Arterial Blood Gases (ABG): An

insight into a comprehensive

interpretetion
José Reyes Rivadeneira MD
 Indications of ABG sampling
• Identification and monitoring of acid
base disturbances
• Measurement of the PaO2 and PaCO2
• Assessment of the response to the
therapeutic interventions
• When a venous sampling is not possible
• Detection and quantification of levels
of abnormal hemoglobins
(carboxyhemoglobin, methemoglobin)
Contraindications of ABG sampling
• An abnormal Allen’s test
• Local infection, thrombus or
distorted anatomy of the
puncture site
• Severe peripheral vascular
disease of the artery selected
for sampling
• Active Raynaud syndrome
• INR >3 activated partial
thromboplastin>100 platelet
count <30.000
Possible sites of puncture
• Radial artery  Allen test

• Brachial artery

• Femoral artery

• Dorsalis pedis
Understanding the acid/base balance

CO2 + H20 H2CO3 H+ + HCO3-

BUFFER MECHANISM

pH

HCO3
H+
Normal Ranges: Sea level

pH 7.35 – 7.45
Po2 >80
pCo2 35 – 45
HCo3 22 – 26
Normal Values: Quito (2800 meters
above sea level)
pH 7.35 – 7.45
Po2 >60
pCo2 30 –35
HCo3 18 – 22
Steps for interpretation
1. Predict the patology we are gonna find based on the
patient´s clinical features

2. pH value
>7.45 alkalosis
<7.35 acidosis
3.What´s the primary disturbance? Respiratory (CO2)

HYPOVENTILATION:
Drugs, lung issues,
COPD, Asthma

HYPERVENTILATION:
Pain, anxious, altitude,
heart failure, high
altitude, pregnancy,
hyperthyroidism
3. What´s the primary disturbance? Metabolic (HCO3)

More causes

Vomiting
Lost H+ Antiacid
Stomach
suction
4. For a metabolic
acidosis; Is there a
high anion gap?

H+
Two ways
How do we solve this puzzle? to
Calculating the anion gap
This Will lead us to the cause
metabolic
of the acidocis
HCO3
Calculating the anion gap…

• Ions Na+ Anions HCO3– Cl-

ANION GAP  Na - (HCO3 + Cl)

Normal values (8-16)

• Therefore the anion gap can be normal or higher

• NEVER LOWER
• HIGHER anion gap means an increase of H+ in blood
• NORMAL anion gap means lower quantities of HCO3
Metabolic acidosis with:
HIGH anion gap: NORMAL anion gap
• Lactic acidosis • Diarrea
• Ketoacidosis • Renal Tubular Acidosis
• Toxins
• Renal failure
• Alcohol/Aspirin
5. Is there any compensation?
One quicker than the other
5. Is there any compensation?
• 5. Is there any compensation? Three scenarios Takes several days

• Fully compensated
• Partially compensated
• Uncompensated
Ejercicio: #1
Respuesta #1
Ejercicio #2
Respuesta #2
Ejercicio #3
Respuesta #3