ABG Interpretation

Basic Interpretation
of
Arterial Blood Gases

Information Gleaned

Jean M. Davis, RN

An indication of the patients acid-base

status
The origin of the imbalance
An impression of the ability of the body
to regulate pH
A reflection of the patients oxygenation
status
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pH

Anatomy of an ABG

pH/PCO2/HCO3-/PO2

May add other parameters

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Base excess
Anion gap
Oxygen saturation
A-a Gradient
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Indicates whether the person is in a

normal, acidotic or alkalotic state
Concentration of hydrogen ions
expressed as a negative logarithm
Homeostatic mechanisms attempt to
maintain balance at a ratio of 20:1
(HCO3- to PCO2)
Normal value: 7.35 7.45

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Partial pressure of CO2 being carried in

the blood to lungs for excretion
Represents RESPIRATORY component
Normal: 35 45 mmHg

Represents the amount of bicarbonate present

in the blood
METABOLIC component
Renal tubules regulate balance of hydrogen
ions and bicarbonate ions

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HCO3-

PCO2

Acidosis excrete hydrogen, reabsorb bicarb

Alkalosis retain hydrogen, excrete bicarb

Kidneys generate additional bicarbonate when

needed
Normal: 22 26 mEq/L
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ABG Interpretation

PO2

Base Excess

Partial pressure of oxygen dissolved in

the blood
Must have sufficient partial pressure in
order to bind to Hgb for transport to
tissues
Normal: 80 100 mmHg

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Using BE to Administer Bicarb

Calculate the deficiency, and give half the calculated

dose; repeat ABG in 5 minutes
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10 x 100 =
1000 / 4 =
250
Give = 125 mEq Bicarb

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= Deficient mEq of bicarb

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Using BE to Administer Bicarb

Patient wgt: 100 Kg

Base Deficit: 10 (BE: -10)

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Approximately 25% of the adults TBW in Kg is

equivalent to the number of liters of extracellular
water
Base deficit x weight in Kg

Using BE to Administer Bicarb

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Calculating Dose of Bicarb

Base deficit is the mEq of bicarb that is

deficient per liter of extracellular fluid
Do not routinely treat a base deficit of
less than 10 (BE: 10)
Do not routinely treat an arterial pH of
greater than 7.20 unless there is CV
instability
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Includes the total of bases (alkalis)

such as bicarb, Hgb, plasma proteins
Excess metabolic acids cause bicarb
level to drop, creating a NEGATIVE BE
(sometimes called base deficit)
May be used to guide bicarbonate
administration
Normal: between -2 and +2

Patient wgt: 70 Kg
Base Deficit: 11 (BE: -11)

11 x 70 =
770 / 4 =
192
Give = 96 mEq Bicarb
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ABG Interpretation

Using BE to Administer Bicarb

Using BE to Administer Bicarb

Patient wgt: 80 Kg
Base Deficit: 12 (BE: -12)

12 x 80 =
960 / 4 =
240
Give = 120 mEq Bicarb
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11 x 120 =
1320 / 4 =
330
Give = 165 mEq Bicarb
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Anion Gap

Formula: (Na++K+)-(HCO3-+Cl-)

Lactic/diabetic acidosis

Bicarb losing acidosis

Increased gap = >11 mEq/L

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Alveolar to arterial Gradient

(A-a Gradient)

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Steps Used to Interpret ABGs

Assessment of alveolar capillary

exchange
The larger the gradient, the more
serious
Normal = 20-65

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Percentage of O2 the Hgb is carrying in

relation to how much it could carry
Percentage of O2 binding sites on Hgb
that are occupied by oxygen
Normal: 95 100 %

Normal gap = 3-11 mEq/L

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SaO2

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Assists in determining which type of

metabolic acidosis

Patient wgt: 120 Kg

Base Deficit: 11 (BE: -11)

