1

ABG Concept:
PH: 7.35-7.45
PaCO2: 35-45 mmhg
HCO3: 22-26 mEq/L
PaO2: 80-100 mmHg
SaO2: 95-100%
Base Excess/ Deficit- 2 - + 2

How to Interpret ABG: ROME

1. Look at the PH
- Is Acidosis or Alkalosis?
- If it’s within the normal ranges then it is normal or compensated.
2. Look at CO2 and HCO3
-Which element is driving the Ph?
-If both are out of normal ranges, which is further out?

Buffer Systems:
H+ concentration: The greater concentration-> acidic, if lower H+ —> basic
Major ECF fluid buffer system; bicarbonate—carbonic buffer system
-Kidneys regulate bicarbonate in ECF; can regenerate carbonic ions as well as reabsorb them.
-Lungs—> under medulla control—>regulate CO2, and carbonic acid in ECF; lungs adjust
ventilation in response to CO2 in blood.

Maintain Balance:
-Metabolic: slower process up to 5 days, effective compensation, kidneys reabsorb or excrete bicarbonate
and H+ ions.
-Respiratory: Rapid process, less effective compensation, respiration increases/decreases to impact level of
CO2

Primary Imbalances:
Respiratory Acidosis: Low PH and High PaCO2
Respiratory Alkalosis: High PH and Low PaCO2
Metabolic Acidosis: Low PH and Low HCO3
Metabolic Alkalosis: High PH and High HCO3

Respiratory Acidosis
Labs/ Diagnostics Low Ph; High CO2;
-Low Ventilation
PaCO2 > 42mm Hg
-Chest X-ray, CT scan can help
determine the cause;
Electrolytes:
Serum K: Typically increased.
Serum Cl: Decreased.
Serum Ca: Increased.
Lactic acid: May be elevated.
Urinalysis: Urine pH decreased.
Other screening tests: As indicated
Pathophysio/Causes CNS Depression or lesion
(anesthesia overdose), head trauma,
hypoventilation, airway obstruction,
Pleural disease, Pneumothorax,
COPD/ARDs, Asthma, Sedation,
OD, Musculoskeletal disorders,
Acute: Pulmonary edema,
aspiration, atelectasis,
pneumothorax, Anesthesia OD,
sleep apnea with morbid obesity,
hypercapnia
Chronic: muscular dystrophy,
multiple sclerosis, myasthesia
gravis, Guillen-bare syndrome
Med Management Bronchodilators, antibiotics,
thrombolytics or anticoagulants,
adequate hydration (2-3L/day),
mechanical ventilation PaCO2 must
be decreased slowly, semi-fowlers
2
Metabolic Acidosis
(Base Carbonate Deficit)
Low pH; Low HCO3
Urine pH: below 4.5 ; Glucose
levels: above 150 mg/dl Arterial
pH: Decreased, less than
7.35.Bicarbonate (HCO3):
Decreased, less than 22
mEq/L.Paco2: Less than 35 mm
Hg.Serum potassium: Increased
(except in diarrhea, renal tubular
acidosis).Serum chloride:
Increased. Urine pH: Decreased,
less than 4.5 (in absence of renal
disease).ECG: Cardiac
dysrhythmias (bradycardia) and
pattern changes associated with
hyperkalemia, e.g., tall T wave.
Direct loss from bicarbonate, lower
intestinal fistulas, ureterostomies,
Renal Failure, DKA, diarrhea,
Lactic Acidosis- shock, starvation,
use of diuretics, excess CH-,
administration of parenteral fluid
without bicarbonate, ketoacidosis,
salicylate poisoning, uremia,
methanol or glycol toxicity,
ketoacidosis w/ starvation
*compensation would lead to low or
High CO2
Na Bicarbonate, Saline, Phosphate,
KCH-, Calcium,

