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BLOOD GAS ANALYSIS

Hasanul Arifin Departemen Anestesiologi dan ReanimasiDepartemen Anestesiologi dan Reanimasi

FKUSU – RSUP. H. Adam Malik FKUSU – RSUP. H. Adam Malik MedanMedan

Apa yang Apa yang dibaca ?dibaca ?

pH, PaCO2, BEpH, PaCO2, BE

HCO3, PaO2, HCO3, PaO2, SaO2SaO2

Hasanul-2004

STEPS IN ACIDS BASE CLASSIFICATION

1. pH Classification

2. PaCO2 Classification

3. Metabolic Classification

4. Compensation Evaluation

5. Complete Acid-Base Classification

Hasanul-2004

pH Classification

Classification

Normal

Acidosis

Alkalosis

pH

7.35-7.45

< 7.35

>7.45

Hasanul-2004

Classification of Laboratory

Respiratory Acid-Base Component

Classification

Normal Resp.ComponentNormal Resp.Component

Respiratory AcidosisRespiratory Acidosis

Respiratory AlkalosisRespiratory Alkalosis

PaCO2 (mmHg)

35-4535-45

>45>45

<35<35

Hasanul-2004

Classification of Laboratory

Metabolic Acid-Base Component

Classification

Normal Metab.Component

Metabolic Acidosis

Metabolic Alkalosis

BE

0±2

< -2

> +2

HCO3

24±2

<22

>26

Hasanul-Hasanul-20042004

Langkah LangkahLangkah Langkah

• Baca pH Baca pH normal, normal, acidosisacidosis, , alkalosisalkalosis• Lihat PaCO2 atau BE, mana yg searah dengan pHLihat PaCO2 atau BE, mana yg searah dengan pH• Bila Bila PaCO2PaCO2 yang searah yang searah respiratorik respiratorik sebagai sebagai

proses primerproses primer• Bila Bila BEBE yang searah yang searah metabolikmetabolik sebagai proses sebagai proses

primerprimer• Bila Bila proses primerproses primer sudah diketahui, lihat dimana sudah diketahui, lihat dimana

posisi komponen yg lain :posisi komponen yg lain : Bila berlawanan Bila berlawanan proses kompensasi proses kompensasi Bila searah Bila searah proses ganda proses ganda Bila posisi normal Bila posisi normal belum atau tidak ada proses belum atau tidak ada proses

kompensasikompensasi

hasanul-2004

7,357,35

4545

-2-2

2222

7,457,45

3535

+2+2

2626

pHpH

PaCOPaCO22

BEBE

HCOHCO33

ACIDOSISACIDOSIS ALKALOSIALKALOSISS

Eddy Rahardjo1990/Hasanul-2004

pH : 7.28, PaCO2 : 40, BE : -10pH : 7.28, PaCO2 : 40, BE : -10

7,357,35

4545

-2-2

2222

7,457,45

3535

+2+2

2626

pHpH

PaCOPaCO22

BEBE

HCOHCO33


7.287.28

-10-10

4040

Acidosis metabolik tanpa Acidosis metabolik tanpa kompensasikompensasi

hasanul-2004

pH : 7.32, PaCO2 : 55, BE : +1pH : 7.32, PaCO2 : 55, BE : +1

7,357,35

4545

-2-2

2222

7,457,45

3535

+2+2

2626

pHpH

PaCOPaCO22

BEBE

HCOHCO33


7.327.32

Acidosis respiratorik tanpa Acidosis respiratorik tanpa kompensasikompensasi

5555

++11

hasanul-2004

7,357,35

4545

-2-2

2222

7,457,45

35 35

+2+2

2626

pHpH

PaCOPaCO22

BEBE

HCOHCO33


pH : 7,50 ; PaCO2 : 30 ; BE : -2 ;pH : 7,50 ; PaCO2 : 30 ; BE : -2 ;

7,507,50

3030

Alkalosis respiratorik tanpa Alkalosis respiratorik tanpa kompensasikompensasi hasanul-2004

7,357,35

4545

-2-2

2222

7,457,45

35 35

+2+2

2626

pHpH

PaCOPaCO22

BEBE

HCOHCO33


pH : 7,55 ; PaCO2 : 30 ; BE : +5 ;pH : 7,55 ; PaCO2 : 30 ; BE : +5 ;

7,557,55

3030

Alkalosis respiratorik dan metabolik Alkalosis respiratorik dan metabolik (proses ganda)(proses ganda)

