Abgs (Lecture 1)

ABG INTERPRETATION
Ruquia Feroz
RCCT
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1
NonCommercial-NoDerivatives 4.0 International License.
INTRODUCTION OF THE TEACHER AND ROLE IN INSTITUTE
Ruquia Feroz a teaching faculty in DIMT.
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LEARNING OBJECTIVES
What’s an ABG?
 Understanding Acid/Base Relationship
 General approach to ABG Interpretation
 Clinical causes Abnormal ABG’s
 Case studies
 Take home

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WHAT IS AN ABG?
A laboratory test to monitor the patient’s acid-base

balance.
It is used to determine the extent of the compensation by
the buffer system and includes the measurements of the
acidity (pH), levels of oxygen, and carbon dioxide in
arterial blood.
It is an invasive procedure.
A blood sample from an arterial blood gas (ABG) is taken
from an artery (commonly on radial or brachial artery).
Caution must be taken with patient on anticoagulants.

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WHAT IS AN ABG?

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WHAT ARE THE COMPONENTS OF ARTERIAL BLOOD GAS?
There are six components of arterial blood gas (ABGs):

pH
• The pH is the concentration of hydrogen ions and determines the acidity
or alkalinity of body fluids.
• A pH of 7.35 indicates acidosis and a pH greater than 7.45 indicates
alkalosis.
• The normal ABG level for pH is 7.35 to 7.45.

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WHAT ARE THE COMPONENTS OF ARTERIAL BLOOD GAS? CONT.
PaCO2 (Partial Pressure of Carbon Dioxide)

• It shows the adequacy of the gas exchange between the alveoli and the external
environment (alveolar Ventilation).
• Carbon dioxide (CO2) cannot escape when there is damage in the alveoli, excess
CO2 combines with water to form carbonic acid (H2CO3) causing an acidotic state.
• When there is hypoventilation in the alveolar level (for example, in COPD), the
PaCO2 is elevated, and respiratory acidosis results. On the other hand, when there is
alveolar hyperventilation (e.g., hyperventilation), the PaCO2 is decreased causing
respiratory alkalosis.
• For PaCO2, the normal range is 35 to 45 mmHg (respiratory determinant).

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SO2 (Oxygen Saturation)

 It measured in percentage, is the amount of oxygen in the blood that
combines with hemoglobin.
 It can be measured indirectly by calculating the PAO2 and pH Or
measured directly by co-oximetry.
 Oxygen saturation, the normal range is 94–100%

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HCO3 (Bicarbonate)
 HCO3 or bicarbonate ion is an alkaline substance that comprises over
half of the total buffer base in the blood.
 A deficit of bicarbonate and other bases indicates metabolic acidosis.
 Alternatively, when there is an increase in bicarbonates present, then
metabolic alkalosis results.

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BE (Base Excess)
BE. Base excess or BE value is routinely checked with
HCO3 value.
A base excess of less than –2 is acidosis and greater than +2 is
alkalosis.
Base excess, the normal range is –2 to +2 mmol/L

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NORMAL VALUES IN ARTERIAL BLOOD GAS
Components Value
pH 7.35 to 7.45
PaCO2 35 to 45 mmHg (respiratory determinant)
PaO2 75 to 100 mmHg

HCO3 22 to 26 mEq/L (metabolic determinant)
Oxygen saturation 94–100%

Base excess –2 to +2 mmol/L

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Acidosis Alkalosis
pH < 7.35 pH > 7.45

PCO2 > 45 PCO2 < 35
HCO3 < 22 HCO3 > 26

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Respiratory Acidosis
Think of CO2 as an acid
 failure of the lungs to exhale adequate CO2
 pH < 7.35
 PCO2 > 45
 CO2 + H2CO3   pH

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Causes of Respiratory Acidosis
 Emphysema
 Drug overdose
 Narcosis
 Respiratory arrest
 Airway obstruction

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Metabolic Acidosis
Failure of kidney function
  blood HCO3 which results in  availability of renal

tubular HCO3 for H+ excretion
 pH < 7.35
 HCO3 < 22

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Causes of Metabolic Acidosis
Renal failure
 Diabetic ketoacidosis
 Lactic acidosis
 Excessive diarrhea
 Cardiac arrest

