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Abg Interpretation: Vicky Honkus MSN RN 2005 Education Department
Abg Interpretation: Vicky Honkus MSN RN 2005 Education Department
Abg Interpretation: Vicky Honkus MSN RN 2005 Education Department
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The chemical balance of body fluids is of
enormous clinical importance, since it is a
critical factor in all metabolic and cellular
functions. The body's own regulatory
mechanisms usually retain this balance
within normal limits, but certain disease
processes, illnesses and treatments can cause
imbalances that may even become life
threatening, unless appropriate interventions
are implemented. Acid base balance refers to
the hydrogen ion concentration of all body
fluids, which is determined by chemical
substances present in the blood and other
body fluids.
I. pH
In chemistry class we learned that pH describes the concentration of hydrogen ions, and that a
pH of 7.0 is perfectly neutral. The acceptable pH range of our blood is 7.35 – 7.45, which is
slightly alkaline. The body needs to maintain the pH of its chemical broth within fairly narrow
limits for proper body functioning. The body’s own regulatory mechanisms usually maintain
this balance, but certain disease processes, illnesses, and treatments can cause imbalances that
may become life threatening unless appropriate interventions are implemented. A pH that is less
than 7.0 or greater than 7.7 is not compatible with life.
The first step in interpreting ABG results is to determine if the pH represents acidosis or
alkalosis, or is perfectly normal. For purposes of ABG interpretation, we will consider the
middle of the acceptable range (7.4) as neutral for the blood, any value less than 7.4 as acidotic,
and any value higher than 7.4 as alkalotic.
pH Acceptable
ranges:
acidotic alkalotic
pH 7.35-7.45
7.35 7.4 7.45
pCO2 35-45
HCO3 22-26
BE +2 to -2
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The following are some pH values for you to practice determining whether a pH is acidic or
alkalotic. Remember to base your decision on a pH of 4.0, which is neutral for blood. Cover up
the answers on the right, and check yourself after your interpretation.
pH 7.0 = _______________________________________acidic
pH 7.9 = _______________________________________alkalotic
pH 7.4 = _______________________________________neutral
pH 7.5 = _______________________________________alkalotic
pH 7.3 = _______________________________________acidic
The pH alone is not sufficient to tell us whether an imbalance is due to a respiratory or metabolic
problem. The other reported values enable us to determine the primary problem, and whether
any attempts are being made by the body to compensate for the imbalance.
The body has several buffer systems that work to maintain the pH within acceptable limits. Of
these, the bicarbonate-carbonic acid buffer system is the most important, and is controlled by the
lungs and kidneys. Normal (aerobic) metabolism produces two forms
of acid: respiratory acid (carbonic acid) and metabolic acids.
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When the patient is moving a normal volume of air in and out of the lungs, the pCO2 will stay
within the normal range. Hypoventilation will prevent sufficient removal of CO2 from the
bloodstream, causing a respiratory acidosis. Some causes of respiratory acidosis include
obstructive lung disease, restrictive lung disease and hypoventilation as a result of oversedation,
anesthesia or improper ventilator settings (e.g., tidal volume too low.) Respiratory acidosis
could also result from a drug overdose and neuromuscular diseases such as Guillain-Barre
syndrome or myasthenia gravis.
Hyperventilation, on the other hand, causes CO2 to be “blown off” or removed, causing a
respiratory alkalosis. The pCO2 falls below 35, and the acid-load decreases, causing an alkalosis.
Some possible causes of respiratory alkalosis include pain, panic attacks, anxiety, pulmonary
embolism, pregnancy, and a tidal volume that is too high for a ventilator patient.
The second step in ABG interpretation, is to evaluate the pCO2, to determine if it falls
within the acceptable range, falls below the lower limit (respiratory alkalosis) or is above
the upper limit (respiratory acidosis.)
Notice that a high value in pCO2 actually represents an acidosis (retention of CO2), whereas a
high value in pH represents an alkalosis. Do not try to memorize, but rather to understand the
concept of what the components represent. A high level of pCO2 simply means there is
retention of CO2 or hypoventilation. CO2 is acidotic in the blood, and too much causes
respiratory acidosis.
Practice with the values below, to determine the status for each pCO2 value. Cover over the
answers on the right, and then check your interpretation.
pCO2 of 40 = ___________________________________normal
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When there is a loss of acid in the body, or an excess of base, the HCO3 will be greater than 26,
resulting in metabolic alkalosis. Some causes of metabolic alkalosis include loss of stomach acid
and potassium from vomiting or gastric suction, and ingestion of large amounts of bicarbonate.
