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Arterial Blood Gas Interpretation
Arterial Blood Gas Interpretation
Arterial Blood Gas Interpretation
COMPONENTS OF AN ABG
pH
Measurement of acidity or alkalinity,
based on the hydrogen (H+) ions
present
PaO2
The partial pressure of oxygen that is
dissolved in arterial blood.
The normal range is 80 to 100 mm Hg.
SaO2
The arterial oxygen saturation.
The normal range is 95% to 100%.
PaCO2
The amount of carbon dioxide dissolved
in arterial blood.
The normal range is 35 to 45 mm Hg.
pH Degree of impairment
< 7.20 Severe acidemia
7.20-7.29 Moderate
7.30-7.34 Mild acidemia
7.35-7.45 Normal pH
7.46-7.50 Mild alkalemia
7.51-7.55 Moderate
> 7.55 Severe alkalemia
HINT:
If pH and PaCO2 are moving in
opposite directions, then the problem is
primarily respiratory in nature
If they are moving in the same direction,
then the problem is primarily metabolic
in nature.
HCO3 HCO3 10
24 HCO3 10
AG 12 AG 26 AG 12
M- methanol Na+
U- uremia
D- HCO3-
DKA
P- paraldehyde
I- iron, INH
H+
L- lactic
acidosis E- High
ethylene glycol anion
Protein-
S- salicylates gap PO4=,SO4=
Organic acids
Na Cl Na Cl Na Cl Na Cl
136 100 136 100 136 106 136 94
HCO3 HCO3
HCO3 14 HCO3 8 20
24
AG 12 AG 22 AG 22 AG 22
AG 10 AG = 10 AG = 10
HCO3= 10 HCO3 16 HCO3 4
Na Cl Na Cl Na Cl Na Cl
136 100 134 110 128 110 140 110
Cl 10 Cl 10 Cl 10
= = =
HCO3 10 HCO3 16 HCO3 4
7.11 -15
7.22 -10
7.33 -5
7.40 0
7.48 +5
7.55 +10
7.60 +15
7.66 +20
Philippine General Hospital
Case 2
A 30 year old male with a history of
epilepsy has a grand mal seizure.
Laboratory tests taken immediately after
the seizure has stopped reveal:
Arterial pH = 7.14
pCO2 = 45 mm Hg
Plasma [Na+] = 140 meq/L
[K+] = 4.0 meq/L
[Cl-] = 98 meq/L
[HCO3-] = 17 meq/L
AG = 25
Philippine General Hospital
3. Determine the primary disorder.
pH
24 - 17 vs. 45 - 40
24 40
7 > 5
24 40
DHCO3 = 24 – 17 = 7
pCO2 = 7 x 1.2 = 8.4
Exp. pCO2 = 40 – 8.4 = 31.6 ± 2
AG 25 – 12 13
= =
HCO3 24 – 17 7
Normal 400-500
Moderate 200-390
Acute lung injury < 300
1. pO2
2. P/F ratio
3. O2 saturation
4. aADO2
- difference in O2 in the alveolus and the arterial
blood
pAO2 = 713 (FiO2) - pCO2
0.8
aADO2 = pAO2 – paO2
Normal 20
P/F >
< Exp.
Hypoxemic
Non Hypoxemic
P02 =
< expected
Uncorrected
Adequate 02
P02 =expected
> expected
Corrected
More than Adequate 02
P02 > expected
Overcorrected
Causes of Hypoxemia
Central hypoventilation
V/Q mismatch
Shunt
Low FIO2
Low mixed venous O2
ACID
Oxygenation
BASE
P/F Compare
ratio actual pO2
Philippine General Hospital
Problem #1 Metabolic acidosis
40M
Room air
• Expected pCO2:
= 1.5 x HCO3 + 8 + 2
pH = 7.20
= 1.5 x 10 + 8 + 2
pCO2 = 25 = 23 + 2 (21-25)
pO2 = 68 • Purely metabolic acidosis
HCO3 = 10 • Oxygenation at room air
Expected pO2 < 60y/o = 100 + 20
• Hypoxemic at room air
New FiO2:
• pAO2 = 713 x (.21) – 25/0.8 = 118.48
Purely metabolic acidosis • ideal O2: 103.5 – 0.42 (40) = 86.7
• Hypoxemic at room air • iO2/aO2 = 86.7/68 x pAO2 = 151
• new FiO2 = 151 + 25/0.8 = 26% (1.5L)
713
Philippine General Hospital
Problem #2
• 32M • Respiratory acidosis
• 3 lpm by n.c. • Expected pH
• pH - 7.06 Acute: 7.4 – 0.008 x (80-40) = 7.08
Chronic: 7.4 – 0.003 x (80-40) = 7.28
• pCO2 - 80 Expected pH range: 7.08 – 7.28
• pO2 - 77 • with underlying metabolic acidosis
• HCO3 - 23 • Actual P/F (FiO2 = 3 x 4 + 20 = 32)
= 77/0.32 = 240
Expected P/F in <60y/o = 400-500
• Hypoxemic at 3 lpm, uncorrected
Respiratory acidosis
with underlying New FiO2:
• pAO2 = 713 (.32) – 80/0.8 = 128.16
metabolic acidosis • ideal O2 = 103.5 - .42 (32) = 90
Hypoxemic at 3 lpm, • iO2/aO2 = 90/77 x 128.16 = 149.9
uncorrected • new FiO2 = 149.9 + 80/0.8 = 35% (3.75 lpm)
713
Philippine General Hospital
Practice Exercises:
pH pC02 P02 HC03
1. 40/M 7.20 25 68 10
2. 32/M 7.08 80 77 26
@ 3lpm
3. 50/F 7.23 25 118 12
@ 5lpm
4. 26/M 7.44 23.7 42.5 16
@3 lpm
5. 70/F 7.48 36 215 30
@50%
Problem #4
Respiratory alkalosis
With uncorrected hypoxemia at 3 lpm
Problem #5
Metabolic alkalosis
With underlying respiratory alkalosis
With more than adequate oxygenation at 50% FiO2
New FiO2 of 21%