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Value
• ABG measurements can document, specify
and quantify cardiopulmonary malfunction
ARTERIAL BLOOD GAS
and acid-base abnormalities.
ANALYSIS
Limitation Guidelines for Interpreting ABG’S
• Absolute values should be interpreted in • The body always tries to maintain a normal ph
conjunction with the clinical situation. • The lungs compensate rapidly;
the kidneys compensate slowly
• There is no overcompensation.
• Consider the underlying disease
• Maintain an adequate level of hemoglobin
Bicarbonate-Carbonic Acid Advantages of Arterial Over Venous
Buffer System: Blood
• Represents a mixture of blood that has come
from various parts of the body
• Gives information of how well lungs are
CO2 + H2O H2CO3 H+ + HCO3-
oxygenating the blood
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Normal Arterial Blood Gas Values Clinically Acceptable Levels
pH: 7.35 – 7.45 pH: 7.30 – 7.50
paCO2: 35 – 45 mm Hg paCO2: 30 – 50 mm Hg
paO2: 80 – 100 mm Hg paO2:
HCO3: 22 – 26 mEq/L Neonates: 60 – 80 mm Hg
Decreases with age: Subtract
BE/BD: - 2 to + 2
1 mm Hg from 80 mm Hg for every
O2 Sat: > 95 % year past the age of 60
Clinical Approach to Interpretation:
Nomenclature for Clinical interpretation Steps
• Acidosis: patho- • Alkalosis: patho-
physiologic state where a physiologic state where
significant base deficit is a significant base excess
present is present
(HCO3 < 22mEq/L) 1. Assessment of the pCO2 and pH:
(HCO3 > 26mEq/L)
ventilatory status and acid-base
balance
2. Assessment of Arterial Oxygenation
Step 1
Step 1 Classification of PaCO2
• Classify carbon dioxide tension < 35 mmHg: alveolar
• Consider pH and determine hyperventilation
classification (respiratory alkalosis)
• Consider BE/BD or HCO3 levels and 35 – 45 mmHg: Normal
determine classification alveolar ventilation
> 45 mmHg: ventilatory failure
(respiratory acidosis)
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Step 1
Three questions to ask: Step 1
• Is the PaCO2 abnormal? PaCO2 < 35 mmHg
• Is the pH explained by the level of PaCO2? pH < 7.35 7.35 7.45 pH > 7.45
Yes: respiratory
No: metabolic
• Is the pH: Partially Compens. Chronic Acute
Abnormal: acute/uncompensated Compens. Metabolic Resp. Resp.
Metabolic Acidosis Alkalosis Alkalosis
Normal: chronic/ compensated
Acidosis
PCO2 < 35 mm Hg PCO2 < 35 mm Hg
pH < 7.35 pH < 7.35
HCO3 decreased HCO3 decreased
partly compensated
metabolic acidosis
PCO2 < 35 mm Hg PCO2 < 35 mm Hg
pH 7.35 – 7.45 pH 7.35 – 7.45
HCO3 decreased HCO3 decreased
chronic respiratory
alkalosis
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PCO2 < 35 mm Hg PCO2 < 35 mm Hg
pH > 7.45 pH > 7.45
HCO3 normal HCO3 normal
acute respiratory
alkalosis
PCO2 < 35 mm Hg PCO2 < 35 mm Hg
pH > 7.45 pH > 7.45
HCO3 decreased HCO3 decreased
partly compensated
respiratory alkalosis
PCO2 < 35 mm Hg PCO2 < 35 mm Hg
pH > 7.45 pH > 7.45
HCO3 increased HCO3 increased
combined respiratory
and metabolic alkalosis
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Step 1
PaCO2 35 – 45 mmHg PCO2 35 – 45 mm Hg
pH < 7.35 7.35 – 7.45 pH > 7.35
pH < 7.35
Acute Normal Acute
HCO3 decreased
Metabolic Acid- Base Metabolic
Acidosis Balance Alkalosis
PCO2 35 – 45 mm Hg PCO2 35 – 45 mm Hg
pH < 7.35 pH 7.35 – 7.45
HCO3 decreased HCO3 normal
acute metabolic
acidosis
PCO2 35 – 45 mm Hg PCO2 35 – 45 mm Hg
pH 7.35 – 7.45 pH > 7.45
HCO3 normal HCO3 increased
normal acid-base
balance
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Step 1
PCO2 35 – 45 mm Hg PaCO2 > 45 mmHg
pH < 7.35 7.35 7.45 pH > 7.45
pH > 7.45
Acute Chronic Compens. Partially
HCO3 increased Resp. Resp. Metabolic Compens.
