Interpreting Arterial Blood Gases

and high H+ concentrations are causing metabolic acidosis. If the pH is >7.45 (alkalosis), the HCO is > 26 mEq/L, and 3 the BE is > + 3 mEq/L, then high bicarbonate levels are causing metabolic alkalosis. 6. Look for compensation. Renal compensation: In respiratory acidosis (pH < 7.35, PaCO2 > 45 mmHg), the kidneys retain HCO to buffer the excess acid, so 3 the HCO is > 26 mEq/L. 3 In respiratory alkalosis (pH > 7.45, PaCO2 < 35 mmHg), the kidneys excrete HCO to minimize the alkalosis, so 3 the HCO is < 22 mEq/L. 3 Respiratory compensation In metabolic acidosis (pH < 7.35, HCO <22 mEq/L), 3 the rate and depth of respirations increase, increasing carbon dioxide elimination, so the PaCO2 is < 35 mmHg. In metabolic alkalosis (pH > 7.45, HCO3 >26 mEq/L), respirations slow, carbon dioxide is retained, so the PaCO2 is > 45 mmHg. 7. Evaluate oxygenation. PaO2 < 80 mmHg = hypoxemia; possible hyperventilation PaO2 > mmHg = hyperventilation

1. Look at the pH. pH < 7.35 = acidosis pH > 7.45 = alkalosis 2. Look at the PaCO2. PaCO2 < 35 mmHg = hypocapnia; more carbon dioxide is being exhaled than normal PaCO2 > 45 mmHg = hypercapnia; carbon dioxide is being retained 3. Evaluate the pHPaCO2 relationship for a possible respiratory problem. If the pH is < 7.35 (acidosis) and the PaCO2 is > 45 mmHg (hypercapnia), retained carbon dioxide is causing increased H+ concentration and respiratory acidosis. If the pH is > 7.45 (alkalosis) and the PaCO2 is < 35 mmHg (hypocapnia), low carbon dioxide levels and decreased H+ concentration are causing respiratory alkalosis. 4. Look at the bicarbonate. If the HCO is < 22 mEq/L, bicarbonate levels are lower 3 than normal. If the HCO is > 26 mEq/L, bicarbonate levels are higher 3 than normal. 5. Evaluate the pH, HCO, and BE for a possible metabolic prob3 lem. If the pH is < 7.35 (acidosis), the HCO is < 22 mEq/L, 3 and the BE is < 3 mEq/L, then low bicarbonate levels