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PLT COLLEGE, INC.

Bayombong, Nueva Vizcaya

Institute of Health Sciences –College of Nursing

Nursing Care Management (NCM 104)


Curative and Rehabilitative Nursing
(Julie Ann T. Garnace, RN- Instrucor)

Critical Facts about Systematic ABG Analysis

How to do ABG analysis incredibly quick and accurate? Follow the following steps:
Step I. Remember the Normal Values

Blood pH 7.35 – 7.45


paO2 80 – 100 mmHg
paCO2 35 – 45 mmHg
HCO3 22 – 26 mEq/L
O2 Saturation 95 – 100%
BE/BD (Base Excess/Base Deficit) -2 to +2

Step II. Look at the pH. Does it indicate presence of academia, or alkalemia, or normal pH?

pH low (below 7.35) ACIDOSIS


pH high (below 7.45) ALKALOSIS

MIDDLE RANGE
7.40
Acid ← 7.35 ---------------------------------------7.45 → Base
(ACIDOSIS) (ALKALOSIS)

e.g. pH 7.31 (low) ACIDOSIS


pH 7.48 (high) ALKALOSIS

Please do these exercises. Identify whether the pH is Normal, ACIDOTIC or ALKALOTIC


1. 7.41 __________________________
2. 7.32 __________________________
3. 7.50 __________________________

Step III. Look at the PaCO2

• PaCO2 is the RESPIRATORY INDICATOR.


• CO2 acts as an ACID. When CO2 combines with plasma, CARBONIC ACID is formed (CO2 + H2O = H2CO3).

PaCO2 high (above 45 mmHg) RESPIRATORY ACIDOSIS


PaCO2 low (below 35 mmHg) RESPIRATORY ALKALOSIS

MIDDLE RANGE
40

Base ← 35----------------------------------------------45 → Acid


(ALKALOSIS) (ACIDOSIS)

Please do these exercises. Identify whether the following values represent RESPIRATORY ACIDOSIS, RESPIRATORY
ALKALOSIS, or NORMAL values.

1. pH 7.32
pCO2 50 __________________________

2. pH 7.50
pCO2 30 __________________________

3. pH 7.37
pCO2 41 __________________________

Step IV. Look at the HCO3 (Bicarbonate)

• HCO3 high (above 26) METABOLIC ACIDOSIS


• HCO3 low (below 22) METABOLIC ALKALOSIS
MIDDLE RANGE
24

Acid ← 22 --------------------------------------- 26 → Base


(ACIDOSIS) (ALKALOSIS)

Please do these exercises. Identify whether the following values represent METABOLIC ACIDOSIS, METABOLIC ALKALOSIS, or
NORMAL values.
1. pH 7.28
HCO3 18 ______________________

2. pH 7.52
HCO3 32 ______________________

3. pH 7.43
HCO3 25 ______________________

4. pH 7.30
HCO3 20 ______________________

5. pH 7.48
HCO3 28 ______________________

Step V. Determine the primary ACID – BASE disturbance

• The change that matches the pH is the primary ACID – BASE DISTURBANCE.

1. pH and PaCO2 match: Respiratory Acid – Base Imbalance

a. pH ↓ ACIDOSIS RESPIRATORY ACIDOSIS


PaCO2 ↑ ACIDOSIS

b. pH ↑ ALKALOSIS RESPIRATORY ALKALOSIS


PaCO2 ↑ ALKALOSIS

2. pH and HCO3 match: Metabolic Acid – Base Imbalance

a. pH ↑ ALKALOSIS METABOLIC ALKALOSIS


HCO3 ↑ ALKALOSIS

b. pH ↓ ACIDOSIS
HCO3 ↓ ACIDOSIS METABOLIC ACIDOSIS

Therefore: If pH are primarily affected


PCO2 (Same interpretation)

RESPIRATORY ACID – BASE IMBALANCE OCCURS

Therefore: If pH are primarily affected


HCO3 (Same interpretation)

METABOLIC ACID – BASE IMBALANCE OCCURS

Or better yet think about ROME!


R – espiratory
O – pposite
M – etabolic
E – qual

Check on these…
1. Respiratory Acid – Base Imbalances
Respiratory Opposite means: the directions of pH and PaCO2 are opposite. Look at these examples.

pH ↓ RESPIRATORY
PaCO2 ↑ ACIDOSIS

pH ↑ RESPIRATORY
PaCO2 ↓ ALKALOSIS
2. Metabolic Acid – Base Imbalances
Metabolic Equal means: the directions of pH and HCO3 are EQUAL or SAME directions.

pH ↑ METABOLIC
HCO3 ↑ ALKALOSIS

pH ↓ RESPIRATORY
HCO3 ↓ ACIDOSIS

Let’s put these in a nutshell…

Acid – Base Imbalances


1. Respiratory
pH pCO2
Acidosis low high Opposite
Alkalosis high low directions

2. Metabolic
pH HCO3
Acidosis low low Same
Alkalosis high high directions

Now, you’re ready to do the following exercises. Indicate in the following spaces provided whether the values represent ACIDOSIS,
ALKALOSIS, or NORMAL.

