Blood Chemistry

Jake West

What techniques do pathologists use to determine blood ion

concentration?

How reliable are the tests? How accurate are the results?

How reasonable are the reference ranges used by pathologists?

Why might an individual's blood solute concentration be outside the

reference range?
o

What, if any, issues arise when this occurs?

What, if any, action should be taken when blood ion concentration lies
outside the normal range?

Introduction
The task of maintaining a stable acid-alkali balance and pH level is vital for a
healthy blood ion concentration (MJ Bookallil, 2008) . Pathologists compare the
plasma concentrations from blood samples against set reference ranges and
analyse the normal values of partial pressure carbon dioxide and oxygen as well
as the pH level of the sample to deduce and diagnose the manifestation of
disease. Abnormal results outside these reference ranges can be induced by
several conditions including starvation, diabetes, asthma and many more
conditions. It is important to have knowledge of blood chemistry and blood solute
concentration within society because it offers pathologists and doctors the ability
to diagnose disease as well as treat and cure the chemical imbalance within the
blood.
What techniques do pathologists use to determine blood ion
concentration?
The main technique used to determine blood ion concentration by pathologists is
known an Arterial Blood Gases analysis or ABG (D Hadjiliadis, 2014). The ABG
technique is used because it is very precise and has very little risks or side
effects. The ABG is used to determine the partial pressure of oxygen and carbon
dioxide within the individuals blood stream as well as determining the pH of the
individuals blood. The test is done so pathologists can examine and asses the
lung and respiratory diseases or conditions that could affect the individuals blood
health as well as the acid and base balance which could affect the blood ion
concentration. The risks involved are minimal if the ABG procedure is done
properly, the risks involved are purely based on the individuality of each patient,
varying artery size and slight displacement of the veins in each patient (D
Hadjiliadis, 2014).
How reliable are the tests? How accurate are the results?
The reliability and accuracy of the results are very reliable with in the singular
laboratory (D Hadjiliadis, 2014). This means when the ABG is done on the same
sample of blood by two or more different laboratory the result changes. This is
because laboratories use different standards to compare their observations and
measurements against while other laboratories use different standards again.
Reliability and accuracy of AGB within the one laboratory is very accurate
because the standards and reference ranges are the same for every test done
within that laboratory. The actual accuracy of the AGB itself is usually reliable to
minute human error (D Hadjiliadis, 2014). The only factor that can affect the
results and the testing and is uncontrollable is that of the elevation of the test;
any sample taken or test undertaken over 900 metres above sea level will affect
the oxygen level of the blood sample.
How reasonable are the reference ranges used by pathologists?
The reference range of the ABG used by pathologists is very strict; normal
arterial blood pH is between 7.38 and 7.42, a 0.04 range, the normal range of

the partial pressure of carbon dioxide is 38 to 42 mmHg, a 4 mmHg range (D

Hadjiliadis, 2014). The reference range used by the pathologists need to be very
strict and precise because abnormal can be a single decimal out of the normal
range and untreated or diagnosed can lead to severe and deadly consequences.
These reference ranges used by pathologists demand that the blood ion
concentration be slightly alkaline, approximately the 7.4 pH level, as well as the
partial pressure of oxygen being quite high, between 75 to 100 mmHg, and the
partial pressure of carbon dioxide to be low, between 38 to 42 mmHg, for the
state of the individuals blood to be healthy and within a normal range (D
Hadjiliadis, 2014).

Why might an individual's blood solute concentration be outside the

reference range?
Disturbances of the blood solute concentration of an individual can be classified
in two singular groups; the first being respiratory and the second metabolic or
non-respiratory (MJ Bookallil, 2008). The reasons that disturbances are grouped
in to respiratory and metabolic is because the treatment for the two groups differ
depending on whether it is respiratory or metabolic and that the disturbances of
each group can be concealed by different mechanisms of the body.
The first sub category of respiratory disturbance in the blood solute
concentration is respiratory acidosis. Respiratory acidosis is directly linked to the
retention of carbon dioxide and is commonly considered an indication of
hypoventilation (MJ Bookallil, 2008). This retention of carbon dioxide causes the
individuals blood to become too acidic. This can be induced through several
causes that affect the chest or lungs of an individual. There are several diseases
that affect the removal of carbon dioxide from the lungs such as asthma or
scoliosis or drugs that suppress breathing abilities, sever sleep apnea and
serious obesity can also affect an individuals breathing capabilities (C Dugdale,
2012). Chronic respiratory acidosis builds up over a long period of time and
allows the kidneys to become attune to the pH alteration in the blood. Acute
respiratory acidosis develops over a very short period of time and does not allow
the kidneys to become familiar with the acid-base destabilisation. Respiratory
acidosis can cause poor function of the individuals organs and possible failure of
the respiratory system. Patients suffering acute respiratory acidosis can also go
into a state of shock (MJ Bookallil, 2008).
The second sub category of respiratory blood solute concentration is respiratory
alkalosis. Respiratory alkalosis is the opposite of respiratory acidosis (D
Hadjiliadis, 2014); instead of an over exposure to carbon dioxide, respiratory
alkalosis is initiated by low levels of carbon dioxide found in the individuals
blood, produced by excessive breathing, causing the blood of the individual to
become alkali instead of acidic. Respiratory alkalosis is initiated through
excessive breathing; this can be cause by hyperventilation or lung diseases that
cause shortness of breath. This respiratory alkalosis can induce dizziness or light
headedness as well as numbness in the hands and feet, if the respiratory

