Arterial Blood Gas Analysis

(ABG)
Parameter Normal Unit Definition
Range
pH H+ concentration 7.35 Negative log of hydrogen ion activity
= log 1 . 7.45 If [H+] = 10-7.4 then pH = 7.4
[H+]
PaO2 Partial pressure 80 100 mm Partial pressure of oxygen in arterial
of O2 Hg blood
PaCO2 Partial pressure 35 - 45 mm Partial pressure of CO2 in arterial blood
of CO2 Hg
HCO3- Bicarbonate 21 27 mEq/L Bicarbonate plasma concentration
Level (calculated and not measured)
SaO2 Oxygen 95 - 100 % Percent of oxygen content to maximum
saturation oxygen carrying capacity of blood
FiO2 Fraction of 21 % Fraction of oxygen in relation to
inspired oxygen inspired air
PaO2 with age (= 100 age in years above 40)
FiO2 at time of ABG sampling should be included in the report.
Step Look at Think: Is there

1 PaO2, PaCO2 Respiratory Failure

Acute Respiratory
2 PaO2/FiO2 Distress Syndrome
)ARDS(
pH, PaCO2, Acid/Base
5-3 Disturbance
Bicarb
, If severe metabolic acidosis
6
Calculate IV Na Bicarb required
 Step 1) Look at PaO2 & PaCO2
Is there Respiratory Failure?
Respiratory failure is a syndrome of inadequate gas exchange
due to dysfunction of one or more essential components of the
respiratory system.
(Airways, Lungs, Respiratory Muscles, Nerve and Blood Supply)
Mechanisms,
Type Name Definition
Examples

Shunt, DD, V/Q

1 Hypoxic RF PaO2 < 60 mm Hg Mismatch: ARDS,
IPF, Pneumonia, PE

Hypoventilation:
2 Hypercapnic RF PaCO2 > 46 mm Hg Central and sleep related
hypoventilation

Hypoxic/ PaO2 < 60 mm Hg, Advanced or

3 combined
Hypercapnoeic RF PaCO2 > 46 mm Hg disorders
 Step 2) Calculate PaO2/FiO2
Is there ARDS?
Acute Respiratory Distress Syndrome is an acute condition
characterized by bilateral pulmonary infiltrates and severe
hypoxaemia in absence of evidence for cardiogenic pulmonary
oedema (Non-Cardiogenic Pulmonary Oedema).
PaO2/FiO2 (Carrico Index) is a quick and simple measure for
integrity of lung tissue and its capacity to oxygenate the blood.
Normal > 300 500 mmHg (at sea level)
ARDS Severity PaO2/FiO2 Mortality
Mild < 300 27%
Moderate < 200 32%
Severe < 100 45%
PaO2/FiO2 can also indicate the degree of lung tissue injury in other
pulmonary disorders, eg Pneumonia
 Examples for Calculation of PaO2/FiO2

PaO2 FiO2 PaO2/FiO2 Comment

95 0.21 452 Normal
80 0.5 160 Moderate ARDS
Two cases of ARDS with bilateral patchy opacities in
middle and lower lung zones.
Common Causes: severe infection, aspiration, irritant
gases, extensive trauma, multi-organ failure.
Bicarb pH pCO2
7.55 55
33 7.54 54
32 7.53 53 Steps 3-5) Look at
7.52 52
31 7.51 51 pH, PaO2, PaCO2
30 7.5 5
7.49 49 Is there Acid/Base
29 7.48 48
7.47 47 Disturbance?
28 7.46 46
27 7.45 45
7.44 44
26 7.43 43
25 7.42 42
7.41 41
24 7.40 40
7.39 39
23 7.38 38
22 7.37 37
7.36 36
21 7.35 35
20 7.34 34
7.33 33
19 7.32 32
7.31 31
18 7.30 30
17 7.29 29
7.28 28
16 7.27 27
15 7.26 26
7.25 25
14 7.24 24
Bicarb pH PCO2
7.55 55
33 7.54 54 Severe Diarrhoea
32 7.53 53
7.52 52
31 7.51 51
30 7.5 5 1ry Defect Compensation
7.49 49
29 7.48 48 Bicarb PCO2
7.47 47
28 7.46 46 (M Ac) (R Alk)
27 7.45 45
7.44 44
26 7.43 43
25 7.42 42
7.41 41
24 7.40 40
23
7.39 39 M Ac & R Ac
7.38 38
22 7.37 37
7.36 36
21 7.35 35
20 7.34 34
7.33 33 M Ac & Comp R Alk
19 7.32 32
7.31 31
18 7.30 30
17 7.29 29
7.28 28
16 7.27 27
15 7.26 26 M Ac & R Alk
7.25 25
14 7.24 24
Bicarb pH PCO2
7.55 55
33 7.54 54 M Alk & R Ac
32 7.53 53
7.52 52
31 7.51 51
30 7.5 5
7.49 49
29 7.48 48
28
7.47 47 M Alk & Comp R Ac
7.46 46
27 7.45 45
7.44 44
26 7.43 43
25 7.42 42
7.41 41 M Alk & R Alk
24 7.40 40
7.39 39
23 7.38 38
22 7.37 37
7.36 36 Persistent Vomiting
21 7.35 35
20 7.34 34
7.33 33
19 7.32 32
7.31 31 1ry Defect Compensation
18 7.30 30
17 7.29 29 Bicarb PCO2
7.28 28 (M Alk) (R Ac)
16 7.27 27
15 7.26 26
7.25 25
14 7.24 24
 Bicarb pH PCO2
7.55 55
33 7.54 54
R Ac & M Alk 32 7.53 53
7.52 52
31 7.51 51
30 7.5 5
7.49 49
29 7.48 48
R Ac & Comp M Alk 28
7.47 47
7.46 46
27 7.45 45
7.44 44
26 7.43 43
25 7.42 42
7.41 41
R Ac & M Ac 24 7.40 40
7.39 39
23 7.38 38
22 7.37 37
Hypoventilation 7.36 36
21 7.35 35
20 7.34 34
7.33 33
19 7.32 32
1ry Defect Compensation 7.31 31
18 7.30 30
PCO2 Bicarb 17 7.29 29
(R Ac) (M Alk) 7.28 28
16 7.27 27
15 7.26 26
7.25 25
14 7.24 24
 Bicarb pH PCO2
7.55 55
33 7.54 54
Hyperventilation 7.53 53
32
7.52 52
31 7.51 51
30 7.5 5
1ry Defect Compensation 7.49 49
29 7.48 48
PCO2 Bicarb 7.47 47
(M Ac) 28 7.46 46
(R Alk)
27 7.45 45
7.44 44
26 7.43 43
25 7.42 42
7.41 41
24 7.40 40
R Alk & M Alk 7.39 39
23 7.38 38
22 7.37 37
7.36 36
21 7.35 35
20 7.34 34
7.33 33
R Alk & Comp M Ac 19 7.32 32
7.31 31
18 7.30 30
17 7.29 29
7.28 28
16 7.27 27
R Alk & M Ac 15 7.26 26
7.25 25
14 7.24 24
 Prediction of Compensatory Response

