Arterial Blood Gas Analysis

ABG Analysis
• Three parameters must be assessed during
interpretation of an arterial blood gas result
– Oxygenation
– Acid – Base status
– Degree of Compensation
ABG Analysis
• Oxygenation
– Evaluate the PaO2
• PaO2 < 80 mmHg
• End result = Hypoxemia
– Evaluate the SaO2
• SaO2 < 93%
• End result = Hypoxia
Ventilation
• Evaluate the PaCO2 (increased, decreased or
normal)
ABG Analysis
• Acid Base Balance
– Evaluate the blood pH (normal, increased or
decreased)
– Evaluate the HCO3 (normal, increased, or
decreased)
ABG Analysis
• Blood pH
– The optimal blood pH is 7.40
– The body tolerates a narrow margin of normal
pH of 7.35 – 7.45
– A pH lower than 7.35 = Acidosis
– A pH greater than 7.45 = Alkalosis
ABG Analysis
• Blood pH
– If the pH is within normal range, it is important
to assess which side of 7.40 it falls.
– This may indicate that the patient may be
acidotic or alkalotic, but compensating.
– 7.35 – 7.39 = Acidosis
– 7.41 – 7.45 = Alkalosis
ABG Analysis
• PaCO2
– A PaCO2 less than 35 is indicative of
respiratory alkalosis

– A PaCO2 greater than 45 is indicative of

respiratory acidosis
ABG Analysis
• HCO3
– A HCO3 level less than 22 is indicative of
metabolic acidosis

– A HCO3 level greater than 26 is indicative of

metabolic alkalosis
The Arrow Method of
ABG Analysis
“Remember ROME”
• Three (3) goals that we need to accomplish
when interpreting arterial blood gases. The
goals are as follows:
• 1. Based on the given ABG values,
determine if values interpret ACIDOSIS or
ALKALOSIS.
• 2. Second, we need to determine if values
define METABOLIC or RESPIRATORY.
• 3. Lastly, we need to determine the
compensation if it is: FULLY
COMPENSATED, PARTIALLY
COMPENSATED, or UNCOMPENSATED.
It’s Easy!
• Assess the pH, PaCO2 and HCO3
– If the values are elevated, place the
corresponding arrow.

– If the values are decreased, place the

corresponding arrow.
• If the pH and PaCO2 arrows are moving in
opposite direction, this signifies a
RESPIRATORY problem.

– pH PaCO2 = Respiratory Acidosis

– pH PaCO2 = Respiratory Alkalosis

Respiratory acidosis occurs when breathing is inadequate

and PaCO2 or respiratory acid builds up. The extra CO2
combines with water to form carbonic acid, causing a state
of acidosis — a common occurrence in emphysema.
Respiratory alkalosis can occur as a result of
hyperventilation.
• If the pH and HCO3 arrows are moving in the
same direction, this signifies a METABOLIC
problem.

– pH HCO3 = Metabolic Acidosis

– pH HCO3 = Metabolic Alkalosis

Metabolic acidosis is when there is a decrease in

bicarbonates and a buildup of lactic acid occurs. This
happens in diarrhea, ketosis, and kidney disorders.
Metabolic alkalosis occurs when bicarbonate ion
concentration increases, causing an elevation in blood pH.
This can occur in excessive vomiting, dehydration, or
endocrine disorders.
 EXAMPLE #1

• pH: 7.22

• PaCO2: 55

• HCO3: 25

pH PaCO2 HCO3
Respiratory Normal
Acidosis
 EXAMPLE #2

• pH: 7.31

• PaCO2: 35

• HCO3: 20

pH PaCO2 HCO3
Metabolic Normal
Acidosis
 EXAMPLE #3

• pH: 7.49

• PaCO2: 30

• HCO3: 23

pH PaCO2 HCO3
Respiratory Normal
Alkalosis
Evaluate for Compensation
• When a patient develops
an acid-base imbalance
the body will typically
attempt to compensate
for the abnormality.
• If the buffer systems
within the body are
unable to maintain a
normal pH, the lungs &
the kidneys will attempt
to compensate.
• If the problem is respiratory in origin, the
kidneys will work to correct it.

• If the problem is metabolic in origin, the lungs

will work to correct it.
• Determine the degree of compensation:
• Uncompensated
• pH is abnormal, & either the PaCO2 or HCO3
is also abnormal
• There is no indication that the opposite
side has tried to correct for the other.
• Partially Compensated
• pH is abnormal, & both the PaCO2 and HCO3
are also abnormal
• This indicates that one system has
attempted to correct for the other but has
not been completely successful.
• Fully Compensated
• pH is normal, & both the PaCO2 & HCO3 are
abnormal
• The normal pH indicates that one system
has been able to compensate for the
other.
• It is FULLY COMPENSATED if pH is normal.
• It is PARTIALLY COMPENSATED if all three
(3) values are abnormal.
• It is UNCOMPENSATED if PaCO2 or HCO3 is
normal and the other is abnormal.
Steps for Evaluating Compensation
• Assess the pH, determine acidosis or
alkalosis.
– Remember, even if the pH is normal,
determine whether the pH falls on the acidotic
or alkalotic side of 7.40.
• Assess the PaCO2 and the HCO3
– Place the corresponding arrows next to the
values.
– Continue the matching game:
– Which value matches with the pH?
– The other component should be moving in the
opposite direction, which indicates
compensation.
Example:
• pH 7.32 ; PaCO2 56 ; HCO3 30

• Which value matches with the pH?

 EXAMPLE #1

• pH: 7.31

• PaCO2: 55

• HCO3: 28
pH PaCO2 HCO3
Partially
Compensated
Respiratory
Acidosis
 EXAMPLE #2

• pH: 7.31

• PaCO2: 25

• HCO3: 20

pH PaCO2 HCO3
Partially
Compensated
Metabolic Acidosis
 EXAMPLE #3

• pH: 7.48

• PaCO2: 25

• HCO3: 21

pH PaCO2 HCO3
Partially
Compensated
Respiratory
Alkalosis
 EXAMPLE #4

• pH: 7.48

• PaCO2: 55

• HCO3: 31

pH PaCO2 HCO3
Partially
Compensated
Metabolic Alkalosis
• Questions?