BloodGasAnalysis.pptVIP

AE(VINAYAKA) Blood Gas Analysis Dr. Prakash Mohanasundaram Department of Emergency Critical Care medicine Vinayaka Missions University Primary Compensatory changes Primary change Compensation Respiratory acidosis PaCO2 [HCO3] Respiratory alkalosis PaCO2 [HCO3] Metabolic acidosis [HCO3] PaCO2 Metabolic alkalosis [HCO3] PaCO2 THE SIX STEP APPROACH The 6 step approach Acidemic or Alkalemic Is the primary disturbance respiratory or metabolic If Respiratory, is it acute or chronic If Metabolic, is there an anion gap? The 6 step approach Are there any other metabolic disturbances with the anion gap acidosis? Assess normal respiratory compensation for a metabolic disturbance. Step - 1 Acidemic or Alkalemic Acidemic : pH 7.35 Alkalemic : pH 7.45 Step - 2 Is the primary disturbance Respiratory or Metabolic Respiratory disorder will alter the PaCO2 High CO2 in acidosis ,Low CO2 in alkalosis Go to Step – 3 Step - 2 Metabolic disorder will alter the [HCO3] HCO3 22, metabolic acidosis “Go to Step-4” HCO3 26 ,metabolic alkalosis Step - 3 RESPIRATORY ACUTE CHRONIC Step - 3 Respiratory Acidosis Acute pH = 0.08 x (PaCO2 – 40 ) /10 Chronic pH = 0.03 x (PaCO2 – 40 ) /10 Step - 3 Respiratory Alkalosis Acute pH = 0.08 x (PaCO2 – 40 ) /10 Chronic pH = 0.03 x (PaCO2 – 40 ) /10 Respiratory Acidosis Hypoventilation : PaCO2 CNS depression : Sedatives , CNS disease Lung disease : Asthma , Chronic lung disease Musculoskeletal disorders : GBS , Myasthenia Respiratory Alkalosis Hyperventilation : PaCO2 CNS events ( hemorrhage) Drugs ( salicylates) Anxiety Step - 4 METABOLIC ACIDOSIS CHECK ANION GAP Step - 4 Anion Gap = Na- (Cl + HCO3) Usually 12 +- 2 Anion Gap Metabolic acidosis : AG 12 Non Anion Gap acidosis : AG 12 Anion Gap Metabolic