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O
2
CO
2
PAO2=150 40 / 0.8
=150 50 = 100 mm Hg
PaO
2
=90 mmHg
p
A
O
2
p
a
O
2
=10 mmHg One click and wait
Alveolar- arterial Difference
Oxygenation Failure
WIDE GAP
p
i
O
2
=150
pCO
2
=40
Ventilation Failure
NORMAL GAP
p
i
O
2
=150
pCO
2
=80
No click
O
2
CO
2
PaO
2
=45
PaO
2
=45
p
alv
O
2
=150 40/.8
=150-50
=100
A-a =100 -45=55
p
alv
O
2
=150-80/.8
=150-100
=50
A-a =50 -45 =5
1 Acidosis or alkalosis
2 Metabolic or respiratory
3 Compensation
Metabolic acidosis: 1.2(HCO3 = PCO2
Metabolic alkalosis: 0.7( HCO3 = PCO2
Respiratory acidosis AcutC 0.1(PCO2) = HCO3
ABCs of ABG
Manisha Sahay
Respiratory acidosis AcutC 0.1(PCO2) = HCO3
Respiratory acidosis: Chronic 0.3(PCO2) = HCO3
Respiratory alkalosis Acute 0.2(PCO2) = HCO3
Respiratory alkalosis chronic0.5(PCO2) = HCO3
4 Anion gap
5 anion gap = HCO3- metabolic alkalosis
6 urine AG
7 Oxygenation and ventilation
Remember the golden rule of acid-base
interpretation: always look at a patient
HANDS ON ABG
Manisha Sahay
Case 1
A 16-year-old male with diabetes mellitus presents after
having eaten no food and taken no insulin for the last 3
days . He is hypotensive, tachycardic, and markedly
tachypneic (respiratory rate 36). He smells strongly of
acetone and is dehydrated, and clinical findings are
Manisha Sahay
acetone and is dehydrated, and clinical findings are
consistent with left lower lobe pneumonia. Results of
ABG testing are:
PaO2 = 68 mm Hg
PaCO2 = 17 mm Hg
HCO3- = 6 mEq/L
pH = 7.30.
What is the acid-base abnormality?
Case 2
A 16-year-old female presents with 24
hours of unremitting emesis. She is
dehydrated and hypotensive. Tests of
her ABG her ABG
PaO2 = 104 mm Hg,
PaCO2 = 46 mm Hg,
HCO3- = 35 mEq/L
pH = 7.49.
What is the acid-base
disturbance here?
Manisha Sahay
Blood Gas Report
Measured 37.0
o
C
pH 7.523
PaCO
2
30.1 mm Hg
Case 3
PaCO
2
30.1 mm Hg
PaO
2
105.3 mm Hg
Calculated Data
HCO
3
act 22 mmol / L
O
2
Sat 98.3 %
PO
2
(A - a) 8 mm Hg
DPO
2
(a / A) 0.93
FiO
2
21.0 %
Case 4 8 year old diabetic with respi. Distress
fatigue and loss of appetite.
Blood Gas Report
Measured 37.0
o
C
pH 7.23
PaCO2 23 mm Hg
PaO2 110.5 mm Hg PaO2 110.5 mm Hg
Calculated Data
HCO
3
act 14 mmol / L
Entered Data
FiO2 21.0 %
Na =130, Cl =90
Case 5
A 16-year-old male presents with anorexia
and unremitting emesis for 4 days
ABG testing
Manisha Sahay
ABG testing
HCO3 - = 18 mEq/L
PaCO2 = 33 mm Hg
pH = 7.36
Na = 130 meq/L
Cl = 89 meq/L
A 15 yr old type 1 diabetic presents with following
abnormalities after missing insulin
ABG:
pH 7.31
Case 6
pH 7.31
PaCO
2
26 mmHg
HCO
3
12 mEq/L
PaO
2
92 mm Hg
Evaluate the acid-base
disturbance(s)?
