ABG INTERPRETATION

Sidra Yousaf,RN
 OUTLINE:
 Introduction
 Definition
 ABG component
 Normal value
 acid-base disorders
 Result interpretation
 Compensation
 Video (Procedure)
 Tutorial
 Introduction
The major function of the pulmonary system (lungs and pulmonary
circulation) is to deliver oxygen to cells and remove carbon dioxide from
the cells.
If the patient’s history and physical examination reveal evidence of
respiratory dysfunction, diagnostic test will help identify and evaluate the
dysfunction.
ABG analysis is one of the first tests ordered to assess respiratory status
because it helps evaluate gas exchange in the lungs.
An ABG test can measure how well the person's lungs and kidneys are
working and how well the body is using energy.
 What is an ABG
Arterial Blood Gas
 It is a diagnostic and an invasive procedure in which a blood is
obtained from an artery- radial, brachial, femoral directly by an
arterial puncture or accessed by a way of indwelling arterial
catheter.
 ABG component
PH:
measures hydrogen ion concentration in the blood, it shows blood’ acidity or
alkalinity.
PCO2 :
It is the partial pressure of CO2 that is carried by the blood for excretion by the
lungs, known as respiratory parameter.
PO2:
It is the partial pressure of O2 that is dissolved in the blood , it reflects the body
ability to pick up oxygen from the lungs.
HCO3 :
known as the metabolic parameter, it reflects the kidney’s ability to retain and excrete
bicarbonate .
 What Is An ABG?
pH [H+]

PCO2 Partial pressure CO2

PO2 Partial pressure O2

HCO3 Bicarbonate

BE Base excess

SaO2 Oxygen Saturation

 Normal ABG values
pH 7.35 – 7.45

PCO2 35 – 45 mmHg

PO2 80 – 100 mmHg

HCO3 22 – 26 mmol/L

BE -2 - +2

SaO2 >95%
 Respiratory Component
 function of the lungs

 Carbonic acid H2CO3

 Approximately 98% normal metabolites are in the form

of CO2
CO2 + H2O  H2CO3
 excess CO2 exhaled by the lungs
 Metabolic Component
 Function of the kidneys.
base bicarbonate Na HCO3

 Process of kidneys excreting H+ into the urine and reabsorbing

HCO3- into the blood from the renal tubules
1) active exchange Na+ for H+ between the tubular
cells and Glomerular filtrate
Acidosis Alkalosis

pH < 7.35 pH > 7.45

PCO2 > 45 PCO2 < 35

HCO3 < 22 HCO3 > 26

 Acid base disorders

Respiratory acidosis

PH PCO2 HCO3
↓ ↑ ------
 Respiratory alkalosis

PH PCO2 HCO3
↑ ↓ ------

12
 Metabolic acidosis

PH PCO2 HCO3
↓ ------ ↓

13
 Metabolic alkalosis

PH PCO2 HCO3
↑ ------ ↑

14
 How to Analyze an ABG
1. PO2 NL = 80 – 100 mmHg

2. pH NL = 7.35 – 7.45
Acidotic <7.35
Alkalotic >7.45

3. PCO2 NL = 35 – 45 mmHg
Acidotic >45
Alkalotic <35

4. HCO3 NL = 22 – 26 mmol/L
Acidotic < 22
Alkalotic > 26
 Four-step ABG Interpretation
Step 1:

 Examine PaO2 & SaO2

 Determine oxygen status

 Low PaO2 (<80 mmHg) & SaO2 means hypoxia

 NL/elevated oxygen means adequate oxygenation

 Four-step ABG Interpretation
Step 2:

 pH acidosis <7.35
alkalosis >7.45
 Four-step ABG Interpretation
Step 3:

 study PaCO2 & HCO 3

 respiratory irregularity if PaCO2 abnl & HCO3 NL

 metabolic irregularity if HCO3 abnl & PaCO2 NL

 Four-step ABG Interpretation
Step 4:

Determine if there is a compensatory mechanism working

to try to correct the PH.

i.e.: if have primary respiratory acidosis will have

increased
PaCO2 and decreased PH. Compensation occurs when
the kidneys retain HCO3.
 Compensation
 The respiratory and metabolic system works together to keep the body’s acid-
base balance within normal limits.

 The respiratory system responds to metabolic based PH imbalances in the

following manner:

* metabolic acidosis: ↑ respiratory rate and depth (↓PaCO2)

* metabolic alkalosis: ↓ respiratory rate and depth (↑PaCO2)

 The metabolic system responds to respiratory based PH imbalances in the

following manner:

*respiratory acidosis: ↑ HCO3 reabsorption

*respiratory alkalosis: ↓HCO3 reabsorption

 A. Respiratory acidosis
Phase PH PaCO2 HCO3
UNCOMPENSATED ↓ ↑ ------

Because there is no response from the kidneys yet to

acidosis the HCO3 will remain normal
Phase PH PaCO2 HCO3
PARTIAL COMPENSATED ↓ ↑ ↑

The kidneys start to respond to the acidosis by increasing

the amount of circulating HCO3

Phase PH PaCO2 HCO3

FULL COMPENSATED N ↑ ↑

PH return to normal PaCO2 & HCO3 levels are still high to

correct acidosis
 B. Respiratory alkalosis
Phase PH PaCO2 HCO3
UNCOMPENSATED ↑ ↓ ------

Because there is no response from the kidneys yet to

acidosis the HCO3 will remain normal
Phase PH PaCO2 HCO3
PARTIAL COMPENSATED ↑ ↓ ↓

