Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic...

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Blood Gases Made Easy Trevor Allison IFCC TF-POCT Director R&D, Siemens HC POC, UK POCT Meeting – Cancun, Mexico November 16 th & 17 th 2015

Transcript of Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic...

Page 1: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Blood Gases Made EasyTrevor Allison

IFCC TF-POCT

Director R&D, Siemens HC POC, UK

POCT Meeting – Cancun, Mexico November 16th & 17th 2015

Page 2: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Life is all about balance…

Page 3: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

-94º C

+56º C

Page 4: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

37 ± 0.5℃

Page 5: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30
Page 6: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30
Page 7: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

Similarly, the pH of body fluids is optimized,

in particular blood pH…

Page 8: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

0 14

7.40

7

7.35 – 7.45

Acid Alkali (Base)

H+H+

Acidosis Alkalosis

pH = log10

1

H+

Page 9: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

7.35 – 7.45

Acidosis Alkalosis

Arterial blood pH

Patient A 7.28

Patient B 7.51

Patient C 7.34

Patient D 7.46

Normal

Acidosis

Alkalosis

Acidosis

Alkalosis

Page 10: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

Henderson – Hasselbach equation

pH = 6.1 + log10 0.03 𝑥

[HCO-3]

pCO2

Page 11: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

Normal range

pH 7.35 7.45

pCO2 35 45 mmHg

HCO3- 22 26 mmol/L

pH = 6.1 + log10 0.03 𝑥

2440

[HCO-3]

pCO2

pH = 7.40

Page 12: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

7.35 – 7.45Acidosis Alkalosis

High

pCO2

Low

HCO3-

Low

pCO2

High

HCO3-

Page 13: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

pH ∝HCO

3⁻

𝑝CO2

Metabolic

Respiratory

Page 14: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

Le Chatelier’s principle

CO2 + H20 H2CO3 H+ + HCO3-

Carbonic Anhydrase

Page 15: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

7.35 – 7.45Acidosis Alkalosis

High

pCO2

Low

HCO3-

Low

pCO2

High

HCO3-

Respiratory

Acidosis

Metabolic

Acidosis

Respiratory

Alkalosis

Metabolic

Alkalosis

Page 16: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

High pCO2 Low HCO3-

Low pCO2 High HCO3-

Respiratory

Acidosis

Metabolic

Acidosis

Respiratory

Alkalosis

Metabolic

Alkalosis

pH pCO2 HCO3-

Patient A 7.28 51 23

Patient B 7.51 32 25

Patient C 7.30 40 19

Patient D 7.55 35 30

Respiratory Acidosis

Respiratory Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

Normal range

pH 7.35 7.45

pCO2 35 45 mmHg

HCO3- 22 26 mmol/L

Page 17: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

Compensation

pH pCO2 HCO3-

Patient A 7.28 51 23 Respiratory Acidosis

3 responses to the change in equilibrium Response time

1. Buffers in the blood Quickly

2. Respiratory Fairly quickly

3. Metabolic Slowly

Page 18: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

Compensation

3 responses to the change in equilibrium

1. Buffers in the blood

pH

Acid added Base added

7.4

Page 19: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

Compensation

3 responses to the change in equilibrium

1. Buffers in the blood

2. Respiratory

pH ∝HCO

3⁻

𝑝CO2

Page 20: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

Compensation

3 responses to the change in equilibrium

1. Buffers in the blood

2. Respiratory

3. Metabolic

pH ∝HCO

3⁻

𝑝CO2

Page 21: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

Compensation

7.35 – 7.45Acidosis Alkalosis

High

pCO2

Increase

HCO3-

Low

pCO2

Decrease

HCO3-

Page 22: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Acid – Base Balance

Compensation

7.35 – 7.45Acidosis Alkalosis

Decrease

pCO2

Low

HCO3-

Increase

pCO2

High

HCO3-

Page 23: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Arterial blood pH

pH 7.35 7.45

pCO2

HCO3- 22 26

35 45

Page 24: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Arterial blood pH

pH 7.35 7.45

pCO2 45 35

HCO3- 22 26

Acid Normal Base Patient A

pH 7.28

pCO2 51

HCO3- 23

pH

pCO2 HCO3-

Uncompensated

Respiratory Acidosis

Page 25: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Arterial blood pH

Acid Normal Base Patient B

pH 7.70

pCO2 24

HCO3- 21

pH

pCO2

HCO3-

Partially compensated

Respiratory Alkalosis

pH 7.35 7.45

pCO2 45 35

HCO3- 22 26

Page 26: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Arterial blood pH

Acid Normal Base Patient C

pH 7.45

pCO2 48

HCO3- 28

pHpCO2 HCO3-

Fully compensated

Metabolic Alkalosis

pH 7.35 7.45

pCO2 45 35

HCO3- 22 26

Page 27: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Arterial blood pO2

Normal range for pO2 in arterial blood is 80 – 100 mmHg

(assuming room air at sea level of circa 160 mmHg)

60 - 79 mmHg mild hypoxia

40 - 59 mmHg moderate hypoxia

< 40 mmHg severe hypoxia

Mexico City

Altitude 2240 metres, BP 585mmHg

Room air pO2 circa 123 mmHg

Normal range 62 to 77 mmHg

Page 28: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Arterial blood pO2

For a patient on oxygen therapy the FiO2 has to considered…

FiO2 Expected pO2 mmHg

30% 150

40% 200

50% 250

Rule of 5X

Page 29: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Blood Gas Interpretation

This is a basic guide to ABG result interpretation

Real life situations are often more complex

Acid Normal Base

pH

pCO2

HCO3-

Additional calculated parameters such as Anion Gap, tHb &

SaO2 can help diagnose root cause

Page 30: Blood Gases Made Easy · Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis pH pCO 2 HCO 3-Patient A 7.28 51 23 Patient B 7.51 32 25 Patient C 7.30

Thank you for your attention


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