ABGS

INTERPRETATION
SADIA RAUF
LARAIB KANWAL
OBJECTIVES
ABG sampling.
Interpretation of ABG.
◦ Gas exchange.
◦ Acid base disorders.
 Applications of ABG
To document respiratory failure and assess its severity.
To monitor patients on ventilators and assist in weaning.
To assess acid base imbalance in critical illness.
To assess response to therapeutic interventions and mechanical ventilation.
 ABGs procedure
Pre heparinized ABG syringes are used.
Syringe flushed with 0.5ml 1:1000 Heparin
and emptied.
Don't leave extra heparin in syringe.
Blood sample is drawn from:
Radial artery is commonly used:
 Radial.  Easy to access.
 Femoral.  Not a deep artery, each to
stabilize and puncture.
 Brachial.  Collateral circulation is there.
 Dorsalis pedis.
1 2 3 4

5 6
7
 Technical errors
Excessive Heparin (dilutional effect, Decreased Bicarbonates, Decreased
Carbon dioxide).
Air bubbles (Contact with air bubbles, Increased Oxygen, Decreased Carbon
dioxide)
Body temperature (Effects on Bicarbonates and Carbon dioxide).
WBC counts.
Transport via Cold chain(Chilling).
Immediate analysis.
 Assessment of gas exchange
PaO2 vs SpO2.
Alveolar arterial oxygen gradient.
PaO2/FiO2.
PaCO2.
 Determinants of PaO2

As age As FiO2
Dependent on increases increases,
Age, FiO2, expected PaO2 PaO2 also
Patm.
decrease. increases.
 Hypoxemia
Normal PaO2 95-100
mmHg. (80-
100mmHg)

Mild Hypoxemia 60-

80 mm Hg.

Moderate
Hypoxemia 40-60
mm HG Tachycardia, hypertension cool extremities.
Severe hypoxemia
PaO2 less than 40 mm
Hg Severe arrhythmias, brain injury and death.
 HYPOXIA & HYPOXEMIA
◦ Inadequate oxygen supply to
body tissues and end organs.
◦ Types (Hypoxic, Anemic,
Circulatory, Histotoxic).
◦ Low oxygen levels in
bloodstream.
◦ Causes (Respiratory,
Cardiovascular, Altitude,
Anaesthsia)*
Acid base status
Acid base disorders
Compensation:
Uncompensated:
◦ If pH is out of range and CO2 or HCO3 is in
range
Partially compensated
◦ If the pH CO2 and HCO3 are ALL out of range
Fully compensated
◦ If the pH is in range (7.35-7.45)
Metabolic acidosis
◦ Anion gap = Na – (HCO3+CL)
◦ Normal is <10-15
◦ High anion gap acidosis -> excessive production of fixed
acids
◦ Normal anion gap acidosis -> usually loss of Na/HCO3
(ileostomies/ small bowel fistulas, lactulose) rapid
infusion of HCO32 deficient fluids, primary
hyperparathyroidism, mafenide acetate, renal tubular
acidosis

Tx: underlying cause

◦ Keep pH > 7.2 with bicarbonate, severely decreased pH
affect myocardial contractility
◦ Correction of acidosis can lead to hypokalemia
Metabolic acidosis
High anion gap acidosis
“MUDPILERS”
◦ Methanol
◦ Uremia
◦ DKA
◦ Paraldehyde
◦ Isoniazid
◦ Lactic acidosis
◦ Ethylene glycol
◦ Rhabdo/Renal failure
◦ Salicylates
Metabolic alkalosis
◦ Usually a contraction alkalosis
◦ Nasogastric suction results in hypochloremic, hypokalemic. Metabolic alkalosis and paradoxical
aciduria
◦ Loss of CL and H ion from stomach secondary to nasogastric tube (hypochloremia and alkalosis)
◦ Loss of water causes kidney to reabsorb Na in exchange for K (Na K ATPase) thus losing K
(hypokalemia)
◦ Na H exchanger activated in effort to reabsorb water along with K/ H exchanger in an effort to reabsorb
K -- results in paradoxical aciduria
◦ Respiratory compensation (CO2 regulation ) takes minutes
◦ Renal compensation (HCO3 regulation) takes hours to days

◦ Tx: Normal saline(need to correct the Chloride deficit)

Respiratory acidosis
◦ pH <7.35
◦ PCO2 >40
◦ Abnormal CO2 retention due to hypoventilation
◦ Airway obstruction
◦ Lung disease (acute/chronic)
◦ Respiratory center depression (opiods, sedatives)
◦ Reduced respiratory muscle ability (nerve/muscle disorders)

◦ Tx: Bronchodilators/ Corticosteriods/ oxygen

◦ Endotracheal intubation, Non invasive positive pressure ventilation (CPAP)
Respiratory alkalosis
◦ This occurs when there is excessive loss of CO2 by alveolar hyperventilation
◦ Hypocapnia develops when a sufficiently strong ventilatory stimulus causes CO2 output in the lungs to
exceed its metabolic production by the tissues.
◦ As a result partial pressure of CO2 and H conc. Falls

Tx
◦ Treat the underlying cause:
Correct Hypoxemia
Treat pneumonia, pulmonary edema, sepsis
Stop responsible drugs
Decrease mechanical ventilation
Reduce pain/ anxiety
◦Thank you