Blood Gas Interpretation Review

Blood Gases
Important diagnostic tool
Reveals:
1. acid-base balance
2. oxygenation status
**arterial gases only**
3. abnormalities of ventilation

2
Acid- base balance
The body is designed for optimum performance at a
specific pH level
Cell division
Metabolism

3
Components of Acid- Base Balance
pH- measures the bloods acidity
Normal range 7.35- 7.45
Overall H+ from both respiratory and metabolic factors
pCO2- partial pressure of carbon dioxide in the blood
Normal range 35-45 mmHg
Snapshot of adequacy of alveolar ventilation
HCO3- the amount of bicarbonate in the blood
Normal range 22- 26 mEq/L

4
 Acid Base Balance

Bicarbonate carbonic acid buffer equation

(H+)(HCO3) (H2CO3) (CO2)(H2O)

Its not that complicated!

pH 1 7 14

Acidic Neutral Alkaline

5
 Acid Base Balance

Lungs Kidneys
Respiratory Metabolic
CO2 (acid) HCO3 ( base/alkaline)

6
 Making sense of it
pH
7.35 7.45

Respiratory Metabolic

CO2=Acidosis HCO3=Acidosis

CO2=Alkalosis HCO3=Alkalosis

7
 Interpretation: 4 steps

Normal Values
pH 7.35 7.45
pCO2 35 45 mmHg
HCO3 22 - 26 mEq/L

Evaluate each component as Acid or Base

8
 Step 1

Evaluate pH and determine acidosis or

alkalosis
7.35 7.40 7.45

Acid Normal Base

Acidosis Alkalosis

9
 Step 2

Evaluate pCO2 (respiratory)

35 40 45

Base Normal Acid

10
 Step 3

Evaluate HCO3 (metabolic)

22 24 26

Acid Normal Base

11
 Step 4

Determine which regulatory system is responsible for

the imbalance by checking to see which component
matches the pH.
If pH and pCO2 match = respiratory

If pH and HCO3 match = metabolic

12
ABG Analysis

pH pCO2 HCO3
Resp. Acidosis A A N
(<7.35) (>45) (22-26)
Resp. B B N
Alkalosis (>7.45) (<35) (22-26)
Metabolic A N A
Acidosis (<7.35) (35-45) (<22)
Metabolic B N B
Alkalosis (>7.45) (35-45) (>26)

13
Lets practice
pH pCO2 HCO3
A A N Respiratory Acidosis
7.26 55 23
B N B Metabolic Alkalosis
7.54 43 39
N N N Normal
7.39 41 25
B B N Respiratory Alkalosis
7.51 29 24
A N A Metabolic Acidosis
7.29 40 17
A A A Mixed Acidosis
7.28 61 18

14
 Compensation

When an acid base imbalance exists, over time the

body attempts to compensate.

15
 Understanding Compensation

Uncompensated the alternate system has not attempted to

adjust (remains within normal range), and the pH remains
abnormal
Example
pH 7.30 A
pCO2 60 A
HCO3 25 N
Uncompensated Respiratory Acidosis

16
 Understanding Compensation

Partial Compensation the alternate system is trying to create

a balanced environment and bring the pH back within normal
limits, but hasnt yet succeeded.
Example
pH 7.34A
pCO2 59 A
HCO3 28 B
Partially Compensated Respiratory Acidosis

17
 Understanding Compensation

Fully Compensated the alternate system has adjusted enough

to restore balance and normalize the pH
Example
pH 7.36 N (but slightly A)
pCO2 58 A
HCO3 31 B
Compensated Respiratory Acidosis

18
Lets Practice Compensation

pH pCO2 HCO3
Metabolic Alkalosis partially
B A B compensated
7.51 49 40
A A N Respiratory Acidosis uncompensated

7.29 53 22
N B A
Metabolic Acidosis fully compensated

7.37 25 18
N A B Respiratory Acidosis fully compensated

7.35 65 28
B B A
Respiratory Alkalosis partially
compensated
7.46 22 20 Respiratory Acidosis partially
A A B compensated
7.34 52 27

19
 A Final Step

Determine level of oxygenation

(arterial samples only)
Normal = 80 100 mmHg
Mild hypoxemia = 60 80 mmHg
Moderate hypoxemia = 40 60 mmHg
Severe hypoxemia = less than 40 mmHg

20
 Respiratory Acidosis

Excessive CO2 retention

Causes
Airway obstruction
Depression of respiratory drive
Sedatives, analgesics
Head trauma
Respiratory muscle weakness resulting from muscle disease
or chest wall abnormalities
Decreased lung surface area participating in gas exchange

21
 Respiratory Acidosis

Clues
Confusion, restlessness
Headache, dizziness
Lethargy
Dyspnea
Tachycardia
Dysrhythmias
Coma leading to death

22
 Respiratory Acidosis

Solutions
Improve ventilation
Ensure adequate airway; positioning,
suctioning
Encourage deep breathing and coughing
Frequent repositioning
Chest physio/ postural drainage
Bronchodilators
Decrease sedation/analgesia
Oxygen therapy
23
 Respiratory Alkalosis

Excessive CO2 loss due to hyperventilation

Causes
CNS injury: brainstem lesions, salicylate overdose, Reyes
Syndrome, hepatic encephalopathy
Aggressive mechanical ventilation
Anxiety, fear or pain
Hypoxia
Fever
Congestive heart failure

24
 Respiratory Alkalosis

Clues
Light headedness
Confusion
Decreased concentration
Tingling fingers and toes
Syncope
Tetany

25
 Respiratory Alkalosis

Solutions
Decrease respiratory rate and depth
Sedation/analgesia as appropriate
Rebreather mask
Paper bag
Emotional support/encourage patient to slow
breathing
Calm, soothing environment

26
 Metabolic Acidosis

Excessive HCO3 loss, or acid gain

Causes
Diabetic ketoacidosis
Sepsis/shock
Diarrhea (fluid losses below gastric sphincter)
Renal Failure
Poison ingestion
Starvation
Dehydration

27
 Metabolic Acidosis

Clues
Stupor
Restlessness
Kussmauls respirations (air hunger)
Seizures
Coma leading to death

28
 Metabolic Acidosis

Solutions
Replace HCO3 while treating underlying cause
Monitor intake and output
Monitor electrolytes, especially K+
Seizure precautions

29
 Metabolic Alkalosis

HCO3 retention, or loss of extracellular acid,

Causes
GI losses above gastric sphincter
Vomiting
Nasogastric suction
Antacids
Diuretic therapy causing electrolyte loss

30
 Metabolic Alkalosis

Clues
Weakness, dizziness
Disorientation
Hypoventilation
Muscle twitching
Tetany

31
 Metabolic Alkalosis

Solutions
Control vomiting
Replace GI losses
Eliminate overuse of antacids
Monitor intake and output
Monitor electrolytes

32