BLOOD GAS

INTERPRETATION
BASIC TEST INTERPRETATION
 LEARNING OUTCOMES

List the normal parameters Recognise the abnormalities on a

01 02
of a blood gas sample blood gas sample

03 Explain the concepts of respiratory and

metabolic compensation
 INTRODUCTION

Normal reference ranges

PaCO2 : 35 - 45 PaO2 : 80 - 100 HCO3- : 22-26 Base excess (BE)

pH : 7.35 - 7.45
mmHg mmHg mEq/L : -2 to +2 mmol/L
 INTERPRETATION MUST INCLUDE
CONTEXT!

‘normal’ PaO2 in a ‘normal’ PaCO2 in a ‘very low’ PaO2 in a

patient on high flow hypoxic asthmatic patient who looks
oxygen patient completely well

Tiring and need ICU Indicates a venous

Abnormal
care sample
 pH

Acidic, alkalotic
Logarithmic
or normal

Amount of
hydrogen ions
Lower the Higher the
value, more value, more
acidic alkalotic
 CO2 BUFFERING SYSTEM

H2O + CO2 ↔ H2CO3 ↔ H+ + HCO3-

Patient “blows
off” more CO2

Blood will Blood will

Patient retains become more
become more
CO2 alkalotic
acidic
 RESPIRATORY ACIDOSIS &
ALKALOSIS

Carbon dioxide level Carbon dioxide level

Carbonic Acid Carbonic Acid

Respiratory Acidosis Respiratory Alkalosis

pH pH
pH is in the opposite correlation
from CO2 levels

Respiratory
Component
 HCO3-

Reabsorption
Bicarbonate homeostasis is
of bicarbonate ions in the
achieved within kidneys
proximal tubule

HCO3- + H+ = H20 Increase hydrogen ion

Excretion of ammonia &
excretion and therefore
monophosphate ions
increase blood pH

Marker of metabolic
homeostasis between
22-28 mmol/L
 Increase in oxygenated
Lot of hydrogen
blood/ insufficient
ions/abnormal increase in
generation of bicarbonate
bicarbonate ions
ions

Low bicarbonate High bicarbonate

concentration concentration
(Metabolic Acidosis) ( Metabolic Alkalosis)
 METABOLIC ACIDOSIS & ALKALOSIS

High base excess (> +2 mmol/L) Low base excess (< -2 mmol/L)

(Primary metabolic (Primary metabolic

alkalosis/compensated respiratory acidosis/compensated respiratory
acidosis) alkalosis)
 ANION GAP

Na+ - HCO3 - Cl = Anion gap (8-16 mmol/L)

OR
Na+ + K+ - HCO3 - Cl = Anion gap (12-20 mmol/L)

High Anion Gap

Acidosis Acidaemia:
Increase in
hydrogen ions
or
Loss of
bicarbonate
Normal Anion ions
Gap Acidosis
 RESPIRATORY ACIDOSIS

Respiratory
Guillain-Barre
Depression

Asthma COPD Iatrogenic

 RESPIRATORY ALKALOSIS

Anxiety Pain Hypoxia

Pulmonary
Pneumothorax Iatrogenic
Embolism
 NON-AG METABOLIC ACIDOSIS

Hyperchloremia & is Calculation of the AG is

referred to as helpful in the differential
hyperchloremic acidosis diagnosis

HCO3- is lost from either

Renal acidification defect
the GI tract/the kidneys
NORMAL ANION GAP HIGH ANION GAP

Acid Load
Glycols

Carbonic anhydrase Oxoproline

inhibitors

Renal tubular acidosis Lactate

(RTA)
D-Lactate
Ureteroenterostomy
Methanol
Expansion/
extra-alimentation Aspirin

Diarrhea
Renal Failure

Ketoacidosis
 CAUSES OF METABOLIC ACIDOSIS

Saline or Saline unresponsive or

Unclassified
chloride responsive normovolaemic

Hyper
Diuretics
aldosteronism

Cushing’s
Vomiting
Syndrome

Respiratory Milk Alkali Severe

Acidosis Syndrome Hypokalemia
 COMPENSATING MECHANISM

Respiratory Metabolic
acidosis/alkalosis acidosis/alkalosis

Increasing/Decreasing
Retaining/Blowing off CO2
HCO3-

Move pH closer to normal Move pH closer to normal

range range
 RESPIRATORY COMPENSATION

Begins in the 1st

06 hour

01
Metabolic acidosis

02 Increases pH
Ventilation

05
increases 03

Drives off carbon

dioxide 04 Reduce the
carbonic acid
 METABOLIC COMPENSATION

Retain more Chronic respiratory

Raises pH
bicarbonate ions conditions

Respiratory Excrete more Takes a few days

acidosis hydrogen ions to achieve
 ABG INTERPRETATION

Match the CO2 or the

Is the pH normal?
HCO3 with the pH

Does the CO2 or the

Is CO2 normal? HCO3 go the opposite
direction of the pH?

Are the pO2 and the O2

Is the HCO3 normal?
saturation normal?
 STEP 1

7.4
-0.5 +0.5

7.35 7.45

< 7.35 > 7.45

 STEP 2

pCO2
< 35 > 45
( 35-45 mmHg )
 STEP 3

01 02 03

HCO3
< 22 > 26
( 22-26 mEq/L )
 STEP 4

pH CO2 Respiratory
Low High Acidosis

pH HCO3 Metabolic
High High Alkalosis
 STEP 5

pH CO2 HCO3
( Acidotic ) ( Acidotic ) ( Alkalotic )

CO2 matches pH

HCO3 is the opposite of pH

Respiratory Acidosis
 Practise Question

● pH 7.35
● CO2 32
● HCO3 19
 THANK YOU
BLOOD GAS INTERPRETATION