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Determine acid/base balance

Determine cause of pH change

Compensated or uncompensated

Determine oxygen status

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ABG Interpretation

Determine Cause of pH Change

Determine Acid/Base Balance

Normal pH: 7.35 7.45

Acidosis: < 7.35

Alkalosis: > 7.45

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Decide whether the cause is

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CO2

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Respiratory Acidosis

Respiratory component

Acid

High CO2 level causes acidosis

Results from Hypoventilation

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In acute respiratory disturbances,

variation from normal PCO2 by 10
mmHg causes change in pH of 0.08

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CO2: 75, pH: 7.12

Chronic

CO2: 78, pH: 7.28

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Acute

CO2: 55, pH: 7.30

In chronic respiratory disturbances,

variation from normal PCO2 by 10
mmHg causes change in pH of 0.03
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Change in PCO2 and pH

Causes retention of CO2

Consequent drop in blood pH

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Change in PCO2 and pH

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Chronic
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ABG Interpretation

Respiratory Acidosis

Respiratory Acidosis

Causes include:

Pneumonia

Sedation
CNS

disease

Guillian-Barre

Pleural disease

Polio

Pneumothorax

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Myasthenia

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Respiratory Alkalosis

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Causes elimination of CO2 from

blood
Consequent rise in blood pH

Catastrophic CNS event

Drugs

Interstitial lung disease

Liver cirrhosis
Anxiety

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Especially the 3rd trimester

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HCO3-

Decreased lung compliance

Salicylates
Progesterone

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Respiratory Alkalosis

CNS hemorrhage

Pregnancy

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Causes include:

Results from hyperventilation

Gravis

Respiratory Alkalosis

Low CO2 level causes alkalosis

Musculoskeletal disorders
Kyphoscoliosis

Obesity

Lung disease
COPD

CNS depression

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Metabolic component

Alkaline

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ABG Interpretation

Anion Gap

Metabolic Acidosis

Low bicarb level causes acidosis

Results from accumulation of acids

or a loss of bicarbonate

Assists in determining which type of

metabolic acidosis

Formula: (Na++K+)-(HCO3-+Cl-)

Lactic/diabetic acidosis

Bicarb losing acidosis

Low HCO3
Consequent drop in blood pH
-

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Normal gap = 3-11 mEq/L

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Metabolic Acidosis

Metabolic Acidosis

Causes include (Gap acidosis):

Uremia
Ketoacidosis

GI loss of bicarb

Renal loss of bicarb

Compensation for respiratory alkalosis
Carbonic anhydrase inhibitor (Diamox)
Renal tubular acidosis
Ureteral diversion

Alcohol poisons or drug intoxication

Methanol, Ethylene glycol intoxication
Ethanol
Salicylates, paraldehyde and other drugs

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High bicarbonate level causes alkalosis

Causes include:

Overdiuresis

High HCO3Consequent elevation of blood pH

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Volume contraction
Vomiting

Results from elevation of serum bicarb

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Metabolic Alkalosis

Hyperalimentation
Acid infusions

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Metabolic Alkalosis

Other:

Lactic acidosis
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Diarrhea

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Causes include (Non-Gap acidosis):

Diabetic hyperglycemia
ETOH withdrawal
Starvation

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Increased gap = >11 mEq/L

Ascites

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Hypokalemia

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ABG Interpretation

Recap of pH and Cause

Metabolic Alkalosis

Alkali ingestion

Bicarbonate

If the pH is low (acidotic)

Excess gluco- or mineralocorticoids

Bartters syndrome

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If the pH is high (alkalotic)

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The body NEVER overcompensates

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Compensation

In metabolic acidosis,
acidosis the CO2 will
decrease
In metabolic alkalosis,
alkalosis the CO2 will
increase
In respiratory acidosis,
acidosis the HCO3- will
increase
In respiratory alkalosis,
alkalosis the HCO3- will
decrease
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Compensates for respiratory problems with

bicarbonate
Compensates for metabolic problems by altering
ventilation

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Compensation

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The body attempts to normalize pH

