Arterial blood gas (ABGs)

pH
paCO2
HCO3
BE
pO2

12/14/2014

7.35-7.45
35- 45 mmHg
22-26 mEq/L
-2 - +2
80 - 100

pH : Measures how much acid or base is in the blood

paCO2: Is the partial concentration of CO2 in the blood
HCO3: Is bicarbonate, which is a buffer (stabilizes acidity) for acid
BE: Is base excess, also a buffer even more sensitive than the
bicarbonate buffer system.
pO2: Is the concentration of O2.
pH
7.35-7.45
paCO2
35- 45 mmHg
HCO3
22-26
1. First look at PH. is it low? or high? Low is acidic and high is
alkalosis.

2. Then look at your paCO2 - if this is within normal range your

answer will be metabolic. If its out of whack its going to be
respiratory.
Also know ROME in case they dont give you lab values.
Respiratory
Opposite
Metabolic
Equal
This means if your pH level and paCO2 is opposite its
respiratory. (one will be up, one will be down).

Respiratory acidosis
Too much CO2 in body
low pH and high C02
hypoventilation (eg: COPD, narcs or sedatives, atelectasis)
*Compensated by metabolic alkalosis (increased HC03)
For example:
ph 7.20 C02 60 HC03 24 (uncompensated respiratory acidosis)
ph 7.33 C02 55 HC03 29 (partially compensated respiratory acidosis)
ph 7.37 C02 60 HC03 37 (compensated respiratory acidosis)

Respiratory alkalosis

Blowing off too much CO2

high pH and low C02
hyperventilation (eg: anxiety, PE, pain, sepsis, brain injury)
*Compensated by metabolic acidosis (decreased HC03)
For example:
ph 7.51 C02 26 HC03 25 (uncompensated respiratory alkalosis)
ph 7.47 C02 32 HC03 20 (partially compensated respiratory alkalosis)
ph 7.43 C02 30 HC03 19 (compensated respiratory alkalosis)

pH
HCO3

7.35-7.45
22- 26 mmHg

1. First look at PH. is it low? or high? Low is acidic and high is

alkalosis.
2. Then look at your HCO3 - if this is within normal range your
answer will be respiratory. If its out of whack its going to be
metabolic.
Also know ROME in case they dont give you lab values.
Respiratory
Opposite
Metabolic
Equal
This means if bicarbonate (HCO3) and ph are both up or both down,
then its a metabolic issue.

Metabolic acidosis
low pH and low HC03
Too much acid accumulates in the body
Remember the three Ds
- Diarrhea
- Diabetic acidosis
- Dialysis (renal failure)
*Compensated by respiratory alkalosis (decreased C02)
Examples:
pH 7.23 C02 36 HC03 14 (uncompensated metabolic acidosis)
pH 7.31 C02 30 HC03 17 (partially compensated metabolic acidosis)
pH 7.38 C02 26 HC03 20 (compensated metabolic acidosis)

Metabolic alkalosis
high ph and high HC03
When too much base accumulates in the body
Example: vomiting, potassium deficit, diuretics.
*Compensated by respiratory acidosis (increased C02)

Example:
pH 7.54 C02 44 HC03 29 (uncompensated metabolic alkalosis)
pH 7.50 C02 49 HC03 32 (partially compensated metabolic alkalosis)
pH 7.44 C02 52 HC02 35 (compensated metabolic alkalosis)
*Remember that compensation corrects the ph.
Now a simple way to remember this......
CO2 = acid, makes things acidic
HCO3 = base, makes things alkalotic
Remember ROME
R-Respiratory
O-Opposite
M-Metabolic
E-Equal
Rules for compensation:
2 odd values= uncompensated
3 odd values= partially compensated

when pH returns to normal value= fully compensated

Respiratory acidosis examples:
pH <7.35 PCO2 >45 HCO3 22-26 (uncompensated)
pH <7.35 PCO2 >45 HCO3 >26 (partially compensated)
pH 7.35-7.45 PCO2 >45 HCO3 >26 (fully compensated)
PH was low & CO2 was high, so HCO3 increases to compensate. The
pH will rise in response to bicarb release from the kidneys. When the bicarb
is enough to bring the pH within normal levels the HCO3 is said to be fully
compensating the pH. The pH level is within normal limits, but CO2 and
HCO3 are not until things eventually normalize.
Respiratory alkalosis examples:
pH >7.45 PCO2 <35 HCO3 22-26 (uncompensated)
pH >7.45 PCO2 <35 HCO3 <22 (partially compensated)
pH 7.35-7.45 PCO2 >45 HCO3 <22 (fully compensated)

Metabolic acidosis examples:

pH <7.35 PCO2 35-45 HCO3 <22 (uncompensated)
pH <7.35 PCO2 <35 HCO3 <22 (partially compensated)
pH 7.35-7.45 PCO2 <35 HCO3 <22 (fully compensated)

Metabolic alkalosis examples:

pH >7.45 PCO2 35-45 HCO3 >26 (uncompensated)
pH >7.45 PCO2 >45 HCO3 >26 (partially compensated)
pH 7.35-7.45 PCO2 >45 HCO3 >26 (fully compensated)

Test

Value

Normals

Analysis

pH:

7.36

7.35-

pH is normal

7.45
PaCO2:

62
mmHg

35-45
mmHg

CO2 tension is high (respiratory

[HCO3-]:

34
mEq/L

22-26
mEq/L

HCO3- concentration is high (me

The pH is at the low end of normal (toward the acidotic side), but the HCO3- and CO
overcompensate, the acidotic factor is the primary culprit. Here, there is a respiratory acid
This is a classic "chronic" COPD gas, where over time, high CO2 levels led to high H
High HCO3- is most often the compensatory result of high CO2