Acidosis Acidosis Alkalosis Metabolic
Alkalosis
acute metabolic
alkalosis
PCO2 > 45 mm Hg PCO2 > 45 mm Hg
pH < 7.35 pH < 7.35
HCO3 normal HCO3 normal
acute respiratory
acidosis
PCO2 > 45 mm Hg PCO2 > 45 mm Hg
pH < 7.35 pH < 7.35
HCO3 decreased HCO3 decreased
combined respiratory
and metabolic acidosis
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PCO2 > 45 mm Hg PCO2 > 45 mm Hg
pH < 7.35 pH < 7.35
HCO3 increased HCO3 increased
partly compensated
respiratory acidosis
PCO2 > 45 mm Hg PCO2 > 45 mm Hg
pH 7.35 – 7.45 pH 7.35 – 7.45
HCO3 increased HCO3 increased
chronic respiratory
acidosis
PCO2 > 45 mm Hg PCO2 > 45 mm Hg
pH > 7.45 pH > 7.45
HCO3 increased HCO3 increased
partly compensated
metabolic alkalosis
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Step 2: Assessment of Arterial
Approximate PaCO2-pH Oxygenation
Relationship Evaluation of Hypoxemia
PaCO2 ( mm Hg) pH
Room Air (Patient < 60 y/o):
80 7.2
Mild: PaO2 < 80 mmHg
60 7.3
Moderate: PaO2 < 60 mmHg
40 7.4
Severe: PaO2 < 40 mm Hg
30 7.5
20 7.6
Step 2 FiO2 (Fractional Inspired
On Oxygen Therapy: Oxygen Concentration)
• Uncorrected hypoxemia: the measurable amount
PaO2 < 80 mm Hg of oxygen received by
• Corrected hypoxemia: the patient
PaO2 = 80 – 100 mm Hg 21% - room air
• Overcorrected hypoxemia: > 21% - supplemental
PaO2 > 100 mm Hg oxygen
Inspired Oxygen to PaO2 Clinically Assess:
Relationship
FiO2 Predicted Minimal PaO2 • Cardiac status
30 % 150 • Peripheral perfusion
40 % 200 • Blood oxygen transport mechanism
50 % 250
80 % 400 Assess 1 and 2 by the vital signs and PE.
If PaO2 < minimal predicted (FiO2 x 5), If 1 and 2 are adequate, then only 3 can be
the patient can be assumed to be interfering with proper tissue oxygenation.
hypoxemic at room air.
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Criteria for choosing site and Technique for
obtaining ABG samples must be based on:
Significant Problems
• Bleeding
• Vessel Obstruction = collateral blood
flow important
• Safety
• Infection
• Accessibility
• Patient Comfort
Preparing the sample
• Syringes
• Anticoagulants
• Anaerobic conditions
• Delay in analysis
Exercises Exercises
pH 7.44 pH 7.44
PCO2 40 PCO2 40 normal
PO2 99 PO2 99 acid-base
HCO3 22 HCO3 22 balance
BE +2 BE +2 with adequate
SaO2 95 SaO2 95 oxygenation
FiO2 21% FiO2 21%
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pH 7.36 pH 7.36
chronic
PCO2 25 PCO2 25
metabolic
PO2 78 PO2 78
acidosis
HCO3 15 HCO3 15
with
BE -10 BE -10
uncorrected
SaO2 95 SaO2 95
hypoxemia
FiO2 35% FiO2 35%
pH 7.24 pH 7.24
PCO2 60 PCO2 60 acute
PO2 80 PO2 80 respiratory
HCO3 26 HCO3 26 acidosis
BE -2 BE -2 with corrected
SaO2 95 SaO2 95 hypoxemia
FiO2 60% FiO2 60%
pH 7.55 pH 7.55
partly
PCO2 52 PCO2 52
compensated
PO2 70 PO2 70
metabolic
HCO3 44 HCO3 44
alkalosis
BE +17 BE +17
with uncorrected
SaO2 97 SaO2 97
hypoxemia
FiO2 90% FiO2 90%
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pH 7.19 pH 7.19
combined
PCO2 56 PCO2 56
metabolic and
PO2 120 PO2 120
respiratory
HCO3 17 HCO3 17
acidosis with
BE -30 BE -30
overcorrected
SaO2 94 SaO2 94
hypoxemia
FiO2 45% FiO2 45%
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