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Arterial Blood Gas

(ABG)
Nancy Ng (SCM-027308)
What is ABG?

The arterial blood gas (ABG) sample is the


clinical tool most commonly used to evaluate
acid-base physiology at the bedside
Components of ABG

Components that are measured directly include


pH

Arterial partial pressure of oxygen (PaO2)

Arterial partial pressure of carbon dioxide (PaCO2)


Components of ABG

Derived components include:


Arterial oxygen saturation (SaO2)

Bicarbonate (HCO3)
Base excess (BE)
How is ABG taken?
A sample of blood from an artery is usually
taken from the radial artery

It can also be taken from the femoral artery or


brachial artery

ABG test will not be done on an arm used for


dialysis or if there is an infection or inflammation
in the area of the puncture site
Normal Range of ABG
pH 7.35 to 7.45

PaO2 80 to 100 mmHg

PaCO2 35 to 45 mmHg

HCO3- 22 to 26 mmol/L

SaO2 95 to 100%

BE -2 to 2 mEq/L
What is Base Excess (BE)?
BE is the amount of acid required to titrate 1
liter of blood to a pH of 7.4 at 37C

Normal values are between 2 and 2 mEq/L

BE reflects the pure metabolic component of the


acid-base disorder and is not affected by acute
changes in respiratory variation
BE Interpretation
A positive BE value indicates a lack of acid,
resulting in a component of metabolic
alkalosis

A negative BE value indicates an excess


amount of acid, with a contributing metabolic
acidosis
BE and HCO3 Correction

Example: With the BE is -10 in a 50kg person


with metabolic acidosis, mM of HCO3 needed for
correction is:
= 0.3 X body weight X BE
= 0.3 X 50 X10
= 150 mM
Interpretation of ABG
Step 1: Assess pH

Assess the pH Acidemia / Alkalemia


If above 7.45: Alkalemia
If below 7.35: Acidemia
Step 2: Assess PaCO2
Assess the PaCO2 level
pH and PaCO2 moves in opposite direction
indicates primary respiratory problem

Respiratory acidosis: pH decreases below 7.35,


paCO2 rise

Respiratory alkalosis: pH rises above 7.45,


PaCO2 fall
Step 2: Assess PaCO2
Assess the HCO3 level
pH and HCO3 moves in same direction indicates
primary metabolic problem

Metabolic acidosis: pH falls below 7.35, HCO3


falls

Metabolic alkalosis: pH rises above 7.45, HCO3


rises
pH CO2 HCO3-

Respiratory
Normal
Acidosis

Respiratory
Normal
Alkalosis

Metabolic
Normal
Acidosis

Metabolic
Normal
Alkalosis
Step 3: Assess PaO2

Assess PaO2
Normal value for PaO2 is 80 to 100 mmHg (Venous:
40mmHg)

PaO2 < 80 mmHg indicated hypoxemia


Step 4: Anion Gap (AG)
Calculation of AG is a useful approach to analyze
metabolic acidosis

AG = (Na+ + K+) (Cl- + HCO3-)

A change in the pH of 0.08 for each 10 mm Hg


indicates an acute condition

A change in the pH of 0.03 for each 10 mm Hg


indicates a chronic condition
Step 5: Compensation

A patient can be:


Uncompensated
Partially compensated
Fully compensated
Step 5: Compensation

Partially compensated: pH remains outside the


normal range

Fully compensated: pH has returned within


normal range but other values may be still
abnormal
Respiratory Compensation
If a metabolic acidosis develops the change is
sensed by chemoreceptors centrally in the
medulla oblongata and peripherally in the
carotid bodies

The body responds by increasing depth and rate


of respiration therefore increasing the excretion
of CO2 to try to keep the pH constant
Metabolic Compensation
In response to a respiratory acidosis, for example
in CO2 retention secondary to COPD, the kidneys
will start to retain more HCO3 in order to correct
the pH

ABG reading would show low normal pH with a


high CO2 and high bicarbonate

This process takes place over days


Fully Compensated
pH PaCO2 HCO3-

Respiratory Normal but



Acidosis <7.40

Respiratory Normal but



Alkalosis >7.40

Metabolidc Normal but



Acidosis <7.40

Metabolic Normal but



Alkalosis >7.40
Partially Compensated
pH PaCO2 HCO3-

Respiratory

Acidosis

Respiratory

Alkalosis

Metabolidc

Acidosis

Metabolic

Alkalosis