Arterial Blood Gas (ABG) Analysis

Mary Ann R. Garcia RN, MSN

Purpose & Objectives



The purpose of this course is to provide the learner with basic information about how to interpret arterial blood gas results Identify components of an ABG. Identify and define abnormal ABG results. Identify different conditions that can cause an acid-base imbalance.

Anatomy and Physiology Related to Acid-Base Imbalance



The Lungs


During the process of exhalation, the lungs excrete carbon dioxide and water from the body

The Kidneys


Since normal metabolism produces acid, the kidneys are continuously at work to maintain homeostasis by excreting metabolic acid

Components of an arterial blood gas



Normal pH: 7.35 to 7.45. Normal CO2 (carbon Dioxide level/PaCO2): 35-45. Normal HCO3 (bicarbonate level): 22-26. Normal O2 (oxygenation level/PaO2/SaO2): 80-100

Step 1: Look at the pH

  

Normal pH is 7.35-7.45 Value <7.35 is acidotic Value >7.45 is alkalotic

The pH is 7.35. This is ___________. The pH is 7.55. This __________. The pH is 7.25. This __________.

Step 2: Look at the CO2

  

normal CO2 is 35-45 Value <35 is alkalotic Value >45 is acidotic

The CO2 is 60. This is ___________. The CO2 is 27. This __________. The CO2 is 40. This __________.

Step 3: Look at the HCO3



 

Normal bicarbonate (HCO3) level is 22-26 Value <22 is acidotic Value >26 is alkalotic

The HCO3 is 24. This is ___________. The HCO3 is 33. This __________. The HCO3 is 18. This __________.

Quick Review
Normal pH is 7.357.45


Normal HCO3 level is 22-26 Value <22 is acidotic Value >26 is alkalotic Normal CO2 is 35-45 Value <35 is alkalotic Value >45 is acidotic

Value <7.35 acidotic Value >7.45 alkalotic

Quick Review


  

Your patients ABG results are as follows: pH: 7.50 CO2: 44 HCO3: 30

Quick Review


  

Your patients ABG results are as follows: pH: 7.30 CO2: 50 HCO3: 22

Assessing Oxygenation


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

Arterial: 97% Venous: 75%

Causes of Acidosis
Respiratory


Metabolic
o

(low pH and high CO2) can result from hypoventilation Pulmonary edema Airway obstruction Injury/trauma to the chest wall Neuromuscular problem

(low pH, HCO3 low) can result from an increase in acid Ketoacidosis from diabetic ketoacidosis Renal failure Lactic acidosis related to tissue hypoxia Bicarbonate loss from diarrhea, pancreatic fistula

Causes of Alkalosis
Respiratory


Metabolic

(pH high, CO2 low) can result from hyperventilation Pulmonary embolism Excessive mechanical ventilation Pneumothorax Fever Anxiety

(high pH, high HCO3) can result from a number of conditions related to a loss of acid that include: Hypokalemia Gastric suction or vomiting Potassium-wasting diuretic medications

Lets Practice

12 year old diabetic presents with Kussmaul breathing

    

pH : pCO2: pO2: HCO3: BE:

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

acidosis with too much

Metabolic

oxygen

17 year old w/severe kyphoscoliosis, admitted for pneumonia

    

pH: pCO2: pO2: HCO3: BE :

7.41 25 mmHg 60 mmHg 24 mEq/L -7 mEq/L

 Respiratory

alkalosis with

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 28 mmHg 35 mmHg 22 mEq/L -2 mEq/L

 Respiratory

alkalosis with severe hypoxia

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

 Metabolic

acidosis with

hypoxia

A sixty year old male was just found unresponsive in the mens bathroom in the lobby of the medical facility where you work.

The blood gas results are as follows:  pH: 7.25  CO2: 50  HCO3: 26  O2: 150

Respiratory acidosis with too much oxygen