Dr. Godfrey G.

Mendoza
Maestro
 An arterial blood gas (ABG) test measures the
acidity (pH) and the levels of oxygen and
carbon dioxide in the blood from an artery.
This test is used to check how well the lungs
are able to move oxygen into the blood and
remove carbon dioxide from the blood.
(ABG) Arterial Blood Gas Analysis is used to
measure the partial pressures of oxygen
(PaO2), carbon dioxide (PaCO2), and the pH
of an arterial blood sample.
 Arteries carry
oxygenated blood
away from the
heart to the body,
and veins carry
oxygen-poor blood
back from the body
to the heart.
 pH is a figure expressing the acidity or alkalinity
of a solution on a logarithmic scale on which 7 is
neutral, lower values are more acid, and higher
values more alkaline.
Acidosis refers to a process that causes a low pH
in blood and tissues.
Acidemia refers specifically to a low pH in the
blood.
Alkalosis is the result of a process reducing
hydrogen ion concentration of arterial blood
plasma (alkalemia). In contrast to acidemia
(serum pH 7.35 or lower), alkalemia occurs when
the serum pH is higher than normal (7.45 or
higher).
 is a medical
emergency in which
decreased ventilation
(hypoventilation)
increases the
concentration of
carbon dioxide in the
blood and decreases
the blood's pH (a
condition generally
called acidosis).
 is a disturbance in acid
and base balance due to
alveolar hyperventilation.
Alveolar hyperventilation
leads to a decreased
partial pressure of
arterial carbon dioxide
(PaCO2).
Respiratory alkalosis can
be acute or chronic.
 is a condition that occurs
when the body produces
excessive quantities of
acid or when
the kidneys are not
removing enough acid
from the body.
Diabetic ketoacidosis is a
serious complication of
diabetes that occurs
when your body produces
high levels of blood acids
called ketones. The
condition develops when
your body can't produce
enough insulin.
 is a metabolic condition
in which the pH of
tissue is elevated
beyond the normal
range (7.35-7.45). This
is the result of
decreased hydrogen ion
concentration, leading
to increased
bicarbonate, or
alternatively a direct
result of increased
bicarbonate
concentrations.
 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 CO2; and if
the kidneys are
unable the lungs will
attempt to adjust
levels of pH and O2
to avoid hypoxemia.
Blood pH 7.35 7.45
paO2 80 100 mmHg
paCO2 35 45 mmHg
HCO3 22 26 mEq/L
O2 Saturation 95 100%
pH low (below 7.35) ACIDOSIS
pH high (above 7.45) ALKALOSIS

MIDDLE RANGE
7.40
Acid 7.35 -------------7.45 Base
(ACIDOSIS) (ALKALOSIS)
1. 7. 41 ------------------ Normal
2. 7.32 ------------------ Acidosis
3. 7.50 ------------------ Alkalosis
4. 7.34 ------------------ Acidosis
5. 7. 46 ------------------ Alkalosis
 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 45mmHg) RESPIRATORY ACIDOSIS

PaCO2 low (below 35 mmHg) RESPIRATORY ALKALOSIS

MIDDLE RANGE
40
Base 35 ----------------- 45 Acid
(ALKALOSIS) (ACIDOSIS)
1. pH 7.32
pCO2 50 ---------RESPIRATORY ACIDOSIS

2. pH 7.50
pcO2 30 --------- RESPIRATORY ALKALOSIS

3. pH 7.37
pCO2 41 --------- NORMAL

4. pH 7.47
pCO2 27 --------- RESPIRATORY ALKALOSIS

5. pH 7.26
pCO2 56 --------- RESPIRATORY ACIDOSIS
 HCO3 is the METABOLIC INDICATOR.

