Acid and Base Balance and Imbalance-investigations and case discussion Dr. WASIF ALI KHAN MD-PATHOLOGY (UNIVERSITY OF BOMBAY) Assistant Prof. in Pathology Al Maarefa College

Normal reference values pH—blood-7.35 to 7.45-avg-7.4 The normal reference range for PaCO 2 is mm Hg. The normal reference range for PaO 2 is mm of Hg. Normal bicarbonate level-HCO3 – 22–26 mEq/L O 2 saturation— %

Blood gas analyser

Pulse Oximeter

Step-wise interpretation of ABG Report pH pCO 2 HCO 3 O 2 saturation.

Case-no-1 A 40 year old female patient presented in the emergency department in a stuporous state. Her relative gave history of diabetes mellitus of 8 years duration. Clinically her skin was warm and breath had a sweet odor with deep and rapid respiration.

Blood report Blood sugar- 350mg/dl. pH Pco mm of Hg (normal—35-45 mm of Hg). HCO mEq/l—(Normal mEq/l). O 2 saturation—95%-( Normal is %)

Questions 1) What does the history of patient indicate? 2) What is the cause of sweet odor? 3) What is the cause of stuporous state? 4) What is the cause of rapid breathing? 5) Interpret laboratory data. 6) What is your diagnosis? 7) how will you treat this patient?

17 Question no-2 A patient is in intensive care because he suffered a severe myocardial infarction 3 days ago. The lab reports the following values from an arterial blood sample: – pH 7.3 – HCO3- = 20 mEq / L ( ) – pCO2 = 32 mm Hg ( )

18 Diagnosis Metabolic acidosis With compensation

Question 3 A 70 year chronic smoker was admitted with complaints of restlessness, breathlessness and productive cough.

Blood report pH Pco mm of Hg (normal—35-45 mm of Hg). HCO mEq/l—(Normal mEq/l). O 2 saturation—85%-( Normal is %)

Diagnosis Respiratory Acidosis with compensation.

ABG Report – pH 7.3 – pCO2 = 32 mm Hg ( ) – HCO3- = 20 mEq / L ( ) O2 saturation is normal.