ACID BASE BALANCE AND

ARTERIAL BLOOD GASES

MOHAMED ZUBAIR BIN ISMAIL

The pH is measurement of the acidity or alkalinity of
the blood
Arterial blood gas (ABG) test measures oxygen and
carbon dioxide levels in blood

https://www.medicinenet.com>main>art
https://www.webmd.com/lung/arterial-blood-gas-test
 pH
(7.35 – 7.45)
ACIDIC ALKALOTIC
<7.35 >7.45

Arterial Blood Gases Made Easy second edition page 27

ARTERIAL BLOOD GASES
PURPOSE

INDICATION

CONTRAINDICATION

COMPLICATION
PURPOSE
• Measurement of oxygen and carbon dioxide levels in blood (how
well the lungs can provide adequate oxygen to the body and
subsequently remove carbon dioxide). Kidney & lungs work to
maintain the acid base balance.
• Also measure pH level, which is normally balanced when healthy
• When inhale and exhale, your lungs move oxygen into your
blood and push carbon dioxide out. That process called gas
exchange.

https://www.medicinenet.com>main>srt
https://www.webmd.com/lung/kidney/arterial-blood-gas-test
INDICATION
• Respiratory Failure
• Cardiac Failure
• Liver Failure
• Renal Failure
• Multiorgan Failure
• Sepsis
• Toxin
• Ventilated patients

https://patient.info/doctor/arterial-blood-gases-indications-
and-interpretation
CONTRAINDICATION

• Severe coagulopathy
• Anticoagulation theraphy
• Absent ulnar circulation
• Arteriovenous fistula
• History of arterial spasms
Nottingham University Hospital/perfoming arterial blood gas
sampling page 5
COMPLICATION

• Hematoma
• Severe Bleeding
• Infection
• Thrombus
• Nerve Damage
https://www.ncbi.nlm.nih.gov/books
ABG INTERPRETATION

6 Easy Steps to ABG Analysis E-Booklet page 3 & 4

ACID BASE DISORDER
RESPIRATORY ACIDOSIS

• Lungs cant remove enough of the carbon dioxide (Co2)

• When air inhaled into and exhaled from the lungs does not get
adequately exchanged between Co2 from the body for O2 from
the air

https://www.medicalnewstoday.com/articles/313110.php
SIGNS AND SYMPTOMS OF RESPIRATORY ACIDOSIS

dyspnea Respiratory Shallow

Pulmonary
distress respirations

Neurological headache restlessness confusion

Cardiovascular tachycardia dysrhythmiaas

Interpretation of the Arterial Blood Gas/self learning packet

page 6
RESPIRATORY ACIDOSIS CAUSES

• Central nervous system depression

• Neuromuscular disorder
• Chest wall abnormalities
• Pleural abnormalities
• Airway obstruction
• Lung disease
• Ventilator malfunction
Morgan & Mikhail’s Clinical Anesthesiology page 1149
RESPIRATORY ALKALOSIS

• Levels of carbon dioxide and oxygen in the blood are not balanced
• When inhale introduce oxygen into the lungs. When exhale release carbon
dioxide (waste product)
• Breathe too fast or too deep low. This causes the pH of the blood to rise and
become too alkaline

https://www.healthline.com/health/respiratory-
alkalosis#treatment
 SIGN AND SYMPTOM OF RESPIRATORY ALKALOSIS
Miscellaneous

Light Numbness
headedness dysrhythmias Dry mouth
and tingling

Tetanic
Inability to spasms of
confusion palpitations
concentrate the arm and
legs

Blurred
vision diaphoresis

Interpretation of the Arterial Blood Gas/self learning packet

page 7
RESPIRATORY ALKALOSIS CAUSES
• Pain
• Anxiety
• Stroke
• Fever
• Hypoxemia
• Pulmonary disease
• Sepsis
• Ventilator induced
Morgan & Mikhail’s Clinical Anesthesiology page 1154
METABOLIC ACIDOSIS

• Body produce excessive quantities of acid or when

the kidneys are not removing enough acid from the
body
SIGN AND SYMPTOM METABOLIC ACIDOSIS
Neurological Cardiovascular Pulmonary Gastrointestinal

Kussmaul’s Nausea and

headache confusion dysrhythmias
respirations vomiting

Stupor or Warm,
lethargy
coma flushed skin

restlessness
Interpretation of the Arterial Blood Gas/self learning packet
page 8
METABOLIC ACIDOSIS CAUSES

• Renal failure
• Ketoacidosis
• Alcoholic
• Ingestion of toxin
Morgan & Mikhail’s Clinical Anesthesiology page 1151
METABOLIC ALKALOSIS