Serum Electrolytes:
Na 140 mEq/L
K 5.0 mEq/L
Cl 100 mEq/L
A 14 yr old boy presents with continuous vomitingof
3 days duration and drowsiness and appears
dehydrated
ABG
pH 7.50
PaCO
2
48
Case 7
PaCO
2
48
HCO
3
32
PaO
2
90
Na 139
K 3.9
Cl 85
Evaluate the acid-base disturbance(s)?
Case 8
A 15 yr girl admitted with renal failure
on furosemide now in respiratory failure
and is on ventilator
ABG ABG
PaCO
2
30 mm Hg
PaO
2
62 mm Hg
Na
+
145 mEq/L
K
+
2.9 mEq/L
Cl
-
98 mEq/L
HCO
3
-
21 mEq/L
pH 7.52
A 12-year-old girl has been mechanically ventilated for two
days following a drug overdose. Her arterial blood gas
values and electrolytes show:
ABG
Case 9
ABG
pH 7.45
PaCO
2
25 mm Hg
Na
+
142 mEq/L
K
+
4.0 mEq/L
Cl
-
100 mEq/L
HCO
3
- 18 mEq/L
A 10 year old boy
with renal
insufficiency admitted
with following values
ABG
Case 10
ABG
pH 7.20
PaCO
2
24 mm Hg
Na
+
140 mEq/L
K
+
5.6 mEq/L
Cl
-
110 mEq/L
HCO
3
- 10 mEq/L
Patient A B C
ECF volume Low Low Normal
Glucose 600 120 120
pH 7.20 7.20 7.20
Na 140 140 140
Types of metabolic acidosis
Na 140 140 140
Cl 103 118 118
HCO
3
-
10 10 10
AG 27 12 12
Ketones 4+ 0 0
Patient A B C
U. Na 10 50
U. K 14 47
U. Cl 74 28
Urine AG 50 +69
Urine electrolytes in Metabolic
Acidosis
Urine AG 50 +69
Dx:
In Normal anion gap Metabolic Acidosis,
Positive Urine AG suggests distal Renal Tubular Acidosis
Negative Urine AG suggests non-renal cause for Metabolic
Acidosis.
Urine Anion Gap = (U. Na + U. K U. Cl)
6 year old male with progressive respiratory distress
Muscular dystrophy .
Blood Gas Report
Measured 37.0
o
C
pH 7.301
PaCO
2
76.2 mm Hg
PaO
2
45.5 mm Hg
Case 11
PaO
2
45.5 mm Hg
Calculated Data
HCO
3
act 35.1
mmol / L
O
2
Sat 78 %
PO
2
(A - a) 9.5 mm Hg
PO
2
(a / A) 0.83
Entered Data
FiO
2
21%
Case 12
8-year-old male asthmatic;
3 days of cough, dyspnea
and orthopnea not
responding to usual
bronchodilators.
Blood Gas Report
Measured 37.0
o
C
pH 7. 24
PaCO
2
49.1 mm Hg
PaO
2
66.3 mm Hg
8-year-old male asthmatic with resp. distress
bronchodilators.
O/E: Respiratory distress;
suprasternal and
intercostal retraction;
tired looking; on 4 L NC.
Calculated Data
HCO
3
act18.0 mmol / L
O2 Sat 92 %
PO
2
(A a) mm Hg
Entered Data
FiO
2
30 %
1 Acidosis or alkalosis
2 Metabolic or respiratory
3 Compensation
Metabolic acidosis: 1.2(HCO3 = PCO2
Metabolic alkalosis: 0.7( HCO3 = PCO2
ABCs of ABG
Manisha Sahay
Respiratory acidosis AcutC 0.1(PCO2) = HCO3
Respiratory acidosis: Chronic 0.3(PCO2) = HCO3
Respiratory alkalosis Acute 0.2(PCO2) = HCO3
Respiratory alkalosis chronic0.5(PCO2) = HCO3
4 Anion gap
5 anion gap = HCO3- metabolic alkalosis
6 urine AG
7 oxygenation and ventilation
Remember the golden rule of acid-base
interpretation: always look at a patient
Practicemakesaman
perfect!!
Manisha Sahay