Nursing Assessment (s/s) ACTIVITY/REST-->May report:
Fatigue, mild to profound May
exhibit: Generalized weakness,
ataxia/staggering, loss of
coordination (chronic), to stupor
CIRCULATION-->May exhibit:
Low BP/hypotension with bounding
pulses, pinkish color, warm skin
(reflects vasodilation of severe
acidosis)Tachycardia, irregular pulse
(other/various dysrhythmias)
Diaphoresis, pallor, and cyanosis
(late stage) FOOD/FLUID-->May
report: Nausea/vomiting
NEUROSENSORY-->May
report: Feeling of fullness in head
(acute—associated with
vasodilation)Headache, dizziness,
visual disturbances. May exhibit:
Confusion, apprehension, agitation,
restlessness, somnolence; coma
(acute) Tremors, decreased reflexes
(severe) RESPIRATION -->May
report: Shortness of breath;
dyspnea with exertion May exhibit:
Respiratory rate dependent on
underlying cause, i.e., decreased in
respiratory center depression/muscle
paralysis; otherwise rate is
rapid/shallow. Increased respiratory
effort with nasal flaring/yawning,
use of neck and upper body muscles.
Decreased respiratory
rate/hypoventilation (associated with
decreased function of respiratory
center as in head trauma,
oversedation, general anesthesia,
metabolic alkalosis) Adventitious
breath sounds (crackles, wheezes);
stridor, crowing
3
May report: Lethargy, fatigue;
muscle weakness May exhibit:
Hypotension, wide pulse pressure;
Pulse may be weak, irregular
(dysrhythmias) Jaundiced sclera,
skin, mucous membranes (liver
failure)ELIMINATION-->May
report: Diarrhea; May exhibit:
Dark/concentrated urine;
FOOD/FLUID-->May report:
Anorexia, nausea/vomiting; May
exhibit: Poor skin turgor, dry
mucous membranes;
NEUROSENSORY-->May
report: Headache, drowsiness,
decreased mental function; May
exhibit: Changes in sensorium, e.g.,
stupor, confusion, lethargy,
depression, delirium, coma;
Decreased deep-tendon reflexes,
muscle weakness RESPIRATION--
>May report: Dyspnea on exertion;
May exhibit: Hyperventilation,
Kussmaul’s respirations (deep, rapid
breathing) SAFETY-->May report:
Transfusion of blood/blood
products; Exposure to hepatitis
virus; May exhibit: Fever, signs of
sepsis

Respiratory Alkalosis
Diagnostics Arterial blood gas (ABG) analysis
indicate PaCO2 less than 35 mmHg;
pH elevated in proportion to the fall
in PaCO2 (acute) or failing toward
normal (chronic). Arterial blood gas
(ABG) studies reveal abnormal
values: pH above 7.45 and partial
pressure of carbon dioxide below 35
mmHg. Arterial pH: Greater than
7.45 (may be near normal in chronic
stage). Bicarbonate (HCO3):
Normal or decreased; less than 25
mEq/L (compensatory
mechanism).Paco2: Decreased, less
than 35 mm Hg (primary).Serum
potassium: Decreased.Serum
chloride: Increased.Serum calcium:
Decreased. Urine pH: Increased,
greater than 7.0. CBC: May reveal
severe anemia (decreasing oxygen-
carrying capacity). Blood cultures:
May identify sepsis (usually Gram-
negative). blood alcohol: Marked
elevation (acute alcoholic
intoxication). Toxicology screen:
May reveal early salicylate
poisoning. Chest x-ray/lung scan:
May reveal multiple pulmonary
emboli.
Causes Hyperventilation (blowing off
CO2); decrease in carbonic acid
production; extreme anxiety;
hypoxemia; early salicylate
poisoning; gram neg bacteria;
chronic hepatic insufficiency
4
Metabolic Alkalosis
Arterial pH: Increased, higher than
7.45. Bicarbonate (HCO3):
Increased, higher than 26 mEq/L
(primary). Paco2: Slightly
increased, higher than 45 mm Hg
(compensatory). Base excess:
Increased.Serum chloride:
Decreased, less than 98 mEq/L,
disproportionately to serum
sodiumdecreases (if alkalosis is
hypochloremia). Serum potassium:
Decreased. Serum calcium: Usually
decreased. Prolonged hypercalcemia
(nonparathyroid) may be a
predisposing factor. Urine pH:
Increased, higher than 7.0. Urine
chloride: Less than 10 mEq/L ECG:
May show hypokalemic changes
including peaked P waves, flat T
waves, depressed ST segment, low
T wave merging to P wave, and
elevated U waves.
Renal Failure, DKA, Diarrhea,
Lactic Acidosis-Shock, Starvation
 5

