Arterial Blood Gas

Interpretation
..

Modified Allens test

 arterial blood gas

O2

HCO3-

Handerson-Hasalbach
equation

pH= 6.1 + log HCO33

0.03 x PaCO22
H++

= 24 x

venous HCO

pH
PaCO2
PaO2
HCO3-

7.35-7.45

35-45

.
80-100

ABG

1. arterial
blood gas
2. oxygenation
3. ventilation
4.
(acidbase disorder)

 arterial blood gas

venous blood gas

Arterial

pH
PaO2

PaCO2
O2

Venous

blood gas blood gas

7.35-7.45 7.32-7.42
85-100
35-45
35-45

97-100%

38-48

70-75%

 oxygenation

1. PaO2

2. A-a gradient

3. PaO2/FiO2

Assess at room air

Assess at any level
FiO2

 Oxygenation

PaO2

Mild

60-80 .

hypoxemia
Moderate

40-60 .

hypoxemia
Severe

PaO
< 40
2

hypoxemia
aO2 = 100-(/4)
FiO2

room air

A-a gradient
A-a gradient
- PaO2

PAO2

A-a gradient
=

(FiO2 x 713) (Pa

713
1 (1 atm =
760 mmHg, = 47
mmHg) = 760 47
R (RQ) (respiratory quotient) = CO2
production/ O2 consumption (normal
RQ = A-a
0.8) gradient = 2.5 + (age/4)
Normal

Approach to Hypoxemia

crease FiO2
ntral/ Neuromuscular hypoventilat
Q mismatch
unt
ffusion defect
w ScvO2

V/Q
mismatch
shunt

Dead
space Q/
Absent

Absent V/ present Q

Do not
response with
100% oxygen

Present V

Response
with
100%
oxygen

100% oxygen
Treat specific
disease

Shunt

Intrapulmonary shunt

Extrapulmonary
shunt

Response to PEEP

Not response to PEEP

ARDS
Severe pulmonary edema

Right to left shunt

Pulmonary AVM

V/Q mismatch : Obstructive

Lung Disease

COPD

Asthma

V/Q mismatch : Restrictive

Lung Disease

15

V/Q mismatch : Restrictive

Lung Disease

16

Shunt

Intrapulmonary shunt

Extrapulmonary shunt
17

Diffusion defect

Interstitial lung disease

18

PaO2/FiO2
PaO2/FiO2
500-550
PaO2/FiO2

hypoxemia

hypoxemia FiO

 50
nosocomial pneumonia

1 : pH 7.49, PaO2 80 mmHg,

PaCO2 30 mmHg, HCO3- 22, O2 sat

97%

3 : pH 7.47,
PaO2 100 mmHg,
1. 1
PaCO2 32 mmHg,
2. 3
3.
HCO3- 24, O2 sat

 50
nosocomial pneumonia

7.49,

1 : pH
PaO2 80 mmHg,
PaCO2 30 mmHg, HCO3- 22, O2 sat 97%
FiO2 0.4 PaO2/FiO2 = 200

3 : pH 7.47, PaO2 100 mmHg,

PaCO2 32 mmHg, HCO3- 24, O2 sat 100%
FiO2 1.0

PaO2/FiO2 =
100

 FiO2
arterial blood gas

(PaO2/FiO2)1
(PaO2/FiO2)2

1. oxygen saturation
PaO2
2.

PaO2/FiO2
22

 ARDS
FiO2 1.0
PaO2 100 . FiO2
oxygen saturation 90%
1.0.9
FiO2

2.0.8
3.0.7
4.0.6
5.0.5

 hemoglobin oxygen
dissociation curve oxygen saturation
90% PaO2 60 .
SaO22 95% = PaO22 80
.
SaO22 90% = PaO22 60
.
SaO22 88% = PaO22 55
.
SaO22 75% = PaO22 40
.
SaO22 50% = PaO22 27
.


ventilation

PaCO2 < 35
mmHg

Hyperventilatio
n
Hypocapnia
Hypocarbia

PaCO2 > 45
mmHg
Hypoventilation
Hypercapnia
Hypercarbia

 ventilation
CO2

PaCO2
production

alveolar ventilation
alveolar ventilation =
minute
ventilation dead space ventilation
=
(V t x
RR) (Vd x RR)
PaCO2
= k x CO2
production
= k x CO2 production
(Vt x
RR) (Vd x RR)
RR (Vt Vd)

 PaCO2

4
1. Carbondioxide production
2. Tidal volume
3. Respiratory rate
4. Dead space volume

 45

myasthenia gravis

FiO2 0.6
tidal volume 400 .
15

PaCO2 50
.

minute ventilation

PaCO2 1/MV
PaCO2 = k (1/MV)
PaCO2 x MV
= k
PaCO2 x MV = k
(PaCO2 x MV)
= 2 x MV)
(PaCO
(PaCO
1
1 =2 x

 45
community acquired pneumonia
FiO2 0.6 tidal

PaCO

volume
400 .