alkalosis is severe this can cause seizures, though this is very erratic (MJ
Bookallil, 2008).
The second group of disturbance, metabolic disturbances of blood solute
concentration, has the identical sub categories as the respiratory disturbances
but are initiated by different causes and have different complications and
treatments than their respiratory counterparts. Metabolic acidosis is where the
bodily fluids of an individual become too acidic (C Dugdale, 2013). There are
several types of metabolic including diabetic acidosis caused by uncontrollable
type 1 diabetes, hyperchloremic acidosis caused by an intense loss of sodium
bicarbonate from the individuals body, usually through extreme diarrhoea, and
lactic acidosis, caused by an excessive amassing of lactic acid initiated through
several causes for example; alcohol, cancer, liver failure, medication and other
prompts. Serious metabolic acidosis can initiate a state of shock or if it is
extremely severe metabolic acidosis it can lead to death.
The second metabolic blood solute concentration disturbance is metabolic
alkalosis where the bodily fluids are over alkali, the opposite too metabolic
acidosis (B Wisse, 2013). Metabolic alkalosis is caused by an excess of
bicarbonate in the blood stream of an individual and the expulsion of sodium by
the body, it can also be initiated through some kinds of kidney disease. Metabolic
alkalosis can lead to confusion, nausea, numbness in the face, fingers and toes
and muscle twitching, if the alkalosis becomes severe and untreated it can lead
to a comatose state, an electrolyte imbalance or heart disorders such as
arrhythmias (B Wisse, 2013).
What, if any, action should be taken when blood ion concentration lies
outside the normal range?
Treatment for blood ion concentration depends on how the ion concentration of
the blood has been disturbed; the four sub categories: respiratory acidosis
disturbance, respiratory alkalosis disturbance, metabolic acidosis disturbance
and metabolic alkalosis disturbance. The aim of treatment for all four
disturbances is to get the pH level of the blood back to its normal level, between
7.38 and 7.42 (D Hadjiliadis, 2014). Treatment for respiratory acidosis is the
simplest treatment of the four disturbances. Instead of treating the targeting
acidosis itself treatment for respiratory acidosis is targeted at the disease or
condition that caused the acidosis originally, lowering the acidity of blood ion
concentration, this can be through medication, direct administration of oxygen or
breathing machines, depending on the severity of the acidosis. Treatment for
respiratory alkalosis is purely aimed at the alkalosis itself and raising the acidity
of the blood ion concentration (C Dugdale, 2012). The first step of treatment for
respiratory alkalosis is identifying cause; most commonly this would be
hyperventilation (MJ Bookallil, 2008). The second step would be raising the
partial pressure of carbon dioxide of the blood; this can be done by directly
administrating carbon dioxide to the blood but usually the technique rebreathing
of carbon dioxide is used, breathing in and out of a paper bag. Treatment for a
metabolic acidosis disturbance, like the treatment for respiratory acidosis, is
targeted at the underlying cause or disease that initially triggered the metabolic

acidosis (C Dugdale, 2013). Once the cause or disease has been treated or
medicated, the acidosis must correct. To lower the acidity of the individuals
blood ion concentration, bicarbonate must either be ingested or injected in to the
individuals blood stream. Metabolic alkalosis treatment is similar to the
treatment of respiratory alkalosis in which it targets the alkalosis itself and not
the underlying cause or disease, like the treatment for acidosis disturbances.
Treatment of metabolic alkalosis begins with identifying the cause and treating or
curing the cause (B Wisse, 2013)., once the cause has been removed or
controlled the aim is to increase the acidity of the blood ion concentration so it is
within the healthy reference range and regain the sodium expelled by the body
during alkalosis (MJ Bookallil, 2008). To do this a sodium chloride solution can
either be ingested or injected into the individual; approximately the same
amount of sodium should be in taken as was expelled by the body.
Conclusion
Blood chemistry is an enormous step forward for society and engages in a vital
function within medical world. Blood chemistry allows doctors to firstly identify
and diagnosed patients with blood ion concentration related diseases, respiratory
and metabolic, as well as detect and isolate the underlying disease or cause;
including diabetes, leukaemia, hypoxia and many more. Blood chemistry doesnt
just allow for identification of disease but knowledge of blood chemistry also
permits pathologists and doctors to treat and cure both the blood ion
concentration related disease as well as the underlying disease or cause. Blood
chemistry may not be a major factor within society as a whole but it has saved
thousands of lives through early recognition (Cancer Council, 2015) and has
changed and shaped the lives of the individuals it has influenced

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