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Respiratory Alkalosis
 Too much CO2 exhaled (hyperventilation)
  PCO2, H2CO3 insufficiency =  pH
 pH > 7.45
 PCO2 < 35

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Causes of Respiratory Alkalosis
Hyperventilation
 Panic
 Pain
 Pregnancy
 Acute anemia
 Salicylate overdose
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Metabolic Alkalosis
  plasma bicarbonate
 pH > 7.45
 HCO3 > 26

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Causes of Metabolic Alkalosis
  loss acid from stomach or kidney
 hypokalemia
 excessive alkali intake

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How to Analyze an ABG
1.PO2 NL = 80 – 100 mmHg
2. pH NL = 7.35 – 7.45
Acidotic <7.35
Alkalotic >7.45
3.PCO2 NL = 35 – 45 mmHg
Acidotic >45
Alkalotic <35
4.HCO3 NL = 22 – 26 mmol/L
Acidotic < 22
Alkalotic > 26
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DETERMINE IF PH IS UNDER NORMAL, ACIDOSIS, OR ALKALOSIS.
 Remember in step #1 that the normal pH range is from 7.35 to 7.45.

• If the blood pH is between 7.35 to 7.39, the interpretation is NORMAL but
SLIGHTLY ACIDOSIS, place it under the NORMAL column.
• If the blood pH is between 7.41 to 7.45, interpretation is NORMAL but
SLIGHTLY ALKALOSIS, place it under the NORMAL column.
• Any blood pH below 7.35 (7.34, 7.33, 7.32, and so on…) is ACIDOSIS,
place it under the ACIDOSIS column.
• Any blood pH above 7.45 (7.46, 7.47, 7.48, and so on…) is ALKALOSIS,
place it under the ALKALOSIS column.

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DETERMINE IF PH IS UNDER NORMAL, ACIDOSIS, OR ALKALOSIS

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DETERMINE IF PACO2 IS UNDER NORMAL, ACIDOSIS, OR ALKALOSIS.
Remember that the normal range for PaCO 2 is from 35 to 45:
• If PaCO2 is below 35, place it under the ALKALOSIS column.

• If PaCO2 is above 45, place it under the ACIDOSIS column.
• If PaCO2 is within its normal range, place it under the
NORMAL column.

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DETERMINE IF PACO2 IS UNDER NORMAL, ACIDOSIS, OR ALKALOSIS

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DETERMINE IF HCO3 IS UNDER NORMAL, ACIDOSIS, OR ALKALOSIS.
Remember that the normal range for HCO 3 is from 22 to 26:
• If HCO3 is below 22, place it under the ACIDOSIS column.

• If HCO3 is above 26, place it under the ALKALOSIS column.
• If HCO3 is within its normal range, place it under the NORMAL
column.

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DETERMINE IF HCO3 IS UNDER NORMAL, ACIDOSIS, OR ALKALOSIS.

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SOLVE FOR GOAL #1: ACIDOSIS OR ALKALOSIS.
• If pH is under the ACIDOSIS column, it is ACIDOSIS.

• If pH is under the ALKALOSIS column, it is ALKALOSIS.
• If pH is under the NORMAL column, determine whether the
value is leaning towards ACIDOSIS or ALKALOSIS and
interpret accordingly.

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SOLVE FOR GOAL #1: ACIDOSIS OR ALKALOSIS.

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SOLVE FOR GOAL #2: METABOLIC OR RESPIRATORY.
Determining if the ABG is RESPIRATORY or METABOLIC.

Interpret the results as follows:
• If pH is under the same column as PaCO 2, it is RESPIRATORY.
• If pH is under the same column as HCO 3, it is METABOLIC.
• If pH is under the NORMAL column, determine whether the
value is leaning towards ACIDOSIS or ALKALOSIS and
interpret accordingly.

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SOLVE FOR GOAL #2: METABOLIC OR RESPIRATORY.

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Solve for goal #3: COMPENSATION.
Lastly, we need to determine the compensation to accomplish

our goal #3. Interpret the results as follows:
• 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.

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Solve for goal #3: COMPENSATION.

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Case study No 1
27 yrs retarded  with insulin-dependent DM arrived at ER from the institution where he
lived. On room air ABG & VS:
pH 7.15 BP 180/110 mmHg

PCO2 22 mmHg Pulse 130/min
PO2 92 mmHg RR 40/min
HCO3 9 mmol/L VT 800ml
BE -30 mmol/L MV 32L
Interpretation: Partly compensated metabolic acidosis.