1522

PaCO2minute
ventilation
50 .
(PaCO

11= PaCO2
22 x MV)
(PaCO
MV)
40 .
22
22 x
50 x 400 x15
=
40
x MV
MV
=
50 x 400 x15
40

PaCO2

HCO3-

acidosis
Metabolic

alkalosis
Respiratory

acidosis
Respiratory

Metabolic

Metabolic acidosis
PaCO2
=
(1.5 x HCO3-) + 8 + 2

Anion gap

Anion
Na+

gap
=
(Cl- + HCO3-)
Predicted pH

Wide anion gap

metabolic acidosis

Lactic acidosis

ype A
oor tissue perfusion)

Ketoacidosis Non lactate, Non ket

DKA
Stravation ketoacidosis
Alcholholic ketoacidosis

Type B
(normal tissue perfusion)

Wide anion gap metabolic acidosis

Non lactate, non ketone

Poisoning

Alcohol

Ethanol
Methanol
Ethylene glycol

Non poisoning

Non-alcohol
Salicylate
Toluene

AKI, CKD
Rhabdomyolysis
Tumor lysis syndrome
Intravascular hemolysis

Metabolic alkalosis
PaCO2
=
(0.7x HCO3-) + 20 + 2

Chloride-responsive

Predicted pH =
7.PaCO2

Chloride-resistant

Gastric fluid loss (eg.

Primary aldosteronism

vomiting, NG

Short-term diuretic

Volume contraction

Bartters syndrome

Long-term diuretic

DOC excess syndrome

therapy

Liddles syndrome

drainage)

therapy

Acute

PaCO2

HCO3-

pH

10

0.08

10

0.08

respiratory
acidosis
Acute
respiratory
alkalosis

chronic

Acute

Acidosis

Alkalosis
10

Acute

Alkalosis
10

Respiratory

Acidosis

10

Chronic

10


Metabo

pH

alkalosi

(1.5 x HCO3-)

HCO3

+ 8 + 2

lic
acidosi
Metabo
s
lic

PaCO2

(0.7 x HCO3-)
+ 20 + 2

 35
6
P.E. : mildly pale, RR 28/min, dyspnea
ABG (room air) ; pH 7.28, PaCO2 60
mmHg, PaO2 60 mmHg, HCO3- 26 mEq/L

1. Pneumonia
2. Myasthenia gravis
3. Atlectasis

ABG (room air) ; pH 7.28, PaCO2 60 mmHg,

PaO2 60 mmHg, HCO3- 26 mEq/L

nation
FiO2 x 713) (PaCO2 / R)
= (0.2 x 713) (60/0.8)
= 67.6 mmHg
PaO2 = 67.6 60 = 7.6 mmHg
A-a gradient = 2.5 + (age/4)
= 2.5 + (35/4) = 11.25

Hypoxemia with normal A-a

hypoxem
ia
A-a gradient

Normal A-a
gradient

Decrease FiO2
Central/
neuromuscular
hypoventilation

Wide A-a
gradient

V/Q
mismatch
Shunt
Diffusion

ABG (room air) ; pH 7.28, PaCO2 60 mmHg,

PaO2 60 mmHg, HCO3- 26 mEq/L

. Ventilation

..Hypoventilation
3. Acid- base imbalance
.. Acidosis, PaCO2 =
respiratory acidosis

ABG (room air) ; pH 7.28, PaCO2 60 mmHg,

PaO2 60 mmHg, HCO3- 26 mEq/L
PaCO2

HCO31

0.08

Acute
acidosis

10

0.08

Chronic
alkalosis

10

0.03

Chronic
acidosis

10

0.02

Acute
respiratory
respiratory
respiratory

10

pH

 25 4

1

P.E. : RR 26/min, Moderately pale, mild

jaundice
: Fine crepitation both lungs

ABG (on O2 canula 5 LPM) : pH 7.23,

PaO2 80 mmHg, PaCO2 23, HCO3- 10
mEq/L
1. Oxygenation
.On O2 canula 5 LPM (RR 26/min)
FiO2
0.4
.........PaO2 80 mmHg = O2 saturation
entilation
95%

.hyperventilation

ABG (on O2 canula 5 LPM) : pH 7.23,

PaO2 80 mmHg, PaCO2 23, HCO3- 10
mEq/L
Predicted PaCO = 23 + 2
3. Acid-base imbalance
2

Metabolic

pH

acidosis

PaCO2

(1.5 x HCO3 )
-

+ 8 + 2
(0.7 x HCO3-)

Respirator

+ 20 + 2

y acidosis
Respirator

Metabolic
alkalosis

HCO3

ABG (on O2 canula 5 LPM) : pH 7.23,

PaO2 80 mmHg, PaCO2 23, HCO3- 10
mEq/L
Dx : G-6-PD
deficiency anemia
with intravascular
hemolysis
: Pulmonary
edema
Rx : Respiratory
support

ABG (on O2 canula 5 LPM) : pH 7.23,

PaO2 80 mmHg, PaCO2 23, HCO3- 10
mEq/L

Hyperkalemia, suspected AKI

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