• A disorder that elevates the serum bicarbonate, can result

from several mechanisms ( intracellular shift of hydrogen
ions, gastrointestinal loss of hydrogen ions, excessive renal
hydrogen ion loss

https://www.osmosis.org/lean/Metabolic_alkalosis
SIGN AND SYMPTOM METABOLIC ALKALOSIS

Pulmonary Neurological Musculoskeletal Gastrointestinal

Respiratory dizziness Muscle

lethargy weakness nausea
depression twitching

coma seizure Muscle

tetany vomiting
cramps

disorientation

Interpretation of the Arterial Blood Gas/self learning packet

page 9
METABOLIC ALKALOSIS CAUSES

• Gastrointestinal (vomiting, gastric drainage, diarrhea)

• Renal (diuretics, low chloride intake)
• Severe hypokalemia
• Miscellaneous (massive blood transfusion)

https://www.medicalnewstoday.com/articles/313110.php
 CASE SCENARIO
• History
A 25 years old man, with no significant medical history, present to
emergency department with a 2 day history of fever, productive cough and
worsening breathlessness
• Examination
He is hot and flushed with a temperature of 39.0 *C. he does not appear
distressed but is using accessory muscle of respiration. There is diminished
chest expansion on the left with dullness to percussion, bronchial breathing
and coarse crackles in the left lower zone posteriorly

PULSE RATE 104 beats/min

RESPIRATORY RATE 28 breaths/min
BLOOD PRESSURE 118/70 mmHg
SPO2 (ROOM AIR) 89 %
 NORMAL VALUE
H+ 31.8 mmol/L 35 – 45
pH 7.50 7.35 – 7.45
PCO2 28.1 mmHg 35 – 45
PO2 57.8 mmHg >80
Bicarb 23.9 mmol/L 22 – 28
BE -0.5 mmol/L -2 to +2
S02 88.7 % >96 %
K 3.7 mmol/L 3.5 – 5
Na 138 mmol/L 135 – 145
Hb 15 g/dL 13 – 18
Glucose 5.4 mmol/L 3.5 – 5.5

QUESTIONS
1. a) describe her gas exchange
b) describe her acid base status
2. should the patient receive supplemental O2?
 NORMAL VALUE
H+ 31.8 mmol/L 35 – 45
pH 7.50 7.35 – 7.45
PCO2 28.1 mmHg 35 – 45
PO2 57.8 mmHg >80
Bicarb 23.9 mmol/L 22 – 28
BE -0.5 mmol/L -2 to +2
S02 88.7 % >96 %
K 3.7 mmol/L 3.5 – 5
Na 138 mmol/L 135 – 145
Hb 15 g/dL 13 – 18
Glucose 5.4 mmol/L 3.5 – 5.5

ANSWER
• 1. a) type 1 respiratory failure
b) uncompensated respiratory alkalosis
• 2. yes
CASE SCENARIO
• History
A 35 years old woman with type 1 diabetis mellitus is brought to the
emergency department by ambulance after being found severely unwell in
her house. Following a discussion with her partner, she has not been eating
for the past few days due to a vomiting illness and as a precaution, has also
been omitting her insulin
• Examination
on examination, she appears drowsy and dry mucous membranes. Her
breath smells of acetone and her respirations are deep and sighing
PULSE RATE 88 beats/min
RESPIRATORY RATE 22 breaths/min
BLOOD PRESSURE 124/76 mmHg
SPO2 (ROOM AIR) 90 %
DXT 25 mmol/L
 NORMAL VALUE
H+ 88.9 mmol/L 35 – 45
pH 7.05 7.35 – 7.45
ON 10L O2 BY MASK PCO2 11 mmHg 35 – 45
PO2 187 mmHg >80
Bicarb 6.0 mmol/L 22 – 28
BE -25.2 mmol/L -2 to +2
S02 99.8 % >96 %
K 4.6 mmol/L 3.5 – 5
Na 141 mmol/L 135 – 145
Hb 12 g/dL 11.5 – 16
Glucose 35 mmol/L 3.5 – 5.5

1. a) describe her gas exchange

b) describe her acid base status
2. What is the most likely diagnosis
 NORMAL VALUE
H+ 88.9 mmol/L 35 – 45
pH 7.05 7.35 – 7.45
PCO2 11 mmHg 35 – 45
PO2 187 mmHg >80
Bicarb 6.0 mmol/L 22 – 28
BE -25.2 mmol/L -2 to +2
S02 99.8 % >96 %
K 4.6 mmol/L 3.5 – 5
Na 141 mmol/L 135 – 145
Hb 12 g/dL 11.5 – 16
ANSWER Glucose 35 mmol/L 3.5 – 5.5

1. a) hyperventilation (secondary)
b) severe metabolic acidosis with partial compensation
2. Diabetic ketoacidosis
THANK YOU