ABG Interpretation

Julie Perkins RRT-NPS

LPCH Respiratory Care

pH

Normal pH is 7.35-7.45
Value <7.35 is acidotic
Value >7.45 is alkalotic
Acidosis & Alkalosis can be caused
by a problem with the respiratory
system or a metabolic cause
Can also have combined
respiratory/metabolic states

Is it Respiratory or Metabolic?
1.

Respiratory Acidosis

Increased pCO2 >50

2.

Respiratory Alkalosis

Decreased pCO2<30

3.

Metabolic Acidosis

4.

Metabolic Alkalosis

Decreased HCO3
<18
Increased HCO3 >30

Compensated or Uncompensatedwhat
does this mean?
1.

Evaluate pHis it normal? Yes

2.

Next evaluate pCO2 & HCO3

pH normal + increased pCO2 + increased

HCO3 = compensated respiratory acidosis

pH normal + decreased HCO3 + decreased

pCO2 = compensated metabolic acidosis

Compensated vs. Uncompensated

Is pH normal? No
Acidotic vs. Alkalotic
Respiratory vs. Metabolic

1.
2.
3.

pH<7.30 + pCO2>50 + normal HCO3

uncompensated respiratory acidosis
pH<7.30 + HCO3<18 + normal pCO2
uncompensated metabolic acidosis
pH>7.50 + pCO2<30 + normal HCO3
uncompensated respiratory alkalosis
pH>7.50 + HCO3>30 + normal pCO2
uncompensated metabolic alkalosis

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Causes of Acidosis

Respiratory

Hypoventilation
Impaired gas
exchange

Metabolic

Ketoacidosis
Diabetes
Renal Tubular
Acidosis
Renal Failure
Lactic Acidosis
Decreased
perfusion
Severe
hypoxemia

Causes of Alkalosis

Respiratory

Hyperventilation
due to:
Hypoxemia
Metabolic
acidosis
Neurologic

Lesions
Trauma
Infection

Metabolic

Hypokalemia

Gastric suction or
vomiting

Hypochloremia

Assessing Oxygenation

Normal value for arterial blood gas

80-100mmHg
Normal value for venous blood gas
40mmHg
Normal SaO2
Arterial:

97%
Venous: 75%

Important points for assessing tissue

oxygenation

This is the O2 thats really available

at the tissue level.
Is the THb normal?
Low

THb means the ability of the blood

to carry the O2 to the tissues is
decreased

Is perfusion normal?
Low

perfusion means the blood isnt

even getting to the tissues

Lets Practice

12 year old diabetic presents with Kussmaul

breathing

pH :
pCO2:
pO2:
HCO3:
BE:
Severe

7.05
12 mmHg
108 mmHg
5 mEq/L
-30 mEq/L

partly compensated metabolic

acidosis without hypoxemia due to
ketoacidosis

17 year old w/severe kyphoscoliosis, admitted for

pneumonia

pH:
pCO2:
pO2:
HCO3:
BE :

7.37
25 mmHg
60 mmHg
14 mEq/L
-7 mEq/L

Compensated

respiratory alkalosis due

to chronic hyperventilation secondary
to hypoxia

9 year old w/hx of asthma, audibly wheezing x 1 week, has

not slept in 2 nights; presents sitting up and using accessory
muscles to breath w/audible wheezes

pH:
pCO2:
pO2
HCO3:
BE:

7.51
25 mmHg
35 mmHg
22 mEq/L
-2 mEq/L

Uncompensated

respiratory alkalosis
with severe hypoxia due to asthma
exacerbation

7 year old post op presenting with chills, fever and

hypotension

pH:
pCO2:
pO2:
HCO3:
BE:

7.25
32 mmHg
55 mmHg
10 mEq/L
-15 mEq/L

Uncompensated

metabolic acidosis due

to low perfusion state and hypoxia
causing increased lactic acid