Med Management Air bag; anti-anxiety meds, -administering sodium chloride

fluids (because continued volume
depletion perpetuates the alkalosis).
In patients with hypokalemia, KCl;
H2 receptor antagonists, cimetidine
(Tagamet), reduce production of
(HCl), decreasing the metabolic
alkalosis associated with gastric
suction. Carbonic anhydrase
inhibitors are useful in patients who
cannot tolerate rapid volume
expansion (e.g., heart failure).
 6

Nursing Assessment (S/S) May exhibit: Tachycardia,

dysrhythmias; Hypotension;
CIRCULATION-->May report: Cyanosis ELIMINATION→ May
History/presence of anemia; report: Diarrhea (with high
Palpitations; May exhibit: chloride content) Use of potassium-
Hypotension Tachycardia, irregular losing diuretics ( Lasix)Laxative
pulse/dysrhythmias May exhibit: abuse FOOD/FLUID-->May
Extreme anxiety (most common report: Anorexia, nausea/prolonged
cause of hyperventilation) vomiting; High salt intake;
FOOD/FLUID-->May report: Dry excessive ingestion of
mouth Nausea/vomiting-->May licorice;Recurrent
exhibit: Abdominal distension indigestion/heartburn with frequent
(elevating diaphragm as with use of antacids/baking soda
ascites, pregnancy) Vomiting NEUROSENSORY-->May
NEUROSENSORY-->May report: Tingling of fingers and toes;
report: Headache, tinnitus; circumoral paresthesia, Muscle
Numbness/tingling of face, hands, twitching,May exhibit:
and toes; circumoral and generalized Hypertonicity of muscles, tetany,
paresthesia; Lightheadedness, tremors, convulsions, loss of
syncope, vertigo, blurred vision reflexes, Confusion, irritability,
May exhibit: Confusion, restlessness, belligerence, apathy,
restlessness, obtunded responses, coma,Picking at bedclothes
coma; Hyperactive reflexes, positive SAFETY--> May report: Recent
Chvostek’s sign, tetany, seizures; blood transfusions
Heightened sensitivity to RESPIRATION-->May exhibit:
environmental noise and activity Hypoventilation (increases Pco2 and
Muscle weakness, unsteady gait conserves carbonic acid), periods of
PAIN-->May report: Muscle apnea.TEACHING/LEARNING--
spasms/cramps, epigastric pain, >Hx Cushing’s syndrome;
precordial pain (tightness) corticosteroid therapy
RESPIRATION->May report:
Dyspnea; History of asthma,
pulmonary fibrosis Recent
move/visit to location at high
altitude May exhibit: Tachypnea;
rapid, shallow breathing;
hyperventilation (often 40 or more
respirations/minute) Intermittent
periods of apnea SAFETY-->May
exhibit: Fever

Interventions Be alert for signs of changes in
neurologic, neuromuscular or
cardiovascular functions. Institute
safety measures for the patient with
vertigo or the unconscious patient.;
Encourage the anxious patient to
verbalize fears; Administer sedation
as ordered to relax the patient; Keep
the patient warm and dry; Encourage
the patient to take deep, slow
breaths or breathe into a brown
paper bag (inspire CO2); Monitor
vital signs; Monitor ABGs,
primarily PaCO2; a value less than
35 mmHg indicates too little CO2
(carbonic acid)
7
Dilute potassium when giving via
I.V. containing potassium salts.
Monitor the infusion rate to prevent
damage and watch out for signs of
phlebitis. Watch for signs of muscle
weakness, tetany or decreased
activity. Monitor vital signs
frequently and record intake and
output to evaluate respiratory, fluid
and electrolyte status. Observe
seizure precautions.