Arterial Blood Gas Analysis

Arterial Blood Gas Analysis

Aims of the lecture:
Interpret simple ABG results

Systematic approach to ABG interpretation

Understand the normal ranges for ABG values

Identify some of the common causes of ABG

abnormalities and what to do to correct them
 Arterial Blood Gases in Adults
Normal Range

pH 7.35 - 7.45

PaCO2 35 - 45 mmHg

PaO2 80 - 100 mmHg on air

HCO3- 22 - 26 mmol l-1

BE +/- 2 mmol l-1

 Arterial Blood Gas Analysis
Assess oxygenation
Assess acid base balance
Determine Respiratory component
Determine Metabolic component
Determine origin of in-balance in Ph
Is there compensation?
 5-Step approach to arterial blood gas
interpretation

Step 1

Normal PaO2 80 -100mmhg

Assess oxygenation

Is the patient hypoxic?

Step 2.

Determine status of the pH or H+ concentration

Is it acidotic or alkalotic?

Normal values 7.35 – 7.45

pH > 7.45 (H+ < 35 mmol l-1) – alkalaemia

pH < 7.35 (H+ > 45 mmol l-1) – acidaemia

Step 3

Determine respiratory component

PaCO2
Normal value 35-45 mmHg

> 45 mmHg – respiratory acidosis

< 35 mmHg – respiratory alkalosis

Step 4

Determine metabolic component

HCO3-
Normal value 22-28mmols/L

< 22 mmol l-1 – metabolic acidosis

> 26 mmol l-1 – metabolic alkalosis

Step 5

Approach to ABG interpretation

Assess oxygenation, acid base (pH) and CO2 to

determine the primary disturbance i.e. metabolic
or respiratory

Is there any metabolic or respiratory

compensation?
Step 5

Is there compensation?

If the direction of change in the PaCO2 reflects

that of the pH, then the primary condition is a
respiratory acidosis or alkalosis.

If the direction of change in the PaCO2 does not

reflect the pH, it is compensation for a metabolic
acidosis or alkalosis.
Step 5

Approach to ABG interpretation (continued)

Acidosis Alkalosis

Respiratory CO2  CO2 

Metabolic HCO3- or base HCO3- or base

excess  excess 
 Compensation
Uncompensated

Partial

Fully compensated
 Summary of changes in pH, PaCO2 and HCO3-
in acid-base disorders

Acid-base disorder pH PaCO2 HCO3-

Respiratory acidosis   N
Metabolic acidosis  N 
Respiratory alkalosis   N
Metabolic alkalosis  N 
Respiratory acidosis with *  
renal compensation
Metabolic acidosis with *  
respiratory compensation
* If the compensation is virtually complete the pH may be in the normal range –
over compensation does not occur.
Scenario 1

A 75 year old man 2 days Post Op after laparotomy

for a perforated sigmoid colon.
He has become hypotensive over the last 6 hours.
His vital signs are:

Heart rate 120

Blood pressure 70/40 mmHg
Respiratory rate 35 breaths min-1
SpO2 on oxygen 92%
Urine output 50 ml in 6 hours
GCS 13
 Arterial blood gases reveal

FiO2 0.4 (40%) approx Normal Values

pH 7.12 7.35 – 7.45

PaCO2 34 mmHg 35–45 mmHg
PaO 2 62 mmHg 80-100mmHg
HCO3- 12 mmol 22 – 26 mmol
BE - 15 mmol l-1 +/- 2 mmol l-1
Scenario two
A 65 year old man with severe chronic obstructive
pulmonary disease (CAL) has just collapsed in the
the ward.
On initial assessment by the ward nurse he is not
breathing, but has a palpable carotid pulse at 90.
His airway is being managed with at pocket mask
at 10 litres.
.
 Arterial blood gas analysis reveals:

FiO2 0.60 Normal Values

pH 7.20 7.35 – 7.45

PaCO2 151 mmHg 35–45 mmHg
PaO 2 147 mmHg 80-100 mmHg
HCO3- 36 mmol l-1 22 – 26 mmol l-1
BE + 12 mmol l-1 +/- 2 mmol l-1
Scenario 3
An 18 year old male who is an insulin dependent
diabetic is admitted to the ward. He has had been
vomiting for 48, not eating and omitted his insulin.
He is in a sinus tachycardia at a rate of 130 min-1
and his blood pressure is 90/65 mmHg. He is
breathing spontaneously with deep breaths at a
rate of 35 min-1 and is receiving oxygen 4 l min-1
via a Hudson mask. His GCS is 12 (E3, M5, V4).
 Arterial blood gas analysis reveals:

Oxygen 30% Normal Values

pH 6.79 7.35 – 7.45
PaCO2 11.3 mmHg35–45 mmHg
PaO2 129.2 mmHg 80-100mmHg
HCO3- 4.7 mmol l-1 2 – 26 mmol l-1
BE - 29.2 mmol l-1 +/- 2 mmol l-1

The blood glucose is 30 mmol l-1 and there are ketones+

++ in the urine
 Summary
Five step approach to ABG interpretation
Assess oxygenation
Determine status of the pH
Determine respiratory component
Determine metabolic component
Overall assessment of oxygenation, acid base
(pH), CO2 to determine the primary
disturbance - and ascertain if there any
metabolic or respiratory compensation?