+5+5

Hasanul-2004

Steps in Evaluation and Classification of Acid-Base Compensation

1. Evaluate for the presence of Evaluate for the presence of compensationcompensation

2.2. Determine the probable primary Determine the probable primary problemproblem

3.3. Classify the degree of compensationClassify the degree of compensationHasanul-2004

Determination of the primary

problempH 7.40-7.45

pH 7.35-7.40

Alkalosis is primary

Acidosis is compensatory

Acidosis is primary,

Alkalosis is compensatory Hasanul-2004

Classification of degree of Compensation

pH

7.35-7.45

<7.35

>7.45

Degree of compensation

Complete

Partial

PartialHasanul-2004

7,357,35

4545

-2-2

2222

7,457,45

35 35

+2+2

2626

pHpH

PaCOPaCO22

BEBE

HCOHCO33



7,487,48

3030

Alkalosis respiratorik dgn kompensasi Alkalosis respiratorik dgn kompensasi parsialparsial

-6-6

hasanul-2004


7,357,35

4545

-2-2

2222

7,457,45

3535

+2+2

2626

pHpH

PaCOPaCO22

BEBE

HCOHCO33


7.327.32

-10-10

3030

Acidosis metabolik dgn Acidosis metabolik dgn kompensasi kompensasi parsialparsial

hasanul-2004


7,357,35

4545

-2-2

2222

7,457,45

3535

+2+2

2626

pHpH

PaCOPaCO22

BEBE

HCOHCO33


-10-10

3030

Acidosis metabolik dgn Acidosis metabolik dgn kompensasi kompensasi penuhpenuh

7,387,38

Hasanul-2003

7,357,35

4545

-2-2

2222

7,457,45

35 35

+2+2

2626

pHpH

PaCOPaCO22

BEBE

HCOHCO33



7,437,43

3030

Alkalosis respiratorik dgn kompensasi Alkalosis respiratorik dgn kompensasi penuhpenuh

-6-6

Hasanul-2003

CLASSIFICATION of PaOCLASSIFICATION of PaO22

CLASSIFICATIONCLASSIFICATION

HyperoxemiaHyperoxemia

NormoxemiaNormoxemia

Mild hypoxemiaMild hypoxemia

Moderate Moderate hypoxemiahypoxemia

Severe hypoxemiaSevere hypoxemia

AdultAdult

>100>100

80-10080-100

60-7960-79

45-5945-59

<45<45

NewbornNewborn

>90>90

60-9060-90

50-5950-59

40-4940-49

<40<40

PaOPaO2 2 (mmHg)(mmHg)

Hasanul-2003

Severity of Generalized Acid-Base Severity of Generalized Acid-Base disturbancesdisturbances

pHpH

<7,20<7,20

7,20-7,297,20-7,29

7,30-7,347,30-7,34

7,35-7,457,35-7,45

7,46-7,507,46-7,50

7,51-7,557,51-7,55

>7,55>7,55

Degree of Degree of ImpairmentImpairment

Severe AcidosisSevere Acidosis

Moderate Moderate AcidosisAcidosis

Mild AcidosisMild Acidosis

Normal pHNormal pH

Mild AlkalosisMild Alkalosis

Moderate Moderate AlkalosisAlkalosis

Severe AlkalosisSevere Alkalosis

Hasanul-2003

Normal Arterial GasesNormal Arterial Gases

ParameterParameter

pHpH

PaCOPaCO22

PaOPaO22

SaOSaO22

ValuesValues

7,35-7,457,35-7,45

35-45 mmHg35-45 mmHg

80-100 mmHg80-100 mmHg

98-100%98-100%Hasanul-2003

Normal mixed venous gasesNormal mixed venous gases

ParameterParameter

pHpH

PaCOPaCO22

PaOPaO22

SaOSaO22

ValuesValues

7,387,38

48 mmHg48 mmHg

40 mmHg40 mmHg

75%75%Hasanul-2003

1. 7,58 20 19 63

2. 7,44 52 34 28

3. 7,21 66 26 47

4. 7.44 31 20 111

5. 7,60 28 27 59

6. 7,50 50 37 75

7. 7,41 42 25 229

8. 7,52 41 32 49

9. 7,44 28 35 87

10. 7,44 35 23 97

No. pH PaCO2 HCO3 PaO2 ClassificationNo. pH PaCO2 HCO3 PaO2 Classification

Hasanul-2003

1. 7.32 30 -10 58

2. 7.52 34 +4 32

3. 7.36 32 - 4 145

4. 7.42 30 - 5 90

5. 7.20 50 - 9 60

6. 7.20 80 +2 90

7. 7.55 25 0 72

8. 7.34 30 - 9 41

9. 7.37 56 +4 57

10. 7.40 38 - 2 350

No.No. pH PaCO2 BE PaO2 ClassificationpH PaCO2 BE PaO2 Classification

Hasanul-2003

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