Pao2   87mm HgSao2   94pH   7.38Paco2   48mm HgHCO3 –   28 mEq/l

Analyze ABG in 4 steps

Step 1 ExaminePaO 2 and SaO2values

PaO 2 = 87mmHg

Acceptable range : 80mmHg – 100mmHg

Hence, PaO 2 value considers NORMAL.

SaO2 = 94%

Acceptable range : 93% - 100% or 95%-100%

Hence, SaO2 value still considers NORMAL.

Step 2 Study pH value to identify the presence of acidosis or alkalosis

Normal value of pH = 7.4 ; Acceptable range = 7.35 – 7.45From the report, pH value = 7.38

Hence, the patient’s pH value is within the acceptable range but it is slightly acidic if compared with the normal value.

Step 3 Determine PaC O2 and HCO3 values

Normal value = 40 mmHg ; Acceptable range = 35 – 45 mmHg

PaCO2 = 48mmHg ( Increased )

Patient’s PaCO2 value is neither in the normal or acceptable range. ↑PaCO2 means RESPIRATORY ACIDOSIS Increased CO2 in arterial blood also indicates hypercapnia.

Normal value = 24 mEq/L ; Acceptable range = 22 – 26 mEq/L

HCO3 = 28mEq/L ( Increased )

Patient’s H CO3 value is neither in the normal or acceptable range. ↑ HC O3 means METABOLIC ACIDOSIS

To determine respiratory or metabolic caused

According to Henderson Hasselbalch Equation :

pH= pK + log ¿¿

↓ pH due to ↑PaCO2 ; ↑ pH due to ↑ HCO3

The primary event in Respiratory Acidosis shows an elevation ofPaCO2 which results in decreased pH. Hence, patient is confirmed to having Respiratory Acidosis.

Step 4 Determine which compensatory mechanism is working

Body will attempt to return the acidic or alkaline status to normal during compensation.

When pH is restored to normal ( 7.4 ), full compensation has occurred.

But in this case,

Abnormal pH + change in PaCO2∧HCO3 = PARTIAL COMPENSATION

In conclusion , this patient is having partially compensated respiratory acidosis.

Chest X-ray Analysis

1: Homogenous density on the left chest

2 : Large hemithorax

3 : Obliteration of left hemidiaphragm

4 : Shifting of mediastinum and trachea away from effusion ; towards the normal side ( right side )

5 : Minimal blunting of right costophrenic angle

6 : Presence of gastric bubble

7 : Loss of silhouette sign of cardiac and left diaphragm

Finding = Large Pleural Effusion on Left side of Lung

References :

1. http://emedicine.medscape.com/article/355524-overview 2. Alexandra, H. (2001). Physiotherapy in Respiratory Care : An

Evidence-Based Approach to Respiratory and Cardiac Management (Third ed.). Lucy Mills.