Blood Gas Interpretation Review

for Pandemic

Blood Gases
Important diagnostic tool
Reveals:
1. acid-base balance
2. oxygenation status
**arterial gases only**

3. abnormalities of ventilation

Acid- base balance

The body is designed for optimum performance at a
specific pH level
Cell division
Metabolism

Components of Acid- Base Balance

pH- measures the bloods acidity
Normal range 7.35- 7.45
Overall H+ from both respiratory and metabolic factors
pCO2- partial pressure of carbon dioxide in the blood
Normal range 35-45 mmHg
Snapshot of adequacy of alveolar ventilation
HCO3- the amount of bicarbonate in the blood
Normal range 22- 26 mEq/L

Acid Base Balance

Bicarbonate carbonic acid buffer equation
(H+)(HCO3)
(H2CO3)
(CO2)(H2O)
Its not that complicated!
pH 1

Acidic

Neutral

14

Alkaline

Acid Base Balance

Lungs
Respiratory
CO2 (acid)

Kidneys
Metabolic
HCO3 ( base/alkaline)

Making sense of it
pH

7.35 7.45

Respiratory

Metabolic

CO2=Acidosis

HCO3=Acidosis

CO2=Alkalosis

HCO3=Alkalosis

Interpretation: 4 steps
Normal Values
pH
pCO2
HCO3

7.35 7.45
35 45 mmHg
22 - 26 mEq/L

Evaluate each component as Acid or Base

Step 1
Evaluate pH and determine acidosis or
alkalosis
7.35
7.40
7.45

Acid
Acidosis

Normal

Base
Alkalosis

Step 2
Evaluate pCO2 (respiratory)

35

Base

40

Normal

45

Acid

10

Step 3
Evaluate HCO3 (metabolic)
22

24

Acid

Normal

26

Base

11

Step 4
Determine which regulatory system is responsible for
the imbalance by checking to see which component
matches the pH.
If pH and pCO2 match = respiratory
If pH and HCO3 match = metabolic

12

ABG Analysis
pH

pCO2

HCO3

Resp. Acidosis

A
(<7.35)

A
(>45)

N
(22-26)

Resp.
Alkalosis

B
(>7.45)

B
(<35)

N
(22-26)

Metabolic
Acidosis

A
(<7.35)

N
(35-45)

A
(<22)

Metabolic
Alkalosis

B
(>7.45)

N
(35-45)

B
(>26)

13

Lets practice
pH

pCO2

HCO3

7.26

55

23

A
B

N
B

7.54

43

39

7.39

41

25

7.51

29

7.29

40

7.28

61

N
B

N
A

N
N

Respiratory Acidosis

Metabolic Alkalosis
Normal
Respiratory Alkalosis

24

Metabolic Acidosis

17

Mixed Acidosis

18

14

Compensation
When an acid base imbalance exists, over time the
body attempts to compensate.

15

Understanding Compensation
Uncompensated the alternate system has not attempted to
adjust (remains within normal range), and the pH remains
abnormal
Example

pH
7.30
A
pCO2
60
A
HCO3
25
N
Uncompensated Respiratory Acidosis

16

Understanding Compensation
Partial Compensation the alternate system is trying to create
a balanced environment and bring the pH back within normal
limits, but hasnt yet succeeded.
Example
pH
7.34A
pCO2
59 A
HCO3
28 B
Partially Compensated Respiratory Acidosis

17

Understanding Compensation
Fully Compensated the alternate system has adjusted enough
to restore balance and normalize the pH
Example

pH
7.36
N (but slightly A)
pCO2
58
A
HCO3
31
B
Compensated Respiratory Acidosis

18

Lets Practice Compensation

pH

pCO2

7.51

49

7.29

53

7.37

25

7.35

65

7.46

7.34

22

52

HCO3

Metabolic Alkalosis partially

compensated

40

Respiratory Acidosis uncompensated

22

18
28

20

Metabolic Acidosis fully compensated

Respiratory Acidosis fully compensated
Respiratory Alkalosis partially
compensated
Respiratory Acidosis partially
compensated

27

19

A Final Step
Determine level of oxygenation
(arterial samples only)
Normal = 80 100 mmHg
Mild hypoxemia = 60 80 mmHg
Moderate hypoxemia = 40 60 mmHg
Severe hypoxemia = less than 40 mmHg

20

Respiratory Acidosis
Excessive CO2 retention
Causes
Airway obstruction
Depression of respiratory drive
Sedatives, analgesics
Head trauma
Respiratory muscle weakness resulting from muscle disease
or chest wall abnormalities
Decreased lung surface area participating in gas exchange

21

Respiratory Acidosis
Clues
Confusion, restlessness
Headache, dizziness
Lethargy
Dyspnea
Tachycardia
Dysrhythmias
Coma leading to death

22

Respiratory Acidosis
Solutions
Improve ventilation
Ensure adequate airway; positioning,
suctioning
Encourage deep breathing and coughing
Frequent repositioning
Chest physio/ postural drainage
Bronchodilators
Decrease sedation/analgesia
Oxygen therapy
23

Respiratory Alkalosis
Excessive CO2 loss due to hyperventilation
Causes
CNS injury: brainstem lesions, salicylate overdose, Reyes
Syndrome, hepatic encephalopathy
Aggressive mechanical ventilation
Anxiety, fear or pain
Hypoxia
Fever
Congestive heart failure

24

Respiratory Alkalosis
Clues
Light headedness
Confusion
Decreased concentration
Tingling fingers and toes
Syncope
Tetany

25

Respiratory Alkalosis
Solutions
Decrease respiratory rate and depth
Sedation/analgesia as appropriate
Rebreather mask
Paper bag
Emotional support/encourage patient to slow
breathing
Calm, soothing environment

26

Metabolic Acidosis
Excessive HCO3 loss, or acid gain
Causes
Diabetic ketoacidosis
Sepsis/shock
Diarrhea (fluid losses below gastric sphincter)
Renal Failure
Poison ingestion
Starvation
Dehydration

27

Metabolic Acidosis
Clues
Stupor
Restlessness
Kussmauls respirations (air hunger)
Seizures
Coma leading to death

28

Metabolic Acidosis
Solutions
Replace HCO3 while treating underlying cause
Monitor intake and output
Monitor electrolytes, especially K+
Seizure precautions

29

Metabolic Alkalosis
HCO3 retention, or loss of extracellular acid,
Causes
GI losses above gastric sphincter
Vomiting
Nasogastric suction
Antacids
Diuretic therapy causing electrolyte loss

30

Metabolic Alkalosis
Clues
Weakness, dizziness
Disorientation
Hypoventilation
Muscle twitching
Tetany

31

Metabolic Alkalosis
Solutions
Control vomiting
Replace GI losses
Eliminate overuse of antacids
Monitor intake and output
Monitor electrolytes

32