HCO3 high (above 26) METABOLIC ALKALOSIS

HCO3 low (below 22) METABOLIC ACIDOSIS

MIDDLE RANGE
24
Acid 22 ---------------- 26 Base
(ACIDOSIS) (ALKALOSIS)
1. pH 7.28
HCO3 18 --------- METABOLIC ACIDOSIS
2. pH 7.52
HCO3 32 --------- METABOLIC ALKALOSIS
3. pH 7.43
HCO3 25 --------- NORMAL
4. pH 7.30
HCO3 20 --------- METABOLIC ACIDOSIS
5. pH 7.48
HCO3 28 --------- METABOLIC ALKALOSIS
 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
PaCO2 ACIDOSIS ACIDOSIS

b. pH ALKALOSIS RESPIRATORY
PaCO2 ALKALOSIS ALKALOSIS
2. pH and HCO3 match: Metabolic Acid-Base
Imbalance
a. pH ALKALOSIS METABOLIC
HCO3 ALKALOSIS ALKALOSIS

b. pH ACIDOSIS METABOLIC
HCO3 ACIDOSIS ACIDOSIS
Therefore: If pH are primarily affected
PaCO2 (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 opposite
M etabolic
E - qual
 Still, it all boils down to
mnemonics. The
mnemonic RO-ME.
Respiratory Opposite
- When pH is up,
PaCO2 is down =
Alkalosis
- When pH is down,
PaCO2 is up = Acidosis

Metabolic Equal
- When pH is up,
HCO3 is up = Alkalosis
- When pH is down,
HCO3 is down = Acidosis
1. Check relationship between PaCO2 and HCO3.
2. Remember: the lungs and kidneys normally attempt
to help each other to maintain acid-base balance.
3. If the lungs are unable to maintain acid-base
balance, the kidneys will attempt to adjust levels of
CO2.
4. If CO2 and HCO3 levels move towards the same
direction, i.e. both are high or both are low, then
acid-base imbalance is COMPENSATED.
Ex:
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 balance is
compensated, and the pH is NORMAL:
COMPLETE COMPENSATION.
When is the acid-base imbalance considered
uncompensated?
1. When the CO2 and HCO3 levels move
towards opposite directions. (The problem
is worsened).
Ex:
PaCO2 high (ACIDOSIS) HCO3 low (ACIDOSIS)
PaCO2 low (ALKALOSIS) HCO3 high (ALKALOSIS)

2. Or when PaCO2 is abnormal and HCO3

remains normal and vice versa, the acid-base
imbalance is also uncompensated.
 The last step is to determine if the ABG is
Compensated, Partially Compensated, or
Uncompensated. Heres the trick:

If pH is NORMAL, PaCO2 and HCO3 are both

ABNORMAL = Compensated

If pH is ABNORMAL, PaCO2 and HCO3 are both

ABNORMAL = Partially Compensated

If pH is ABNORMAL, PaCO2 or HCO3 is

ABNORMAL = Uncompensated
 1. pH 7.5
PaCo2 31 Respiratory Alkalosis,
HCO3 26 Uncompensated
2. pH 7.38
PaCO2 32 Metabolic Acidosis,
HCO3 19 Complete Compensation
3. pH 7.24
PaCO2 60 Respiratory Acidosis,
HCO3 32 Partial Compensation
4. pH 7.41
PaCO2 60 Respiratory Alkalosis,
HCO3 18 Complete Compensation
5. pH 7.5
PaCO2 42 Metabolic Alkalosis,
HCO3 33 Uncompensated
Identifying the Primary Process
1. Recall the normal values.
2. Look at the pH.
3. Look at the PaCO2.
4. Look at the HCO3.
5. Determine the primary acid-base
imbalance.
6. Determine whether the acid-base imbalance
is compensated or uncompensated.
7. If the acid base imbalance is compensated,
determine whether it is partial
compensation or complete compensation.
Finally,evaluate the PaO2
and O2 sat. If they are
below normal there is
evidence of hypoxemia.
 You have learned a crucial
knowledge towards excellence
in CARE!
Next TopicCardiovascular Disorder
and Management!