Prolonged therapy with potassium-wasting diuretics, steroid therapy, Cushing's disease, and
aldosteronism can also deplete potassium, chloride, and hydrogen levels, resulting in metabolic
alkalosis.
When there is an excess of metabolic acid, or not enough base, the HCO3 will be less than 22,
causing metabolic acidosis. Conditions that increase acid-load include diabetic ketoacidosis or
prolonged fasting, lactic acidosis, and renal failure. Actual loss of bicarbonate ions through
severe diarrhea leads to metabolic acidosis. During cardiac arrest, or when low cardiac output
states (as in external cardiac compression) are present, anaerobic metabolism occurs and there is
an increase in the [production of lactic acid. Metabolism of lactic acid is normally effected
through the Krebs cycle, and oxygen is the essential element for this metabolic process. In the
absence of adequate tissue oxygenation, lactic acid cannot be metabolized; its quantity increases
and the result is metabolic acidosis.
The third step in ABG interpretation is to determine the direction of the metabolic
component HCO3, whether it is within normal limits, is high (metabolic alkalosis), or low
(metabolic acidosis.) Simply think of HCO3 as a base, and too much causes metabolic
alkalosis, whereas too little causes metabolic acidosis. Practice and check your answers below:
HCO3 of 25 = ___________________________________normal
Base Excess (BE) is another metabolic component that is reported with our blood gas report.
This value is a calculation of the circulating buffer/base, and is reported as milliequivalents per
liter of base above or below the normal buffer base range. The normal range for BE is –2 to
+2.
A base excess value of –8 would represent a deficit of base and therefore metabolic acidosis.
A base excess value of +10 would represent an excess of base and therefore metabolic alkalosis.
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The base excess can be used to help determine the presence of a metabolic imbalance, whether
acidosis or alkalosis. For the rest of this self learning module however, bicarbonate will be the
only metabolic component used in interpreting arterial blood gases.
Practice interpreting the following results (check your interpretation with answers below):
pH pCO2 HCO3 Interpretation
#1 7.41 40 24
#2 7.5 42 35
#3 6.72 40 5
#4 7.26 63 25
#5 7.52 18 25
#1: normal
#2: metabolic alkalosis
#3: metabolic acidosis
#4: respiratory acidosis
#5: respiratory alkalosis
The acid-base imbalances above involved only one component (respiratory or metabolic.)
Sometimes it is possible to have both components reflect the same abnormality. For example,
the patient who is in respiratory distress, and not exchanging air sufficiently develops respiratory
acidosis due to retention of CO2 (and hypoxemia.) If that same patient’s condition should
deteriorate to the point where his cells are not receiving oxygen, and CO2 is building up in the
blood, anaerobic metabolism will take place, causing a metabolic acidosis as well. That patient
would be said to have a combined respiratory and metabolic acidosis, which is typically seen in
the arrest setting.
IV. Compensation
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The regulation of respiration is achieved mainly by chemoreceptors in the medulla, that are
stimulated or inhibited by an increase or decrease in the carbonic acid and hydrogen ion levels.
Normally an increase in carbonic acid or hydrogen ion concentration in the blood stimulates an
increase in the rate and depth of ventilations, cause more carbon dioxide to be removed. A
decrease in concentration of carbonic acid results in a decrease in rate and depth of breathing,
thus retaining more carbon dioxide. The lungs can begin to compensate for metabolic
imbalances immediately, but can only partially correct pH deviations (can return pH to normal
range, but never to perfectly normal 7.4).
The kidneys, on the other hand, take much longer to compensate, sometimes as long as 3-5 days
to fully compensate. An increase in hydrogen ion concentration is corrected by increasing the
amount of bicarbonate that is returned to the blood, and increasing the amount of acid that is
excreted. A decrease in hydrogen ion concentration is corrected by increasing the amount of
acid that is retuned to the blood, and increasing the amount of bases, particularly, bicarbonate,
that are excreted. The kidneys may be slower to compensate, but they are much more powerful,
and can return the pH to perfectly normal 7.4.
The fourth and final step in ABG interpretation, then is to determine if compensation is
present, and to what extent.
One patient has chronic pulmonary problems, and is in a chronic respiratory acidosis. His
kidneys will compensate by retaining bicarbonate, creating a metabolic alkalosis to balance his
chronic respiratory acidosis.
