ABG Interpretation

Julie Perkins RRT-NPS LPCH Respiratory Care

pH

Normal pH is 7.35-7.45 Value <7.35 is acidotic Value >7.45 is alkalotic Acidosis & Alkalosis can be caused by a problem with the respiratory system or a metabolic cause Can also have combined respiratory/metabolic states

Is it Respiratory or Metabolic?
1.

Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis

Increased pCO2 >50 Decreased pCO2<30 Decreased HCO3 <18 Increased HCO3 >30

2.

3.

4.

Compensated or Uncompensatedwhat does this mean?

1.

Evaluate pHis it normal? Yes Next evaluate pCO2 & HCO3

2.

pH normal + increased pCO2 + increased HCO3 = compensated respiratory acidosis pH normal + decreased HCO3 + decreased pCO2 = compensated metabolic acidosis

Compensated vs. Uncompensated

1. 2. 3.

Is pH normal? No Acidotic vs. Alkalotic Respiratory vs. Metabolic

pH<7.30 + pCO2>50 + normal HCO3 uncompensated respiratory acidosis pH<7.30 + HCO3<18 + normal pCO2 uncompensated metabolic acidosis pH>7.50 + pCO2<30 + normal HCO3 uncompensated respiratory alkalosis pH>7.50 + HCO3>30 + normal pCO2 uncompensated metabolic alkalosis = = = =

Causes of Acidosis

Respiratory

Metabolic

Hypoventilation Impaired gas exchange

Ketoacidosis Diabetes Renal Tubular Acidosis Renal Failure Lactic Acidosis Decreased perfusion Severe hypoxemia

Causes of Alkalosis

Respiratory

Metabolic

Hyperventilation due to: Hypoxemia Metabolic acidosis Neurologic

Hypokalemia
Gastric suction or vomiting Hypochloremia

Lesions Trauma Infection

Assessing Oxygenation

Normal value for arterial blood gas 80-100mmHg Normal value for venous blood gas 40mmHg Normal SaO2

Arterial: 97% Venous: 75%

Important points for assessing tissue oxygenation

This is the O2 thats really available at the tissue level. Is the THb normal?

Low THb means the ability of the blood to carry the O2 to the tissues is decreased Low perfusion means the blood isnt even getting to the tissues

Is perfusion normal?

Lets Practice

12 year old diabetic presents with Kussmaul breathing

pH : pCO2: pO2: HCO3: BE:

7.05 12 mmHg 108 mmHg 5 mEq/L -30 mEq/L

Severe partly compensated metabolic acidosis without hypoxemia due to ketoacidosis

17 year old w/severe kyphoscoliosis, admitted for pneumonia

pH: pCO2: pO2: HCO3: BE :

7.37 25 mmHg 60 mmHg 14 mEq/L -7 mEq/L

Compensated respiratory alkalosis due to chronic hyperventilation secondary to hypoxia

9 year old w/hx of asthma, audibly wheezing x 1 week, has not slept in 2 nights; presents sitting up and using accessory muscles to breath w/audible wheezes

pH: pCO2: pO2 HCO3: BE:

7.51 25 mmHg 35 mmHg 22 mEq/L -2 mEq/L

Uncompensated respiratory alkalosis with severe hypoxia due to asthma exacerbation

7 year old post op presenting with chills, fever and hypotension

pH: pCO2: pO2: HCO3: BE:

7.25 32 mmHg 55 mmHg 10 mEq/L -15 mEq/L

Uncompensated metabolic acidosis due to low perfusion state and hypoxia causing increased lactic acid