1. pH 7.5 ________________________
PaCO2 32 ________________________
HCO3 26 ________________________

Please encircle your answer.


Interpretation: RESPIRATORY ACIDOSIS
RESPIRATORY ALKALOSIS
METABOLIC ACIDOSIS
METABOLIC ALKALOSIS

2. pH 7.54 ________________________
PaCO2 60 ________________________
HCO3 32 ________________________

Please encircle your answer.


Interpretation: RESPIRATORY ACIDOSIS
RESPIRATORY ALKALOSIS
METABOLIC ACIDOSIS
METABOLIC ALKALOSIS

3. pH 7.30 ________________________
PaCO2 52 ________________________
HCO3 30 ________________________

Please encircle your answer.


Interpretation: RESPIRATORY ACIDOSIS
RESPIRATORY ALKALOSIS
METABOLIC ACIDOSIS
METABOLIC ALKALOSIS

4. pH 7.32 ________________________
PaCO2 30 ________________________
HCO3 18 ________________________

Please encircle your answer.


Interpretation: RESPIRATORY ACIDOSIS
RESPIRATORY ALKALOSIS
METABOLIC ACIDOSIS
METABOLIC ALKALOSIS

How are you doing at this point? If you’re doing well, then proceed to the next step.

Step VI. Look at the degree of compensation.


• Check relationship between PaCO2 and HCO3
• Remember: the lungs and kidneys normally attempt to help each other to maintain acid – base balance.
• If the lungs are unable to maintain acid – base balance, the kidneys will attempt to adjust levels of HCO3.
• If the kidneys are unable to maintain acid – base balance, the lungs will attempt to adjust levels of CO2.
• If CO2 and HCO3 levels move towards the same direction, i.e. both are high or both are low, then the acid – base imbalance are
COMPENSATED.

E.g.
PaCO2 high (ACIDOSIS) HCO3 high (ALKALOSIS)
PaCO2 low (ALKALOSIS) HCO3 low (ACIDOSIS)

When is the acid – base imbalance considered as partial or complete compensation?

1. When the acid-base balance is compensated, but the pH is still ABNORMAL: PARTIAL COMPENSATION.
2. When the acid-base is balance compensated, and the pH is NORMAL : COMPLETE COMPENSATION.

When is the acid – base imbalance considered uncompensated?

• When the CO2 and HCO3 levels more towards opposite directions. (The problem is worsened.)

E.g.
PaCO2 high (ACIDOSIS) HCO3 high (ALKALOSIS)

PaCO2 low (ALKALOSIS) HCO3 low (ACIDOSIS)

• Or when PaCO2 is abnormal and HCO3 remains normal and vise versa, the acid-base imbalance is also uncompensated

In capsule: to do the AGB analysis, do the following steps:


I. Recall the normal values.
II. Look at the pH.
III. Look at the PaCO2.
IV. Look at the HCO3.
V. Determine the primary acid-base imbalance.
VI. Determine whether the acid-base imbalance is compensated or uncompensated.
VII. If the acid-base imbalance is compensated, determine whether it is partial compensation or complete compensation.

You are now ready to apply your knowledge

Please do the following exercises.

Remember, retention of the knowledge is 90% when you say it and you do it.

ACID – BASE IMBALANCE INTERPRETATION EXERCISES.

Place a check (√) in the appropriate column indicating whether the pH is Normal, ACIDOTIC, or ALKALOTIC.
pH Normal Acidosis Alkalosis
1. 7.37
2. 7.61
3. 7.19
4. 7.50
5. 7.30
6. 7.41
7. 7.48
8. 7.28
9. 7.35
10. 7.52

Check (√) whether the following data represent RESPIRATORY ACIDOSIS, RESPIRATORY ALKALOSIS or NORMAL
pH PaCO2 Respiratory Acidosis Respiratory Alkalosis Normal
11. 7.20
12. 7.52
13. 7.33
14. 7.48
15. 7.38

Check (√) whether the following data represent METABOLIC ACIDOSIS, METABOLIC ALKALOSIS or NORMAL
pH HCO3 BE Metabolic Acidosis Metabolic Alkalosis Normal
16. 7.26 19 -6
17. 7.42 24 0
18. 7.42 15 -8
19. 7.54 35 +6
20. 7.51 30 +4
Identify the primary acid – base disturbance if any, and indicate whether compensation is partial or complete or uncompensated acid –
base imbalance.
21. pH 7.5
PaCO2 31
HCO3 26 ________________________________________________

22. pH 7.38
PaCO2 32
HCO3 19 ________________________________________________

23. pH 7.24
PaCO2 60
HCO3 32 ________________________________________________

24. pH 7.41
PaCO2 30
HCO3 18 ________________________________________________

25. pH 7.5
PaCO2 42
HCO3 33 ________________________________________________

Congratulations!
You have learned a crucial knowledge towards excellence in CARE!