34
Case study No 2
74 yo  with hx chronic renal failure and chronic diuretic therapy was admitted
to ICU comatose and severely dehydrated. On 40% oxygen her ABG & VS:
pH 7.52 BP 130/90 mmHg

BE 17 mmol/L MV 3.75L
Interpretation: Partly compensated metabolic alkalosis with corrected

hypoxemia.

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Case study No 3
43 yo  arrives in ER 20 minutes after a MVA in which he injured his face on the
dashboard. He is agitated, has mottled,cold and clammy skin and has obvious
partial airway obstruction.An oxygen mask at 10 L is placed on his face. ABG &
VS:
pH 7.10 BP 150/110 mmHg

HCO3 18 mmol/L VT ? ml
BE -15 mmol/L MV ? L
Interpretation: Acute ventilatory failure (resp. acidosis) and acute metabolic
acidosis with corrected hypoxemia
36
Case study No 3
17 yrs, 48 kg  with known insulin-dependent DM came to ER with Kussmaul
breathing and irregular pulse. Room air ABG & VS:
pH 7.05 BP 140/90 mmHg

BE -30 mmol/L MV 48L
Interpretation: Severe partly compensated metabolic acidosis without

hypoxemia.

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Case No. 5
67 yo  who had closed reduction of leg fx without incident. Four days later
she experienced a sudden onset of severe chest pain and SOB. Room air ABG
& VS:
pH 7.36 BP 130/90 mmHg

HCO3 18 mmol/L
BE -5 mmol/L MV 18L
SaO2 88%
Interpretation: Compensated metabolic acidosis with moderate hypoxemia. Dx: PE

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Practice ABG’s
1. PaO2 90 SaO2 95 pH 7.48 PaCO2 32 HCO3 24


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Answers to Practice ABG’s
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic acidosis
4. Compensated Respiratory acidosis
5. Metabolic alkalosis
6. Compensated Respiratory acidosis
7. Compensated Metabolic alkalosis
8. Metabolic acidosis
9. Respiratory acidosis
10.Metabolic alkalosis
40
THANK YOU
Ruquia Feroz
Ruquia.noor@duhs.
edu.pk


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ABG INTERPRETATION

This work is licensed under a Creative Commons Attribution-

This work is licensed under a Creative Commons Attribution- 2

 Understanding Acid/Base Relationship

 General approach to ABG Interpretation

 Clinical causes Abnormal ABG’s

This work is licensed under a Creative Commons Attribution-

A laboratory test to monitor the patient’s acid-base

This work is licensed under a Creative Commons Attribution-

This work is licensed under a Creative Commons Attribution-

There are six components of arterial blood gas (ABGs):

This work is licensed under a Creative Commons Attribution-

PaCO2 (Partial Pressure of Carbon Dioxide)

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SO2 (Oxygen Saturation)

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PaO2 75 to 100 mmHg

Oxygen saturation 94–100%

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pH < 7.35 pH > 7.45

HCO3 < 22 HCO3 > 26

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Think of CO2 as an acid

 failure of the lungs to exhale adequate CO2

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  blood HCO3 which results in  availability of renal

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This work is licensed under a Creative Commons Attribution-

 Too much CO2 exhaled (hyperventilation)

  PCO2, H2CO3 insufficiency =  pH

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This work is licensed under a Creative Commons Attribution-

  loss acid from stomach or kidney

 excessive alkali intake

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 Remember in step #1 that the normal pH range is from 7.35 to 7.45.

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This work is licensed under a Creative Commons Attribution-

Remember that the normal range for PaCO 2 is from 35 to 45:

• If PaCO2 is below 35, place it under the ALKALOSIS column.

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Remember that the normal range for HCO 3 is from 22 to 26:

• If HCO3 is below 22, place it under the ACIDOSIS column.

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• If pH is under the ACIDOSIS column, it is ACIDOSIS.

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Determining if the ABG is RESPIRATORY or METABOLIC.

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Lastly, we need to determine the compensation to accomplish

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pH 7.15 BP 180/110 mmHg

Interpretation: Partly compensated metabolic acidosis.

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pH 7.52 BP 130/90 mmHg

Interpretation: Partly compensated metabolic alkalosis with corrected