS
ACID-BASE PH PCO2 HC03
RESPIRATORY
ACIDOSIS
N
RESPIRATORY
ALKALOSIS
N
METABOLIC
ACIDOSIS
N
METABOLIC
ALKALOSIS
N
09-04-2024 13
COMPENSATION
 The respiratory and metabolic system works together to keep the body’s acid-base
balance within normal limits.
 The respiratory system responds to metabolic based PH imbalances in the following
manner:
* metabolic acidosis: ↑ respiratory rate and depth (↓PaCO2)
* metabolic alkalosis: ↓ respiratory rate and depth (↑PaCO2)
 The metabolic system responds to respiratory based PH imbalances in the
following manner:
*respiratory acidosis: ↑ HCO3 reabsorption
*respiratory alkalosis: ↓HCO3 reabsorption
09-04-2024 14
RESPIRATORY ACIDOSIS
PHASE PH PACO2 HCO3 REASON
UNCOMPENSATED --------- There is no response from
the kidneys yet to acidosis
the HCO3 will remain
normal
PARTIALLY
COMPENSATED
The kidneys start to
respond to the acidosis by
increasing the amount of
circulating HCO3
FULLY
COMPENSATED
N PH return to normal
PaCO2 & HCO3 levels are
still high to correct acidosis
09-04-2024 15
RESPIRATORY ALKALOSIS
PHASE PH PACO2 HCO3 REASON
UNCOMPENSATED --------- There is no response from
the kidneys yet to acidosis
the HCO3 will remain
normal
PARTIALLY
COMPENSATED
The kidneys start to
respond to the alkalosis by
decreasing the amount of
circulating HCO3
FULLY
COMPENSATED
N PH return to normal
PaCO2 & HCO3 levels are
still low to correct alkalosis
09-04-2024 16
METABOLIC ACIDOSIS
PHASE PH PACO2 HCO3 REASON
UNCOMPENSATED -------- There is no response from
the lungs yet to acidosis the
PaCO2 will remain normal
PARTIALLY
COMPENSATED
The lungs start to respond
to the acidosis by
decreasing the amount of
circulating PaCO2
FULLY
COMPENSATED
N PH return to normal
PaCO2 & HCO3 levels are
still low to correct acidosis
09-04-2024 17
METABOLIC ALKALOSIS
PHASE PH PACO2 HCO3 REASON
UNCOMPENSATED -------- There is no response from
the lungs yet to alkalosis
the PaCO2 will remain
normal
PARTIALLY
COMPENSATED
The lungs start to respond
to the alkalosis by
increasing the amount of
circulating PaCO2
FULLY
COMPENSATED
N PH return to normal
PaCO2 & HCO3 levels are
still high to correct
alkalosis 09-04-2024 18
CLINICAL SIGNS
 Respiratory acidosis: chronic pulmonary dysfunction and CNS depression , neuro
muscular diseases
 Respiratory alkalosis.: Paraesthesia, Severe hyperventilation may lead to hyperactive
reflexes, tetanic convulsions
 Metabolic acidosis: increases in minute ventilation, dyspnoea, increases tidal volume,
neuro symp like lethargy and coma
 Metabolic alkalosis: hypoventilation
09-04-2024 19
SUMMARY
09-04-2024 20
REFERENCES
 ESSENTIALS OF CARDIOPULMONARY PHYSICAL THERAPY, 3RD ED;
ELLEN HILLEGAS.
