Basics of ABG CSLC

July 7th, 2017

Normal values: pH 7.35-7.45, pCO2 4.6-6 kPa (35-45 mmHg), pO2 12 to 13 kPa (90-100
mmHg), standard HCO3 22 to 26 mmol/L, BE -2 to 2 mmol/L

Scenario 01

A 24 year old woman is found unconscious in the toilet of a disco. On arrival at the A&E
Department, she is found to be unresponsive to pain and to have small pin-point pupils and
slow irregular breathing. She is given oxygen supplement of 2L/min by nasal catheter.

ABG results: pH 7.11, pCO2 10.4kPa (79 mmHg), pO2 16.8 kPa (128 mmHg), BE -2mmol/L

Hyperventilation with type 2 respiratory failure

Respiratory acidosis

Scenario 02

A 12 year old boy is found collapsed at school. He has been complaining of polyuria and
polydipsia in the past 2 weeks.

ABG results: pH 7.32, pCO2 3kPa (23 mmHg), pO2 14.3 kPa (108 mmHg), BE -12 mmol/L

Metabolic acidosis with compensation by hyperventilation

May be suffering from diabetes, leading to production of ketoacids
There would be an expected increase in the anion gap
pO2 is slightly higher, presumably due to hyperventilation
Will need insulin for treatment

Scenario 03

A 65 year old man presents to the A&E department with chest pain and shortness of breath.
He is given oxygen by nasal catheter at 2L/min. His ECG shows acute myocardial infarction.

ABG results: pH 7.47, pCO2 4.4kPa (33mmHg), pO2 12.5 kPa (95 mmHg), BE 0mmol/L

Respiratory alkalosis and a corrected hypoxemia (no metabolic acidosis initially)

Shortness of breath leads to hyperventilation and explains CO2 and pH
Problem with gas transfer across the alveolus
o Left ventricular failure with pulmonary edema, therefore fluid in the alveoli,
causes the shortness of breath, affecting gas exchange and oxygen
diffusability (while CO2 transfer remains intact)
Scenario 04

A frail 85 year old woman develops sudden onset of abdominal pain for 4 hours. She is given
oxygen supplement by nasal catheter at 2L/min.

ABG result: pH 7.19, pCO2 4.6 kPa (35 mmHg), pO2 12.9 kPa (98 mmHg), BE -12 mmol/L

Metabolic acidosis with failed compensation

o Need of oxygen supplement to maintain pO2 suggest problem with
pulmonary function (e.g. muscle weakness and limited respiratory capacity
due to frailty, unable to use accessory muscles, painful to move the
diaphragm, analgesia may have effect of suppressing respiration)
Gut infarction

Scenario 05

A 15 year old boy has acute exacerbation of asthma

ABG results: pH 7.52, pCO2 4.1 kPa (31 mmHg), pO2 11.6 kPa (88 mmHg), BE +2 mmol/L

Respiratory alkalosis due to hyperventilation

Oxygen levels lowered, as it is more difficult for oxygen to enter than it is for carbon
dioxide to be transferred
Moderately severe severe enough to make him hypoxic, but not severe enough to
make him acidotic
o If left untreated, can cause exhaustion and would eventually switch to
respiratory acidosis

Scenario 06

A 68 year old man with chronic obstructive airway disease and respiratory failure is home
bound. Among other medications he receives oxygen supplement of 1L/min by nasal
catheter

ABG results: pH 7.34, pCO2 7.9 kPa (60mmHg), pO2 8.6 kPa (65 mmHg), BE 6 mmol/L

Respiratory acidosis with metabolic compensation

Chronic type 2 respiratory failure oxygen can be lethal as they lose their
chemoreceptor sensitivity to carbon dioxide, dependent on pO2 as driver of
respiration
o Raising pO2 would lead to loss of hypoxic drive
o Must treat the patient and not that number
1L/min allows for maintenance of pH but still maintaining hypoxic drive
Scenario 07

A 68 year old man with chronic renal failure presents to the A&E with 3 days history of
increasing shortness of breath

ABG Results: pH 7.33, pCO2 3.2 kPa (24mmHg), pO2 11.6 kPa (88 mmHg), BE -11 mmol/L

Metabolic acidosis with respiratory compensation

Metabolic acidosis caused by chronic renal failure
Pulmonary edema or pleural effusion may cause shortness of breath
Acute on chronic renal failure
Anion gap may be increased or normal

Scenario 08

A 34 year old laborer has fallen from a 15 feet scaffolding at work and is brought to the A&E
department bleeding heavily from a compounding fracture of his right femur. He is given an
oxygen supplement by facemask at 10L/min

ABG results: pH 7.07, pCO2 8kPa (61 mmHg), pO2 10.1 kPa (77mmHg), BE -11mmol/L

Compound fracture is when bone pierces through the skin

Haemorrhagic hypovolemic shock, anaerobic processes leading to metabolic acidosis
which is not compensated
pO2 still low despite 10L/min of oxygen supplement suggesting severe respiratory
failure which could be due to multiple causes:
o Most likely fat embolism (e.g. bone marrow) from the area of fracture
o Could have broken some ribs, or might not be breathing properly due to
unconsciousness after hitting his head, suppressing drug