Arterial blood Gases
1
POSSIBLE CAUSES
Acid-base disorders
DISORDERS AND ARTERIAL BLOOD
GAS FINDINGS
Respiratory acidosis (excess
CO2 retention)
pH < 7.35 (SI, < 7.35), HCO3 > 26 mEq/L
(SI, > 26 mmol/L) (if compensating),
PaCO2 > 45 mm Hg (SI, > 5.3 kPa)
Respiratory alkalosis (excess
CO2 excretion)
pH > 7.45 (SI, > 7.45), HCO3 < 22 mEq/L
(SI, < 22 mmol/L) (if compensating),
PaCO2 < 35 mm Hg (SI, < 4.7 kPa)
Metabolic acidosis (HCO3 loss, acid
retention)
pH < 7.35 (SI, < 7.35), HCO3 < 22 mEq/L
(SI, < 22 mmol/L), PaCO2 < 35 mm Hg (SI,
< 4.7 kPa) (if compensating)
SIGNS AND SYMPTOMS
Central nervous system depression Diaphoresis, headache, tachycardia,
from drugs, injury, or disease confusion, restlessness, apprehension
Asphyxia
Hypoventilation due to pulmonary,
cardiac, musculoskeletal, or
neuromuscular disease
Obesity
Postoperative pain
Abdominal distention
Hyperventilation due to anxiety, Rapid, deep breathing; paresthesia; light-
pain, or improper ventilator settings headedness; twitching; anxiety; fear
Respiratory stimulation caused by
drugs, disease, hypoxia, fever, or
high room temperature
Gram-negative bacteremia
Compensation for metabolic acidosis
(chronic renal failure)
HCO3 depletion due to renal Rapid, deep breathing; fruity breath;
disease, diarrhea, or small-bowel fatigue; headache; lethargy; drowsiness;
fistulas nausea; vomiting; coma (if severe)
Arterial blood Gases

Excessive production of organic

acids due to hepatic disease;
endocrine disorders, including
diabetes mellitus, hypoxia, shock;
and drug intoxication
Inadequate excretion of acids due
to renal disease

Metabolic alkalosis (HCO3

retention, acid loss)
pH > 7.45 (SI, > 7.45), HCO3 > 26 mEq/L
(SI,> 26 mmol/L), PaCO2 > 45 mm Hg (SI,
> 5.3 kPa)
Loss of hydrochloric acid from Slow, shallow breathing; hypertonic
prolonged vomiting or gastric muscles; restlessness; twitching; confusion;
suctioning irritability; apathy; tetany; seizures; coma
Loss of potassium due to increased (if severe)
renal excretion (as in diuretic
therapy) or steroid overdose
Excessive alkali ingestion
Compensation for chronic
respiratory acidosis

Fischbach, F., & Dunning, M. B. (2014). A manual of laboratory and diagnostic tests (9th ed.). Philadelphia, PA: Wolters Kluwer.