Arterial Blood Gas

Analysis
 ABG Analysis

• Three parameters must be assessed

during interpretation of an arterial
blood gas result
– Oxygenation
– Acid – Base status
– Degree of Compensation
 ABG Analysis
• Oxygenation
– Evaluate the PaO2
• PaO2 < 80 mmHg
• Consider age related alterations
• End result = Hypoxemia
– Evaluate the SaO2
• SaO2 < 93%
• Inadequate amount of oxygen is bound to
hemoglobin for transport to tissues.
• End result = Hypoxia
 ABG Analysis
• Acid Base Balance
– Evaluate the blood pH (normal,
increased or decreased)

– Evaluate the PaCO2 (increased,

decreased or normal)

– Evaluate the HCO3 (normal, increased,

or decreased)
 ABG Analysis
• Blood pH
– The optimal blood pH is 7.40
– The body tolerates a narrow margin of
normal pH of 7.35 – 7.45
– A pH lower than 7.35 = Acidosis
– A pH greater than 7.45 = Alkalosis
 ABG Analysis
• Blood pH
– If the pH is within normal range, it is
important to assess which side of 7.40 it falls.
– This may indicate that the patient may be
acidotic or alkalotic, but compensating.
– 7.35 – 7.39 = Acidosis
– 7.41 – 7.45 = Alkalosis
 ABG Analysis
• PaCO2
– A PaCO2 less than 35 is indicative of
respiratory alkalosis

– A PaCO2 greater than 45 is indicative of

respiratory acidosis
 ABG Analysis
• HCO3
– A HCO3 level less than 22 is indicative
of metabolic acidosis

– A HCO3 level greater than 26 is

indicative of metabolic alkalosis
The Arrow Method
of
ABG Analysis
 “Remember ROME”

Respiratory Opposite

Metabolic Equal
(if arrows with PH is opposite= resp.
If same= metabolic)
 It’s Easy!
• Assess the pH, PaCO2 and HCO3
– If the values are elevated, place the
corresponding arrow.

– If the values are decreased, place the

corresponding arrow.
 Now “Match Em”
• If the pH and PaCO2 arrows are
moving in opposite direction, this
signifies a RESPIRATORY problem.

– pH PaCO2 = Respiratory Acidosis

– pH PaCO2 = Respiratory Alkalosis

 Now “Match Em”
• If the pH and HCO3 arrows are
moving in the same direction, this
signifies a METABOLIC problem.

– pH HCO3 = Metabolic Acidosis

– pH HCO3 = Metabolic Alkalosis

 EXAMPLE #1
• pH: 7.22

• PaCO2: 55

• HCO3: 25

pH PaCO2 HCO3
Respiratory Normal
Acidosis
 EXAMPLE #2
• pH: 7.31

• PaCO2: 35

• HCO3: 20

pH PaCO2 HCO3
Metabolic Normal
Acidosis
 EXAMPLE #3
• pH: 7.49

• PaCO2: 30

• HCO3: 23

pH PaCO2 HCO3
Respiratory Normal
Alkalosis
 Evaluate for
Compensation
• When a patient develops an acid-base
imbalance the body will typically attempt
to compensate for the abnormality.

• If the buffer systems within the body are

unable to maintain a normal pH, the lungs &
the kidneys will attempt to compensate.
 Evaluate for
Compensation
• If the problem is respiratory in
origin, the kidneys will work to
correct it.

• If the problem is metabolic in origin,

the lungs will work to correct it.
 Evaluate for
Compensation
• Determine the degree of
compensation:
– Uncompensated (if PH abnormal,
and one other abnormal)
– Partially compensated (all 3
abnormal)
– Fully compensated (pH normal, but
others both abnormal)
 Consequences:
Impaired Cellular and Organ Function
• When compensatory mechanisms fail, the
following physiologic consequences occur:
– Altered cell function, especially in the brain
when CO2 crosses the blood–brain barrier
– Change in intracellular enzyme activity
resulting in cell dysfunction
– Acidosis: decreases the level of
consciousness (LOC)
– Alkalosis: decreases the LOC and has other
neurologic manifestations; may cause
dysrhythmias
 Evaluate for
Compensation
• Uncompensated
• pH is abnormal, & either the PaCO2 or
HCO3 is also abnormal
• There is no indication that the
opposite side has tried to correct
for the other.
 Evaluate for
Compensation
• Partially Compensated
• pH is abnormal, & both the PaCO2 and
HCO3 are also abnormal
• This indicates that one system has
attempted to correct for the other
but has not been completely
successful.
 Evaluate for
Compensation
• Fully Compensated
• pH is normal, & both the PaCO2 &
HCO3 are abnormal
• The normal pH indicates that one
system has been able to
compensate for the other.
 Steps for Evaluating
Compensation
• Assess the pH, determine acidosis or
alkalosis.
– Remember, even if the pH is normal, determine
whether the pH falls on the acidotic or
alkalotic side of 7.40.
– Place the corresponding arrow next to the pH
 Steps for Evaluating
Compensation
• Assess the PaCO2 and the HCO3
– Place the corresponding arrows next to
the values.
– Continue the matching game:
Which value matches with the pH?
– The other component should be moving
in the opposite direction, which
indicates compensation.
 Steps for Evaluating
Compensation
• Example:
• pH 7.32 ; PaCO2 56 ; HCO3 30