The kidneys start to respond to the alkalosis by

decreasing the amount of circulating HCO3

Phase PH PaCO2 HCO3

FULL COMPENSATED N ↓ ↓

PH return to normal PaCO2 & HCO3 levels are still low to

correct alkalosis
 C. Metabolic acidosis
Phase PH PaCO2 HCO3
UNCOMPENSATED ↓ ------- ↓

Because there is no response from the lungs yet to

acidosis the PaCO2 will remain normal
Phase PH PaCO2 HCO3
PARTIAL COMPENSATED ↓ ↓ ↓

The lungs start to respond to the acidosis by decreasing

the amount of circulating PaCO2

Phase PH PaCO2 HCO3

FULL COMPENSATED N ↓ ↓

PH return to normal PaCO2 & HCO3 levels are still low to

correct acidosis
 D. Metabolic alkalosis
Phase PH PaCO2 HCO3
UNCOMPENSATED ↑ ------- ↑

Because there is no response from the lungs yet to

alkalosis the PaCO2 will remain normal
Phase PH PaCO2 HCO3
PARTIAL COMPENSATED ↑ ↑ ↑

The lungs start to respond to the alkalosis by increasing

the amount of circulating PaCO2

Phase PH PaCO2 HCO3

FULL COMPENSATED N ↑ ↑

PH return to normal PaCO2 & HCO3 levels are still high to

correct alkalosis
 Mixed Acid-Base Abnormalities
Case Study No. 1:

56 year   neurologic required ventilator support for several

weeks. She seemed most comfortable when hyperventilated
to PaCO2 28-30 mmHg. She required daily doses of lasix to
assure adequate urine output and received 40 mmol/L IV K+
each day. On 10th day of ICU her ABG on 24% oxygen & VS:
ABG Results
pH 7.62 BP 115/80 mmHg
PCO2 30 mmHg Pulse 88/min
PO2 85 mmHg RR 10/min
HCO3 30 mmol/L VT 1000ml
BE 10 mmol/L MV 10L
K+ 2.5 mmol/L

Interpretation: Acute alveolar hyperventilation

(resp. alkalosis) and metabolic alkalosis with corrected
hypoxemia.
 Case study No. 2
27 yo retarded  with insulin-dependent DM arrived at ER
from the institution where he lived. On room air ABG & VS:

pH 7.15 BP 180/110 mmHg

PCO2 22 mmHg Pulse 130/min
PO2 92 mmHg RR 40/min
HCO3 9 mmol/L VT 800ml
BE -30 mmol/L MV 32L

Interpretation: Partly compensated metabolic acidosis.

 Case study No. 3
74 yo  with hx chronic renal failure and chronic diuretic therapy
was admitted to ICU comatose and severely dehydrated. On
40% oxygen her ABG & VS:

pH 7.52 BP 130/90 mmHg

PCO2 55 mmHg Pulse 120/min
PO2 92 mmHg RR 25/min
HCO3 42 mmol/L VT 150ml
BE 17 mmol/L MV 3.75L

Interpretation: Partly compensated metabolic alkalosis with

corrected hypoxemia.
 Case study No. 4
43 yo  arrives in ER 20 minutes after a MVA in which he
injured his face on the dashboard. He is agitated, has mottled,
cold and clammy skin and has obvious partial airway obstruction.
An oxygen mask at 10 L is placed on his face. ABG & VS:

pH 7.10 BP 150/110 mmHg

PCO2 60 mmHg Pulse 150/min
PO2 125 mmHg RR 45/min
HCO3 18 mmol/L VT ? ml
BE -15 mmol/L MV ? L
.
Interpretation: Acute ventilatory failure (resp. acidosis) and
acute metabolic acidosis with corrected hypoxemia
 Case study No. 5
17 yo, 48 kg  with known insulin-dependent DM came to ER
with Kussmaul breathing and irregular pulse. Room air
ABG & VS:

pH 7.05 BP 140/90 mmHg

PCO2 12 mmHg Pulse 118/min
PO2 108 mmHg RR 40/min
HCO3 5 mmol/L VT 1200ml
BE -30 mmol/L MV 48L
Interpretation: Severe partly compensated metabolic
acidosis without hypoxemia.
It’s not magic understanding
ABG’s, it just takes a little
practice!
Any Questions?
References

1. Shapiro, Barry A., et al; Clinical Application of Blood

Gases; 1994

2. American Journal of Nursing1999;Aug99(8):34-6

3. Journal Post Anesthesia Nursing1990;Aug;5(4)264-72

4. Irvine, David;ABG Interpretation, A Rough and Dirty

Production
 Practice ABG’s
1. PaO2 90 SaO2 95 pH 7.48 PaCO2 32 HCO3 24
2. PaO2 60 SaO2 90 pH 7.32 PaCO2 48 HCO3 25
3. PaO2 95 SaO2 100 pH 7.30 PaCO2 40 HCO3 18
4. PaO2 87 SaO2 94 pH 7.38 PaCO2 48 HCO3 28
5. PaO2 94 SaO2 99 pH 7.49 PaCO2 40 HCO3 30
6. PaO2 62 SaO2 91 pH 7.35 PaCO2 48 HCO3 27
7. PaO2 93 SaO2 97 pH 7.45 PaCO2 47 HCO3 29
8. PaO2 95 SaO2 99 pH 7.31 PaCO2 38 HCO3 15
9. PaO2 65 SaO2 89 pH 7.30 PaCO2 50 HCO3 24
10. PaO2 110 SaO2 100 pH 7.48 PaCO2 40 HCO3 30
 Answers to Practice ABG’s
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic acidosis
4. Compensated Respiratory acidosis
5. Metabolic alkalosis
6. Compensated Respiratory acidosis
7. Compensated Metabolic alkalosis
8. Metabolic acidosis
9. Respiratory acidosis
10. Metabolic alkalosis