Hasanul Arifin

DepartemenAnestesiologidanReanimasi
FKUSURSUP.H.AdamMalikMedan
Apa yang dibaca ?
pH, PaCO2, BE
HCO3, PaO2,
SaO2
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.Component
Respiratory Acidosis
Respiratory Alkalosis

PaCO2 (mmHg)
35-45
>45
<35
Hasanul-2004
Classification of Laboratory
Metabolic Acid-Base Component
Classification
Normal Metab.Component
Metabolic Acidosis
Metabolic Alkalosis

BE
02
< -2
> +2
HCO3
242
<22
>26
Hasanul-2004
Baca pH normal, acidosis, alkalosis
Lihat PaCO2 atau BE, mana yg searah dengan pH
Bila PaCO2 yang searah respiratorik sebagai
proses primer
Bila BE yang searah metabolik sebagai proses
primer
Bila proses primer sudah diketahui, lihat dimana
posisi komponen yg lain :
Bila berlawanan proses kompensasi
Bila searah proses ganda
Bila posisi normal belum atau tidak ada proses
kompensasi
hasanul-2004
7,35
45
-2
22
7,45
35
+2
26
pH
PaCO
2
BE
HCO
3
ACIDOSIS ALKALOSIS
Eddy Rahardjo1990/Hasanul-2004
pH : 7.28, PaCO2 : 40, BE : -10
7,35
45
-2
22
7,45
35
+2
26
pH
PaCO
2
BE
HCO
3
ACIDOSIS ALKALOSIS
7.28
-10
40
Acidosismetaboliktanpakompensasi
hasanul-2004
pH : 7.32, PaCO2 : 55, BE : +1
7,35
45
-2
22
7,45
35
+2
26
pH
PaCO
2
BE
HCO
3
ACIDOSIS ALKALOSIS
7.32
Acidosisrespiratoriktanpakompensasi
55
+1
hasanul-2004
7,35
45
-2
22
7,45
35
+2
26
pH
PaCO
2
BE
HCO
3
ACIDOSIS ALKALOSIS
pH:7,50;PaCO2:30;BE:-2;
7,50
30
Alkalosisrespiratoriktanpakompensasi
hasanul-2004
7,35
45
-2
22
7,45
35
+2
26
pH
PaCO
2
BE
HCO
3
ACIDOSIS ALKALOSIS
pH:7,55;PaCO2:30;BE:+5;
7,55
30
Alkalosisrespiratorikdanmetabolik
(prosesganda)
+5
Hasanul-2004
Steps in Evaluation and Classification of
Acid-Base Compensation
1. Evaluate for the presence of compensation
2. Determine the probable primary problem
3. Classify the degree of compensation
Hasanul-2004
Determination of the
primary problem
pH 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
Partial
Hasanul-2004
7,35
45
-2
22
7,45
35
+2
26
pH
PaCO
2
BE
HCO
3
ACIDOSIS ALKALOSIS
pH:7,48;PaCO2:30;BE:-6;
7,48
30
Alkalosisrespiratorikdgnkompensasiparsial
-6
hasanul-2004
pH : 7.32, PaCO2 : 30, BE : -10
7,35
45
-2
22
7,45
35
+2
26
pH
PaCO
2
BE
HCO
3
ACIDOSIS ALKALOSIS
7.32
-10
30
Acidosismetabolikdgnkompensasiparsial
hasanul-2004
pH : 7.38, PaCO2 : 30, BE : -10
7,35
45
-2
22
7,45
35
+2
26
pH
PaCO
2
BE
HCO
3
ACIDOSIS ALKALOSIS
-10
30
Acidosismetabolikdgnkompensasipenuh
7,38
Hasanul-2003
7,35
45
-2
22
7,45
35
+2
26
pH
PaCO
2
BE
HCO
3
ACIDOSIS ALKALOSIS
pH:7,43;PaCO2:30;BE:-6;
7,43
30
Alkalosisrespiratorikdgnkompensasipenuh
-6
Hasanul-2003
CLASSIFICATION of PaO
2
CLASSIFICATION
Hyperoxemia
Normoxemia
Mildhypoxemia
Moderatehypoxemia
Severehypoxemia
Adult
>100
80-100
60-79
45-59
<45
Newborn
>90
60-90
50-59
40-49
<40
PaO
2
(mmHg)
Hasanul-2003
Severity of Generalized Acid-Base
disturbances
pH
<7,20
7,20-7,29
7,30-7,34
7,35-7,45
7,46-7,50
7,51-7,55
>7,55
DegreeofImpairment
SevereAcidosis
ModerateAcidosis
MildAcidosis
NormalpH
MildAlkalosis
ModerateAlkalosis
SevereAlkalosis
Hasanul-2003
Normal Arterial Gases
Parameter
pH
PaCO
2
PaO
2
SaO
2
Values
7,35-7,45
35-45 mmHg
80-100 mmHg
98-100%
Hasanul-2003
Normal mixed venous gases
Parameter
pH
PaCO
2
PaO
2
SaO
2
Values
7,38
48 mmHg
40 mmHg
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 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. pH PaCO2 BE PaO2 Classification
Hasanul-2003
Kam shia