:

1.1

1.2

1.3PaCO2HCO3

PH
PaO2
PaCO2
HCO3
BE
SpO2

PH

:7.35~7.45
(acid)(base)

(Acidemia)
(Alkalemia)
(Acidosis)
(Alkalosis)

-PaO2

:80-100mmHg

(/)
(ventilation/perfusion)

Ventilation (V) v.s. Perfusion (Q)

Ventilation: alveolar gas

Perfusion: pulmonary capillary
The ratio of V/Q ranges from 0
(shunt) to (dead space)
Gas exchange depends on the proper
matching of ventilation and perfusion

-PCO2

PCO2:35~45 (38~42) mmHg

(ventilation)
PCO2 -

(Acid)

-HCO3

(HCO3)
: 22-26 meq / L

(Base)

HCO3/ PCO2=20/1PH

-BE

(Bass Excess):-2~+2

(Base)

HCO3
-
-

S8100390

2.

2.1Heparin11000----------------------------- 1

2.2 2ml------------------------------------------- 1-2

2.3----------------------------------------------- 1
HeparinHeparin-- 1

2.4AlcoholAlcohol B-I-----3

2.5---------------------------------------1

2.6 22------------------------------------------- 2

2.7 --------------------------------------------1

(1)

3.1

3.2

3.3Heparin

3.4

3.5

3.6Allen's test

3.7

3.8Alcohol B-I30Alcohol

(2)

3.9

3.1022

3.11

3.12

Allen's test

blood ABG

(oxygenation)

(alveolar ventilation)

(gas exchange)

(acid-base balance)

:80~100mmHg

98%-
2%-(ABG)
:<80mmhg
:<60mmhg
:<40mmhg

>60 - .PaO21mmHg
FiO210%. PaO250mmHg

Hypoventilation

Ventilation-Perfusion mismatch

Right to left shunt

Diffusion impairment

Hypoventilation

PCO2

-high cervical spine

injury
-flail chest.

Ventilation-Perfusion mismatch

V/Q mismatch

Obstructive lung diseases

Pulmonary vascular disease
paranchymal disease

Right to left shunt

lober pneumonia
Acute respiratory distress syndrome
pulmonary arteriovenous malfuntoin
intracardiac right-to-left shunt

Diffusion impairment

Interstitial fiberosis

PCO2

:35~45(38~42)mmHg

(hypoventilation):>50(42)mmHg

(hyperventilation):<30(38)mmHg

(gas exchange)

PaO2 / AaDO2

(ventilation/perfusion)

Alveolar to Arterial Oxygen Gradient

(A-aDO2)

PAO2=FiO2(PB-PH2O) 1.25(PaCO2)
A-aDO2 = PAO2 PaO2
Normally < 30 mmHg
High A-aDO2 means mismatch of V and Q

()- PCO2
()-HCO3

/ -BE

(Respiratory Acidosis)
(Respiratory Alkalosis)
(Metabolic Acidosis)
(Metabolic Alkalosis)

Respiratory Acidosis

PCO2

Respiratory Acidosis

:(PCO2

COPD

Respiratory Alkalosis

PCO2

Respiratory Alkalosis
: ( PCO2

Metabolic Acidosis

Acid HCO3

Metabolic Acidosis
(Anion Gap)

Acid
-
-
-
-
-
-

HCO3
-
-
-

Metabolic Alkalosis

Acid

HCO3

Metabolic Alkalosis
:(or)

Acid
-
-
-
-
-
-

HCO3
-
-
-

ABG

PO2

PCO2

PO2(AaDO2)

PCO2HCO3

Case 1

71 y/o man with COPD has 2 days of

dyspnea and sputum production. The CXR
reveals a LLL pneumonia.
ABG: pH 7.25 pCO2 70 mmHg
[HCO3] 30 mEq/L PO2 30mmHg
After treated with O2
ABG: pH 7.18 pCO2 86 mmHg
[HCO3] 31 mEq/L PO2 62 mmHg

A-aDO2 = [0.21 x (760-47) 1.25 x 70] 30 = 32

Response to O2 : V/Q mismatch (pneumonia)
pH 7.25, PaCO2 70mmHg: Respiratory acidosis
Time course: acute
Expected [HCO3-] : 24 + (1 x 3) = 27 2 mmHg
Respiratory acidosis with partial compensation
(underlying COPD and pneumonia)
Because the ventilatory stimulation is dependent on
O2 in COPD patient, increase the PaO2 will suppress
the ventilation and induce CO2 retention

Case 2

30y/o female was sent to ER for sudden

fainting. Her friends note she suffered from
severe dyspnea and limbs cramp.

Na 140, K 3.8, Cl 108

pH 7.55, pCO2 25 mmHg, pO2 110 mmHg,

HCO3 22 mEq/L

pH 7.55: alkalosis, CO2 25 mmHg:

akalosis,
HCO3 22 mEq/L: acidosis Resp.
alkalosis

Expected HCO3: 24 - (2 x 1.5) = 21

mmHg

Dx: hyperventilation syndrome

Case 3

45 y/o female reports 6 days of persistent

vomiting. PE: BP:100/60 mmHg, decreased skin
turgor and the jugular neck veins are flat.
Na 140, K 2.2 , Cl 86 (mEq/L)
BUN 80 , Cr 1.9 (mg/dL)
ABG: pH 7.53, HCO3 42 mEq/L PCO2 53
mmHg
Urine pH 5.0, Na 2 , K 21, Cl 3 (mEq/L)

pH 7.53: alkalosis, CO2 53 mmHg: acidosis,

HCO3 42 mEq/L: alkalosis meta. Alkalosis

Expected CO2: 40 + (0.6 x 18) = 51 mmHg

Urine Cl: < 10 Cl- responsive meta. Alkalosis

Correct with saline hydration