Arterial Blood Gases

ABG’s
 Arterial blood gas measurement to
determine the concentration of:
 Oxygen (Pa02) (80 – 100 mm Hg)
 Carbon dioxide (PaC02) ( 35 – 45 mm Hg)
 Bicarbonate (HCO3) (22 – 26 mEq/liter)
 Acidity (pH) (7.35 – 7.45)
 SaO2 (saturation) (95 – 100%)
 Base excess (B.E.) (-2 to +2 mEq/liter)
Acid-Base Balance
 pH
 Measurement of acidity or alkalinity of
blood
 Inversely proportional to the number of
hydrogen ions (H+) in blood
 More H+ present the lower the pH
 Less H+ present the higher the pH
Acid-Base Balance
 pH of a solution is measured on a scale
of 1 (very acidic) to 14 (very alkalotic)
 pH of 7, such as water, is neutral
 Normal blood pH range = 7.35 – 7.45
 Below 7.35 = acidic
 Above 7.45 = alkalotic
 Normal pH = 7.4
Respiratory Buffer Response
 C02 – normal by-product of cellular
metabolism, carried in blood to lungs
 Excess C02 combines with H2O to form
carbonic acid (H2CO3).
 Blood ph will change according to the
level of carbonic acid present
 This triggers the lungs to ↓ or ↑ the rate
and depth of ventilation
Renal Buffer Response
 Kidneys excrete or retain bicarbonate
(HCO3) in an effort to maintain normal
ph of the blood
 As blood pH ↓ the kidneys retain HCO3

 As blood pH ↑ the kidneys excrete

HCO3 through the urine

(may take hours or days to correct
imbalance this way)
Respiratory Acidosis
 pH < 7.35 with a PC02 > 45 mm Hg
 Caused by an accumulation of CO2
 Hypoventilation can result in respiratory
acidosis
 CNS depression
 Impaired respiratory muscle function
 Pulmonary disorders
 PE
Respiratory Acidosis
 Signs and Symptoms
 Dyspnea
 Respiratory distress and/or shallow
respirations
 Headache, restless and confusion
 Drowsiness and unresponsiveness
 Tachycardia and dysrhythmias
Respiratory Alkalosis
 Defined as a pH > 7.45 with a PCO2 < 35
mm Hg
 Any condition that causes hyperventilation
can result in alkalosis
 Anxiety, fear
 Pain
 Increased metabolic demands
 Respiratory stimulants
 CNS lesions
Metabolic Acidosis
 Defined as a bicarbonate (HCO3) level
of < 22 mEq/L with a pH of < 7.35
 Caused by either a deficit of base in the
bloodstream or an excess of acids,
other than C02
 Decreased levels of base
 Diarrhea
 Intestinal fistulas
Metabolic Acidosis
 Causes of increased  Symptoms
acids  Headache
 Renal failure  Confusion
 Diabetic ketoacidosis  Restlessness
 Anaerobic progressing to
metabolism lethargy, then stupor
 Starvation or coma
 Salicylate
 Kussmaul
intoxication respirations
 Cardiac arrythmias
Metabolic Alkalosis
 Defined as a bicarbonate (HCO3) level > than
26 mEq/liter with a pH > 7.45
 Either an excess of base or a loss of acid can
cause metabolic alkalosis
 Excess base: antacids, excess use of
bicarbonate, use of lactate in dialysis
 Loss of acids: protracted vomiting, gastric
suction, hypochloremia, diuretics, high levels
of aldosterone
Metabolic Alkalosis
Symptoms
 Dizziness  Muscle twitching
 Lethargy  Muscle cramps
 Disorientation  Tetany
 Seizures  May also experience
 Coma  Respiratory
depression
 Weakness  Nausea
 Vomiting
Arterial Blood Gas
Interpretation
 Step One
 Assess the pH to determine if the blood is
within normal range, alkalotic or acidotic.
 ↑ 7.45 = alkalotic
 ↓ 7.35 = acidotic
ABG Interpretation
 Step Two
 Determine if acidosis or alkalosis is caused
primarily by a respiratory or metabolic problem.
To do this assess the PCO2 level.
 Respiratory: As pH ↓ PCO2 ↑: As pH ↑ PC02 ↓
 If pH and PC02 are moving in opposite directions,
then the problem is primarily respiratory
ABG Interpretation
 Step Three
 Assess the HCO3 value
 As pH ↑ the HCO3 should also ↑
 As pH ↓ the HCO3 should also ↓
 If pH and HCO3 are moving in the same
direction then the problem is primarily
metabolic in nature
 ABG Interpretation

pH PCO2 HCO3

Respiratory Acidosis
↓ ↑ normal
Respiratory Alkalosis
↑ ↓ normal
Metabolic Acidosis
↓ normal ↓
Metabolic Alkalosis
↑ normal ↑
Example # 1
 pH = 7.32
 PC02 = 48
 HC03 = 22
Example # 2
 pH = 7.48
 PC02 = 32
 HC03 = 24
Example # 3
 pH = 7.33
 PC02 = 40
 HC03= 18
Example # 4
 pH = 7.48
 PC02 = 35
 HC03 = 40