ABG INTERPRETATION

NORMAL VALUES:
pH: 7.35 – 7.45
pO2: 11 – 13 kPa H2O + CO2  H2CO3  HCO3- + H+
pCO2: 4.5 – 6.0 kPa
HCO3- : 22 – 26 mmol/L
BE: -2 to +2
SaO2  95%

STEP 1 – Oxygenation
Assess oxygenation – Hypoxic?
Significant alveolar – arterial gradient?
ALVEOLAR – ARTERIAL GRADIENT = partial pressure of oxygen in airways (PAO2) – partial pressure of oxygen in artery (PaO2)
STEP 2 – Determine pH status
Acidosis (pH ↓)
Alkalosis (pH ↑)
STEP 3 – Determine respiratory component (PaCO2)
Respiratory acidosis (pH↓, PaCO2 ↑)
Respiratory alkalosis (pH↑, PaCO2↓)
STEP 4 – Determine the metabolic component (HCO3- or BE)
Metabolic acidosis (pH↓, HCO3-↓)
Metabolic alkalosis (pH↑, HCO3-↑)
STEP 5 – In Combination
What is the primary disturbance? Refer to the above steps.
Is there compensation?
If either the respiratory or metabolic component was not consistent with the pH, there is
compensation.
ACIDOSIS maybe compensated by:
Respiratory compensation: increasing respiratory rate to blow off CO2 (will result in ↓ CO2)
Metabolic compensation: increased bicarbonate production by kidney (will result in ↑HCO3-)
Alkalosis maybe compensated by:
Respiratory compensation: decreasing respiratory rate to retain CO2 (will result in ↑ CO2)
Metabolic compensation: decreased bicarbonate production by kidney (will result in ↓ HCO3-)
Is there respiratory failure component ?
Type 1 respiratory failure = one gas abnormal (↓O2 Normal CO2) eg. Ventilation perfusion (V/Q)
mismatch
Type 2 respiratory failure = two gases abnormal (↓O2+↑CO2) eg. COPD
NOTE: Metabolic compensation by kidneys takes three days
Respiratory compensation is fast

Reference: 2013 Dr Christopher Mansbridge at www.OSCEstop.com