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Basic Interpretation
of
Arterial Blood Gases
Information Gleaned
Jean M. Davis, RN
pH
Anatomy of an ABG
pH/PCO2/HCO3-/PO2
7.40/40/24/98
Base excess
Anion gap
Oxygen saturation
A-a Gradient
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HCO3-
PCO2
ABG Interpretation
PO2
Base Excess
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10 x 100 =
1000 / 4 =
250
Give = 125 mEq Bicarb
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Patient wgt: 70 Kg
Base Deficit: 11 (BE: -11)
11 x 70 =
770 / 4 =
192
Give = 96 mEq Bicarb
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ABG Interpretation
Patient wgt: 80 Kg
Base Deficit: 12 (BE: -12)
12 x 80 =
960 / 4 =
240
Give = 120 mEq Bicarb
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11 x 120 =
1320 / 4 =
330
Give = 165 mEq Bicarb
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Anion Gap
Formula: (Na++K+)-(HCO3-+Cl-)
Lactic/diabetic acidosis
15
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SaO2
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Compensated or uncompensated
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ABG Interpretation
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CO2
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Respiratory Acidosis
Respiratory component
Acid
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Chronic
23
Acute
22
21
20
Chronic
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ABG Interpretation
Respiratory Acidosis
Respiratory Acidosis
Causes include:
Pneumonia
Sedation
CNS
disease
Guillian-Barre
Pleural disease
Polio
Pneumothorax
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Myasthenia
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Respiratory Alkalosis
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Drugs
Liver cirrhosis
Anxiety
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HCO3-
Salicylates
Progesterone
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Respiratory Alkalosis
CNS hemorrhage
Pregnancy
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Causes include:
Gravis
Respiratory Alkalosis
Musculoskeletal disorders
Kyphoscoliosis
Obesity
Lung disease
COPD
CNS depression
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Metabolic component
Alkaline
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ABG Interpretation
Anion Gap
Metabolic Acidosis
Formula: (Na++K+)-(HCO3-+Cl-)
Lactic/diabetic acidosis
Low HCO3
Consequent drop in blood pH
-
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Metabolic Acidosis
Metabolic Acidosis
Uremia
Ketoacidosis
GI loss of bicarb
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Causes include:
Overdiuresis
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Volume contraction
Vomiting
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Metabolic Alkalosis
Hyperalimentation
Acid infusions
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Metabolic Alkalosis
Other:
Lactic acidosis
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Diarrhea
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Diabetic hyperglycemia
ETOH withdrawal
Starvation
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Ascites
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Hypokalemia
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ABG Interpretation
Metabolic Alkalosis
Alkali ingestion
Bicarbonate
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Compensation
In metabolic acidosis,
acidosis the CO2 will
decrease
In metabolic alkalosis,
alkalosis the CO2 will
increase
In respiratory acidosis,
acidosis the HCO3- will
increase
In respiratory alkalosis,
alkalosis the HCO3- will
decrease
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Compensation
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Compensation
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minutes
hours to days
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ABG Interpretation
Compensation
No compensation
of
of
of
of
44
Oxygen Facts
1L = .24
4L = .36
2L = .28
5L = .40
3L = .32
6L = .44
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Rule of 7s
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Rule of 7s
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PO2
PO2
PO2
PO2
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Oxygen Facts
Partial compensation
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ABG Interpretation
Eval of Hypoxemia
Using the A-a Gradient
A-a Gradient
Normal 20-65
Severe distress >400
The larger the gradient, the worse the
respiratory failure
Give 100% O2
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Example #1
pH
7.34
PCO2
33.9
HCO3-
18.2
BE
-6.2
PO2
85.2
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Example #2
pH
7.44
PCO2
27.8
HCO3-
19.2
BE
-4.0
PO2
100
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#2
Fully Compensated
Respiratory Alkalosis
with Normal Oxygenation
Normal
Low
Low
Low
Normal
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Partially Compensated
Metabolic Acidosis
with Normal Oxygenation
Acidotic
Low
Low
Low
Normal
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ABG Interpretation
Example #3
#3
Partially Compensated
Metabolic Alkalosis
with Moderate Hypoxemia
Alkalotic
High
High
High
Low
pH
7.59
PCO2
49.0
HCO3-
48.2
BE
+21.6
PO2
58.7
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Example #4
pH
7.17
PCO2
69.3
HCO3-
21.0
BE
-5.5
PO2
40.9
57
Example #5
7.28
PCO2
79.5
HCO3-
37.1
BE
+8.4
PO2
30.0
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#5
Partially Compensated
Respiratory Acidosis
with Severe Hypoxemia
Acidotic
High
High
High
Low
pH
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#4
Combined Metabolic
and Respiratory Acidosis
with Moderate Hypoxemia
Acidotic
High
Low
Low
Low
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ABG Interpretation
Example #6
pH
7.39
PCO2
39.0
HCO3-
23.4
BE
-1.0
PO2
61.2
Normal
Normal
Normal
Normal
Low
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#6
Normal Acid/Base Balance
with Mild Hypoxemia
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Hooray!!!
Youve done it!!
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