• Which value matches with the pH?

 EXAMPLE #1 (COPD PTS)
• pH: 7.31

• PaCO2: 55

• HCO3: 28

pH PaCO2 HCO3
Partially Compensated
Respiratory Acidosis
 EXAMPLE #2 (Kidney
Issues)
• pH: 7.31

• PaCO2: 25

• HCO3: 20

pH PaCO2 HCO3
Partially Compensated
Metabolic Acidosis
 EXAMPLE #3 (Anxiety)
• pH: 7.48

• PaCO2: 25

• HCO3: 21

pH PaCO2 HCO3
Partially Compensated
Respiratory Alkalosis
 EXAMPLE #4 (NG
drainage/vomiting)
• pH: 7.48

• PaCO2: 55

• HCO3: 31

pH PaCO2 HCO3
Partially Compensated
Metabolic Alkalosis
 EXAMPLE #5
• pH: 7.39 Normal

• PaCO2: 60

• HCO3: 30

pH PaCO2 HCO3
Fully Compensated N
Respiratory Acidosis
 Case Study
A 21 year old college student is admitted to
the Emergency Department after taking
an overdose of Oxycontin. The patient is
unconscious & breathing at a rate of 6 to 7
bpm. The patient’s ABG on room air is as
follows:
• pH: 7.23 (low); PaCO2: 71 (high); PaO2: 64;
HCO3: 26 (normal)
– Interpretation: (resp. acidosis.
Uncompensated)

– Possible Cause? Drug overdose

– Nursing Interventions: intubation (high

resp above 20, high Fio2 40) NARCAN
 Case Study
A woman with a history of panic disorder
arrives at the Emergency Department
complaining of not being able to “catch her
breath”. The woman is crying, shaking and
breathing rapidly. An ABG is obtained:
• pH: 7.52 (high); PaCO2: 28 (norm); HCO3: 22
(norm); SaO2: 90%
– Interpretation: Respiratory Alkalosis
uncompensated, hypoxia

– Possible Cause? Hyperventilating

– Nursing Interventions: Calm down, paper

bag, pain
 Case Study
A teenager is being evaluated at the emergency
room for complaints of muscle weakness and
twitching. Her mother reports “she is always on a
dieting” The patient is 5’6 and weighs 102lbs.
Among the teenager’s lab results are the following
ABG values:
• pH: 7.50 (high); PaCO2: 45 (normal); HCO3: 30
(low); SaO2 94%
– Interpretation? Metabolic alkalosis
uncompensated (difficult to treat)

– Possible Cause?

– Nursing Interventions? Deep breaths, positioning,

2L NC O2, nutrition education, replace electrolytes,
MONITOR
 Case Study
A patient has been mechanically ventilated
for the past two days in the ICU. The
ventilator settings are as follows: AC, rate
of 16, FIO2 50%, and TV 600. The
patient’s 6am ABG results are as follows:
• pH: 7.49 (high); PaCO2: 29 (low); PaO2: 70;
HCO3: 25 (normal):
– Interpretation? Respiratory alkalosis
uncompensated

– Possible Cause? Hyperventilation, slow

rate/tidal volume

– Nursing Interventions? Pain control,

increase PEEP,
 Case Study
A 53 year old patient presents to the
Emergency Department with complaints of
weakness, nausea, and shortness of
breath. The patient’s STAT ABG results
are as follows:
• pH: 7.29 (low); PaCO2: 32 (normal); HCO3:
18 (normal); PaO2 80
– Interpretation:partially compensated
metabolic acidosis

– Possible Cause?

– Nursing Interventions?
 Case Study
The nurse is caring for a patient 2 days post-
abdominal surgery The nurse notes 500cc of
coffee ground drainage over the last four hours.
The patient is neurologically intact. ABG results
are ordered with the following results.
• pH: 7.29 (low); PaCO2: 65(high); PaO2: 60; HCO3:
26 (normal)
– Interpretation? Respiratory acidosis,
uncompensated

– Possible Cause?

– Nursing Interventions?

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