 EGAN’S FUNDAMENTALS OF RESPIRATORY CARE, 10TH ED
09-04-2024 21

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ARTERIAL BLOOD GAS ANALYSIS........pptx

  • 2. INTRODUCTION  Blood gas analysis is crucial to the assessment of problems related to 1. acid–base balance 2. Ventilation 3. and oxygenation. 09-04-2024 2
  • 3. A LOOK AT ACIDS AND BASES The body constantly works to maintain a balance (homeostasis) between acids and bases. Without that balance, cells can’t function properly. As cells use nutrient to produce the energy, two by-products are formed H+ & CO2. Acid-base balance depends on the regulation of the free hydrogen ions Even slight imbalance can affect metabolism and essential body functions. Several conditions as infection or trauma and medications can affect acid-base balance 09-04-2024 3
  • 5. WHY ABG The major function of the pulmonary system (lungs and pulmonary circulation) is to deliver oxygen to cells and remove carbon dioxide from the cells. If the patient’s history and physical examination reveal evidence of respiratory dysfunction, diagnostic test will help identify and evaluate the dysfunction. An ABG test can measure how well the person's lungs and kidneys are working. 09-04-2024 5
  • 7. INDICATION To obtain information about patient ventilation (PCO2) , oxygenation (PO2) and acid base balance Monitor gas exchange and acid base abnormalities for patient on mechanical ventilator or not To evaluate response to clinical intervention and diagnostic evaluation ( oxygen therapy ) are frequently used to monitor the condition of patients in the critical care setting and to help modify respiratory interventions 09-04-2024 7
  • 8. SITES FOR OBTAINING ABG  Radial artery ( most common )  Brachial artery  Femoral artery Radial is the most preferable site used because:  It is easy to access  It is not a deep artery which facilitate palpation, stabilization and puncturing  The artery has a collateral blood circulation 09-04-2024 8
  • 9. COMPONENETS • Measures hydrogen ion concentration in the blood, it shows blood’ acidity or alkalinity Ph • It is the partial pressure of CO2 that is carried by the blood for excretion by the lungs, known as respiratory parameter Pco2 • It is the partial pressure of O2 that is dissolved in the blood , it reflects the body’s ability to pick up oxygen from the lungs Po2 • Known as the metabolic parameter, it reflects the kidney’s ability to retain and excrete bicarbonate Hco3 09-04-2024 9
  • 12. HENDERSON-HASSELBALCH EQUATION (H-H eq)  The H-H eq is specific for calculation of pH of bicarbonate buffer system of the blood.  pH=6.1 + log {[HCO3-]/PaCO2*0.03}  Can be conceptually written as pH ≈ Kidney control of [HCO3-] Lung control of PCO2 09-04-2024 12
  • 13. ACID-BASE DISORDERS ACID-BASE PH PCO2 HC03 RESPIRATORY ACIDOSIS N RESPIRATORY ALKALOSIS N METABOLIC ACIDOSIS N METABOLIC ALKALOSIS N 09-04-2024 13
  • 14. COMPENSATION  The respiratory and metabolic system works together to keep the body’s acid-base balance within normal limits.  The respiratory system responds to metabolic based PH imbalances in the following manner: * metabolic acidosis: ↑ respiratory rate and depth (↓PaCO2) * metabolic alkalosis: ↓ respiratory rate and depth (↑PaCO2)  The metabolic system responds to respiratory based PH imbalances in the following manner: *respiratory acidosis: ↑ HCO3 reabsorption *respiratory alkalosis: ↓HCO3 reabsorption 09-04-2024 14
  • 15. RESPIRATORY ACIDOSIS PHASE PH PACO2 HCO3 REASON UNCOMPENSATED --------- There is no response from the kidneys yet to acidosis the HCO3 will remain normal PARTIALLY COMPENSATED The kidneys start to respond to the acidosis by increasing the amount of circulating HCO3 FULLY COMPENSATED N PH return to normal PaCO2 & HCO3 levels are still high to correct acidosis 09-04-2024 15
  • 16. RESPIRATORY ALKALOSIS PHASE PH PACO2 HCO3 REASON UNCOMPENSATED --------- There is no response from the kidneys yet to acidosis the HCO3 will remain normal PARTIALLY COMPENSATED The kidneys start to respond to the alkalosis by decreasing the amount of circulating HCO3 FULLY COMPENSATED N PH return to normal PaCO2 & HCO3 levels are still low to correct alkalosis 09-04-2024 16
  • 17. METABOLIC ACIDOSIS PHASE PH PACO2 HCO3 REASON UNCOMPENSATED -------- There is no response from the lungs yet to acidosis the PaCO2 will remain normal PARTIALLY COMPENSATED The lungs start to respond to the acidosis by decreasing the amount of circulating PaCO2 FULLY COMPENSATED N PH return to normal PaCO2 & HCO3 levels are still low to correct acidosis 09-04-2024 17
  • 18. METABOLIC ALKALOSIS PHASE PH PACO2 HCO3 REASON UNCOMPENSATED -------- There is no response from the lungs yet to alkalosis the PaCO2 will remain normal PARTIALLY COMPENSATED The lungs start to respond to the alkalosis by increasing the amount of circulating PaCO2 FULLY COMPENSATED N PH return to normal PaCO2 & HCO3 levels are still high to correct alkalosis 09-04-2024 18
  • 19. CLINICAL SIGNS  Respiratory acidosis: chronic pulmonary dysfunction and CNS depression , neuro muscular diseases  Respiratory alkalosis.: Paraesthesia, Severe hyperventilation may lead to hyperactive reflexes, tetanic convulsions  Metabolic acidosis: increases in minute ventilation, dyspnoea, increases tidal volume, neuro symp like lethargy and coma  Metabolic alkalosis: hypoventilation 09-04-2024 19
  • 21. REFERENCES  ESSENTIALS OF CARDIOPULMONARY PHYSICAL THERAPY, 3RD ED; ELLEN HILLEGAS.  EGAN’S FUNDAMENTALS OF RESPIRATORY CARE, 10TH ED 09-04-2024 21