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A diabetic patient goes into ketoacidosis and develops Kussmaul breathing, causing him to blow
off CO2, creating a respiratory alkalosis to help balance his pH.
BELOW ARE SOME PRACTICE ABG RESULTS FOR YOU TO DO, AND THE ANSWERS
ARE AT THE END OF THIS SELF LEARNING MODULE.
Practice:
#1 pH 7.52 = ___________________________________
pCO2 40 = ____________________________________
HCO3 35 = ____________________________________
Interpretation_______________________________________________
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#2 pH 7.25 = ___________________________________
pCO2 60 = ____________________________________
HCO3 27 = ____________________________________
Interpretation_______________________________________________
#3 pH 7.25 = __________________________________
pCO2 40 = ___________________________________
HCO3 12 = ___________________________________
Interpretation______________________________________________
#4 pH 7.55 = _________________________________
pCO2 20 = ___________________________________
HCO3 26 = ___________________________________
Interpretation______________________________________________
#5 pH 7.29 = _________________________________
pCO2 20 = __________________________________
HCO3 18 = __________________________________
Interpretation______________________________________________
#6 pH 7.48 = _________________________________
pCO2 50 = ___________________________________
HCO3 34 = ___________________________________
Interpretation_______________________________________________
#7 pH 7.5 = __________________________________
pCO2 20 = __________________________________
HCO3 30 = __________________________________
Interpretation_____________________________________________
#8 pH 7.18 = _________________________________
pCO2 60 = _________________________________
HCO3 26 = _________________________________
Interpretation_____________________________________________
#9 pH 7.29 = ________________________________
pCO2 60 = __________________________________
HCO3 35 = __________________________________
Interpretation_____________________________________________
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#10 pH 7.48 = _________________________________
pCO2 20 = __________________________________
HCO3 34 = __________________________________
Interpretation______________________________________________
ABG studies are very helpful to reveal numerous underlying problems, and provide clues to a
patient’s ventilatory status, hypoxemic state, and tissue oxygenation. This is an important skill
to have and is invaluable when looking at the clinical picture.
#2 pH 7.25 = acidosis
pCO2 60 = respiratory acidosis
HCO3 27 = slight metabolic alkalosis
Respiratory acidosis, and kidneys are beginning to compensate (retain
bicarb. Note that the pH has a long way to go before it comes back into
normal range, so compensation has just begun.)
#3 pH 7.25 = acidosis
pCO2 40 = normal
HCO3 12 = metabolic acidosis
Metabolic acidosis (no compensation)
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#4 pH 7.55 = alkalosis
pCO2 20 = respiratory alkalosis
HCO3 26 = normal
Respiratory alkalosis (no compensation)
#5 pH 7.29 = acidosis
pCO2 20 = respiratory alkalosis
HCO3 18 = metabolic acidosis
Metabolic acidosis with some compensation by the lungs (not very effective;
has not returned pH to acceptable range yet)
#6 pH 7.48 = alkalosis
pCO2 50 = respiratory acidosis
HCO3 34 = metabolic alkalosis
Metabolic alkalosis with almost complete compensation by the lungs
#7 pH 7.5 = alkalosis
pCO2 20 = respiratory alkalosis
HCO3 30 = metabolic alkalosis
Combined respiratory & metabolic alkalosis
#8 pH 7.18 = acidosis
pCO2 60 = respiratory acidosis
HCO3 26 = normal
Respiratory acidosis
#9 pH 7.29 = acidosis
pCO2 60 = respiratory acidosis
HCO3 35 = metabolic alkalosis
Respiratory acidosis with some compensation from kidneys
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are strong enough in compensation to bring the pH back to perfectly normal,
the primary problem has to be respiratory acidosis, with complete
compensation by the kidneys.
REFERENCES:
Kirksey, KM, et al. An Easy Method for Interpreting the Results of Arterial Blood Gas Analysis.
Critical Care Nurse. 21(5):49-54.
Lanford A. Name that Acid Base. Critical Care Nurse. March/April 1981:10-12.
McCance K, Huether S. Pathophysiology: The Biologic Basis for Disease in Adults and
Children. 1994:110-120.
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SELF LEARNING MODULE EVALUATION
Professional Title:
RN
LPN
RT
OTHER Date:__________
3. Regarding content:
Was the information presented clearly? 1 2 3 4
Was the information pertinent to your professional needs? 1 2 3 4