BE +/- 1

Four-Step Guide to ABG Analysis

1. Is the pH normal, acidotic or alkalotic?

2. Are the pCO2 or HCO3 abnormal? Which one appears to influence the pH?
3. If both the pCO2 and HCO3 are abnormal, the one which deviates most from
the norm is most likely causing an abnormal pH.
4. Check the pO2. Is the patient hypoxic?

I used Swearingen's handbook (1990) to base the results of this calculator. The book
makes the distinction between acute and chronic disorders based on symptoms from
identical ABGs. This calculator only differentiates between acute (pH abnormal) and
compensated (pH normal). Compensation can be seen when both the PCO2 and
HCO3 rise or fall together to maintain a normal pH. Part compensation occurs when
the PCO2 and HCO3 rise or fall together but the pH remains abnormal. This indicates
a compensatory mechanism attempted to restore a normal pH. I have not put exact
limits into the calculator. For example, it will perceive respiratory acidosis as any pH
< 7.35 and any CO2 > 45 (i.e. a pH of 1 and CO2 of 1000). These results do not
naturally occur.

pH PaCO2 HCO3
Respiratory
Acidosis
Acute < 7.35 > 45 Normal
Partly
< 7.35 > 45 > 26
Compensated
Compensated Normal > 45 > 26
Respiratory
Alkalosis
Acute > 7.45 < 35 Normal
Partly
> 7.45 < 35 < 22
Compensated
Compensated Normal < 35 < 22
Metabolic
Acidosis
Acute < 7.35 Normal < 22
Partly
< 7.35 < 35 < 22
Compensated
Compensated Normal < 35 < 22
Metabolic
Alkalosis
Acute > 7.45 Normal > 26
Partly
> 7.45 > 45 > 26
Compensated
Compensated Normal > 45 > 26

Mixed Disorders

It's possible to have more than one disorder influencing blood gas values. For
example ABG's with an alkalemic pH may exhibit respiratory acidosis and metabolic
alkalosis. These disorders are termed complex acid-base or mixed disorders.
*This table is able to classify most clinical blood gas values but not all. In cases
where blood gas values do not fall into any of the above classifications, an answer
"unable to determine" will appear when using the interpreter. For example a pH of
7.428, pCO2 43.6, and a HCO3 of 29.1 do not match any of the classifications (I
found these results in someone's chart). While the pH and pCO2 are normal, the
HCO3 is abnormally high.