Disorder Predicted Compensation

Metabolic Acidosis pCO2 = (1.5 X Bicarb) + 8 + 2
Metabolic Alkalosis pCO2 = (0.7 X Bicarb) + 20 + 5
Acute Respiratory Acidosis Bicarb = 0.1 pCO2
Chronic Respiratory Acidosis Bicarb = 0.4 pCO2
Acute Respiratory Alkalosis Bicarb = 0.2 pCO2
Chronic Respiratory Alkalosis Bicarb = 0.5 pCO2
or Bicarb in relation to 24 mEq/L
or PCO2 in relation to 40 mm Hg
Another useful tool in estimating the PCO2 in metabolic acidosis is the recognition that
pCO2 is approximately equal to the last 2 digits of the pH.
 Step 6) If severe metabolic acidosis,
calculate Na Bicarbonate Required
Na Bicarb Required =
0.5 X Wt (Kg) X desired increase in serum bicarbonate (mEq/L)
Apply only if severe metabolic acidosis (pH < 7.2)
Rather than the normal bicarb level of 24 mEq/L, target a lower level,
eg. 12 mEq/L

Risks of Bicarbonate Therapy in Metabolic Acidosis:

Paradoxical transient intracellular acidosis.
Shift of O2- Hb dissociation curve to the left.
Hypokalaemia.
Hypernatraemia and Hypervolaemia
Paradoxical Transient Intracellular Acidosis
Whereas the arterial pH tends to rapidly after
administration of Na bicarb, intracellular pH more slowly:
Slow passage of bicarb ion across the cell membrane.
Rapid conversion of plasma bicarb to carbonic acid which
dissociates producing CO2 and water. CO2 diffuses into cells
more rapidly than bicarb
intracellular bicarb/CO2 ratio intracellular pH.
The intracellular acidosis will persist as long as bicarb
administration exceeds CO2 elimination.
Therefore, adequate tissue perfusion and ventilation should
be secured in line with Na bicarb administration.
Shift of O2-Hb Dissociation Curve to the Left
( Hb Affinity for Oxygen)
Oxygen delivery to tissues tissue hypoxia
tendency for lactic acidosis
Hypokalaemia
Acidosis stimulates movement of K+ from intracellular to
extracellular compartment. Correction of acidosis by alkali
has the reverse effect: movement of K+ from extracellular
to intracellular compartment:
Roughly, for each 0.1 rise in pH,
serum K+ by about 0.5 mEq/L

Hypernatraemia and Hypervolaemia

These are problematic in patients with cardiac
and/or renal dysfunction
 1 2 3 4 5 6
pH 7.34 7.5 7.6 7.3 7.43 7.14
PaO2 58 75 80 74 55 94
PaCO2 50 41 30 32 39 28
HCO3
- 30 32 24 19 25 8
FiO2 0.5 0.3 0.21 0.21 0.21 0.21
Disorder Predicted Compensation
Metabolic Acidosis pCO2 = (1.5 X Bicarb) + 8 + 2
Metabolic Alkalosis pCO2 = (0.7 X Bicarb) + 20 + 5
Acute Respiratory Acidosis Bicarb = 0.1 pCO2
Chronic Respiratory Acidosis Bicarb = 0.4 pCO2
Acute Respiratory Alkalosis Bicarb = 0.2 pCO2
Chronic Respiratory Alkalosis Bicarb = 0.5 pCO