ABG

Prepared by: Dr Tang Ying Qian Click to edit Master subtitle style Supervised by: Dr Zihni

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Information Obtained from an ABG

Acid base status Oxygenation Dissolved O2 (pO2) Saturation of hemoglobin CO2 elimination Levels of carboxyhemoglobin and methemoglobin
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Assess the ventilatory status, oxygenation and acid base status Assess the response to an intervention

Indications

Contraindications
Bleeding diathesis
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Components of ABG
pH - Measurement of acidity or alkalinity, based on thehydrogen(H+) 7.35 7.45 PaO2 - The partial pressure oxygen that is dissolved in arterial blood. 80-100 mm Hg PaCO2 Theamountofcarbondioxidedisso lvedinarterialblood.
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3545mmHg

Steps of interpretation

1 Acidosis or alkalosis 2 Metabolic or respiratory 3 Acute or chronic 4 Compensation 5 Anion gap 6 - AG and HCO3
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Step 1

Look at the pH (N: 7.35 7.45) Acidemia when pH< 7.35 Alkaledemia when pH > 7.45

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Step 2

Look at the PCO2 (N: 35 45 mmHg)

pH and PCO2 change in opposite direction respiratory problem

Look at the HCO3 (N: 22-26 mmol/L)

pH and HCO3 change in same direction metabolic problem

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Step 3

If the primary disturbance is respiratory: Acute: HCO3 changes 1-2 mEq for every 10mmHg change in PaCO2 Chronic: HCO3 changes 4-5 mEq for every 10mmHg change in PaCO2

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If the primary disturbance is metabolic, is the compensation in PaCO2 appropriate Calculate expected PaCO2 Metabolic acidosis

Step 4

PaCO2 = (1.5 x HCO3) + 8 (+/- 2) mmHg Metabolic alkalosis PaCO2 = (0.6 x HCO3) + 40 (+/-2) 5/17/12 mmHg

Step 5

Anion gap- difference in the measuredcationsand the measuredanions Calculation of AG is useful approach to analyse metabolic acidosis AG = (Na + K) (Cl+ HCO3) Normal AG = 10 +/- 2 Metabolic acidosis should be suspected with a raised AG, even 5/17/12

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Step 6

Check difference between changes in AG and changes in HCO3 Increase in AG should be equal to fall in HCO3 AG = HCO3 ( AG = AG -12 HCO3 = 24

HCO3)

GAP = AG - HCO3 If high AG with GAP >0, mixed

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OXYGENATION STATUS

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P(A-a)O2

alveolar-arterial difference in partial pressure of oxygen commonly called the A-a gradient results from gravity-related blood flow changes within the lungs (normal ventilation-perfusion imbalance).

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PAO2 = (FiO2 x (Patm-Ph2o)) PaCO2/0.8

= FiO2 x (760-47) PaCO2/0.8

Normal P(A-a)O2 ranges from 5 to 25 mmHg at FiO2 0.21 < 150 mmHg at FiO2 1.0 A higher than normal P(A-a)O2 means the lungs are not transferring oxygen properly from alveoli into the pulmonary capillaries. 5/17/12

Ventilation-perfusion Imbalance

A normal amount of ventilationperfusion

(V-Q) imbalance accounts for the normal P(A-a)O2.

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all lung diseases lower PaO2 via V-Q imbalance, e.g., asthma, pneumonia, atelectasis, pulmonary edema, COPD.

PF ratio

PF ratio = PaO2 FiO2 N : < 60 years old - >400 > 60 years old, expected PF ratio=400 (age-

60)x5

< 300 : Acute lung injury < 200 : ARDS Actual PF ratio > expected 5/17/12

If hypoxaemic, correct it with O2 supplementation Maintain PaO2 80-100 mmHg Relationship between FiO2 and PaO2 in normal lungs
FiO2 0.3 0.4 0.5 0.8 1.0 PaO2 >150 >200 >250 >400 >500

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J is a 45 years old female admitted with the severe attack of asthma. Shehas been experiencing increasing shortness of breath since admission three hours ago. Her arterial blood gasresult is as follows: pH : 7.22 paCO2 : 55 HCO3 : 25

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Mrs. H is admitted, heis on regular HD but had missed his last 2 appointments. At the dialysis centre his ABG results: pH:7.32 paCo2:32 HCO3:18 Pao2:88

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A 55-year-old man came with shortness of breath. He is a chronic smoker, smokes a pack per day. His regular medications include a diuretic for hypertension and one aspirin a day. pH 7.53 paCO2 37 mm Hg PaO2 62 mm Hg
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HCO3- 30 mEq/L

A 46-year-old man has been in the hospital two days with pneumonia. He was recovering but has just become dyspneic, and hypotensive. His ABG under nasal prong 3L/min. pH 7.40 PaCO2 20 mm Hg PaO2 80 mm Hg HCO3- 12 mEq/L
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