The cause is respiratory if the

CO2 is low
The cause is metabolic if the
HCO3- is elevated
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Compensation

Recap of pH and Cause

The cause is respiratory if the

CO2 is elevated
The cause is metabolic if the
HCO3- is low

Respiratory compensation is rapid

Metabolic compensation is slow

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minutes
hours to days

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ABG Interpretation

Determine the Oxygen Status

Compensation

No compensation

Opposing parameter abnormal, but pH remains

abnormal

Full or Complete compensation

Opposing parameter abnormal, and pH is

normal
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of
of
of
of

80 100 is within normal limits

60 80 is mild hypoxemia
40 60 is moderate hypoxemia
<40 is severe hypoxemia
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Oxygen Facts

Supplemental oxygen will increase the

PO2

For each liter of nasal oxygen, the FIO2 is

increased by .04 (4%)

To determine the anticipated PO2,

multiply the FI02 by 5

1L = .24

4L = .36

2L = .28

5L = .40

3L = .32

6L = .44
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For every decrease in FIO2 of 1%, the

PO2 will decrease by 7

For every increase in FIO2 of 1%, the

PO2 will increase by 7

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Rule of 7s

PO2 is 380 on 90% FIO2. What

change will you make in the FIO2 to
attain a PO2 of 100?

380-100=280 (want to drop 280 points)

280/7= 40 (can decrease FIO2 by 40)
FIO2 = .50

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On RA, the anticipated PO2 is

approximately 100
On 3L NC, the PO2 should be 160
On a .40 VM, the PO2 should be 200

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Rule of 7s

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Subtract 1/3 of patients age from 100

PO2
PO2
PO2
PO2

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Oxygen Facts

Normal oxygenation decreases with

age

Partial compensation

Opposing parameter remains WNL

Acute problem

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ABG Interpretation

Eval of Hypoxemia
Using the A-a Gradient

A-a Gradient

Normal 20-65
Severe distress >400
The larger the gradient, the worse the
respiratory failure

Normal A-a gradient = hypoventilation

High A-a gradient

Give 100% O2

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Example #1
pH

7.34

PCO2

33.9

HCO3-

18.2

BE

-6.2

PO2

85.2

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Example #2
pH

7.44

PCO2

27.8

HCO3-

19.2

BE

-4.0

PO2

100

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50

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#2
Fully Compensated
Respiratory Alkalosis
with Normal Oxygenation

Normal
Low
Low
Low
Normal

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Increased PO2 = V/Q abnormality

No change in PO2 = shunt

#1
Partially Compensated
Metabolic Acidosis
with Normal Oxygenation

Acidotic
Low
Low
Low
Normal

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V/Q imbalance (ventilation without

perfusion)
Shunting (perfusion without ventilation)

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ABG Interpretation

Example #3

#3
Partially Compensated
Metabolic Alkalosis
with Moderate Hypoxemia

Alkalotic
High
High
High
Low

pH

7.59

PCO2

49.0

HCO3-

48.2

BE

+21.6

PO2

58.7

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Example #4
pH

7.17

PCO2

69.3

HCO3-

21.0

BE

-5.5

PO2

40.9

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Example #5
7.28

PCO2

79.5

HCO3-

37.1

BE

+8.4

PO2

30.0

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#5
Partially Compensated
Respiratory Acidosis
with Severe Hypoxemia

Acidotic
High
High
High
Low

pH

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#4
Combined Metabolic
and Respiratory Acidosis
with Moderate Hypoxemia

Acidotic
High
Low
Low
Low

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60

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ABG Interpretation

Example #6
pH

7.39

PCO2

39.0

HCO3-

23.4

BE

-1.0

PO2

61.2

Normal
Normal
Normal
Normal
Low

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#6
Normal Acid/Base Balance
with Mild Hypoxemia

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Hooray!!!
Youve done it!!

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