Julienne Anjeli J.

Cabradilla, MD
First Year, Department of Pediatrics
ITRMC
 Arterial Blood Gas
Analysis and Interpretation
Arterial Blood Gas
(ABG)
ACIDOSIS and ALKALOSIS –physiological process –Lower or raises
the pH

ACIDEMIA and ALKALEMIA – state of having an abnormal pH

COMPENSATION -Acidosis or alkalosis- homeostatic

mechanisms to normalize the pH
Arterial Blood Gas
(ABG)
Determine: ARTERIAL VENOUS
Venous Blood Gas
 Arterial Oxygen (Pa02)
pH
 Carbon Dioxide (pC02) 7.35-7.45
 pH 7.30-7.40
 Acidity (pH)  C02
pCO2
 Oxygen Saturation (Sa02)
 Bicarbonate (HC03)
35-45
 Bicarb levels 41-45

pO2 85-105 Oxygenation 25-45

O2 95-100 70-75
tCO2 22-26 22-26
ABG
INDICATIONS CONTRAINDICATIONS

Evaluating the Presence of local

respiratory status inflammation, infection,
Acid-base equilibrium burns
Bleeding problems
Arterial Blood Gas
(ABG)
pH pCO2 HCO3 Base Excess

 Assess the metabolic component of an acid-

Base Excess base disturbance
 Describes the amount of acid that must be
added to return the pH to 7.40
Basic steps in ABG interpretation:
Determine the primary acid base disorder

Determine if the compensation is

appropriate

Check for secondary acid-base disorder

Check for oxygenation status

 Determine the primary acid base disorder

NORMAL VALUES Mean Lower Values Higher Values

Value Suggests Suggests

pH 7.35 – 7.45 7.4 Acidosis Alkalosis

pCO2 35 – 45 40 Alkalosis Acidosis

HCO3 20 – 28 24 Acidosis Alkalosis

 Determine the primary acid base disorder

A. Check for pH, pCO2, HCO3 levels:

1. CHECK pH:
 pH: 7.32 (7.35-7.45) ACIDOSIS

pH: 7.32
HCO3: 19.9
pCO2: 37.7

2. Look for RESPIRATORY and METABOLIC component:

 pCO2: 37.7 (35-45) NORMAL
 HCO3: 19.9 (20-28) ACIDOSIS
 Determine the primary acid base disorder

Check pH CHECK pCO2 and HCO3 PRIMARY

DISORDER
PCO2 HCO3

Low pH Low or Normal Low (Acidosis) Metabolic Acidosis

pH: 7.32
HCO3: 19.9
<7.4
pCO2: 37.7
ACIDOSIS High (Acidosis) High or Respiratory Acidosis
Normal

High pH >7.4 High or Normal High Metabolic Alkalosis

(Alkalosis)
ALKALOSIS
Low (Alkalosis) Low or Normal Respiratory Alkalosis
 Determine the primary acid base disorder
B. Determine Primary disorder by comparing Changes
in HCO3 and pCO2
HCO3 > ACIDOSIS
pH: 7.32 pCO2
0.17>0.05
Changes in pCO2 Changes in HCO3
ΔpCO2 = (pCO2 – 40) ΔHCO3 = (24-HCO3)
pH: 7.32 40 24
HCO3: 19.9
pCO2: 37.7
ΔpCO2 = (37.7– 40) HCO3 = (24-19.9)
40 24
=0.05 = 0.17
METABOLIC Acidosis
 Determine the primary acid base disorder
B. Determine Primary disorder by comparing Changes
in HCO3 and pCO2

pH: 7.32 ACIDOSIS

Check pH ΔpC02 and ΔHCO3 PRIMARY DISORDER

Low pH <7.4 ΔHCO3 > ΔpC02 METABOLIC ACIDOSIS

ACIDOSIS
ΔpC02 > ΔHCO3 RESPIRATORY ACIDOSIS

High pH >7.4 ΔHCO3 > ΔpC02 METABOLIC ALKALOSIS

ALKALOSIS
ΔpC02 > ΔHCO3 REPIRATORY ALKALOSIS
 Determine if the compensation is appropriate

PRIMARY DISORDER Physiologic Compensation

Metabolic Acidosis pCO2 should decrease

Low pH + Low HCO3

Metabolic Alkalosis pCO2 should increase

High pH + High HCO3

Respiratory Acidosis HCO3 should increase

Low pH + High pCO2

Respiratory Alkalosis HCO3 should decrease

High pH + Low pCO2
PRIMARY DISORDER
Determine if the compensation is appropriate
Respiratory Acidosis
Low pH + High pCO2
Respiratory Alkalosis
High pH + Low pCO2
Physiologic Expected Compensatory Value
Compensation
Acute: HCO3 increases by 1
mEq/L for each 10 mmHg
HCO3 should increase increase in pCO2
Chronic: HCO3 increases by
3.5 mEq/L for each 10 mmHg
increase in pCO2
Acute: HCO3 falls b 2 mEq/L
HCO3 should decrease for each 10 mmhg decrease
in pCO2
Chronic: HCO3 falls by 4
mEq/L for each 10 mmhg
decrease in pCO2
 Determine if the compensation is appropriate

PRIMARY DISORDER Physiologic Expected Compensatory Value

Compensation
Metabolic Acidosis pCO2 should decrease
Low pH + Low HCO3 pCO2 = (1.5 x HCO3) +8 ± 2

Metabolic Alkalosis pCO2 should increase

High pH + High HCO3

pCO2 increase by 7
10 mEqs/L increase in HCO3
Determine if the compensation is appropriate
Determine if the compensation is appropriate
Increase in Plasma Hydrogen

Respiratory Control Centers

Muscles of Ventilation

Increase rate and depth of

breathing

Decrease in Plasma CO2

Decrease in H+
 Determine if the compensation is appropriate

FULLY COMPENSATED

PARTIALLY
COMPENSATED

UNCOMPENSATED
 Check for secondary acid-base disorder

METABOLIC ALKALOSIS Actual increase in PCO2 from Secondary

High pH + High HCO3 baseline is GREATER than the Respiratory
computed compensation Acidosis

Compensation:
pCO2 should Increase Actual increase in PCO2 from Secondary
pCO2 increase by 7 baseline is LESS than the Respiratory
10 mEqs/L increase in HCO3 computed compensation Alkalosis
 Check for secondary acid-base disorder

METABOLIC ACIDOSIS Actual reduction of PCO2 from Secondary

Low pH + Low HCO3 the baseline is GREATER than Respiratory
the calculated value Alkalosis

Actual reduction of PCO2 from

Compensation: Secondary
the baseline is LESS than the
pCO2 should decrease Respiratory
pCO2 = (1.5 x HCO3) + 8 ± 2 calculated value
ACIDOSIS
 Check for secondary acid-base disorder

RESPIRATORY ACIDOSIS Increase of HCO3 > Calculated Secondary

Low pH + High pCO2 compensation Metabolic
Alkalosis

Compensation: Secondary
Increase of HCO3 < Calculated
HCO3 should increase metabolic
compensation
Acidosis
 Check for secondary acid-base disorder

RESPIRATORY ALKALOSIS Decrease of HCO3 > Secondary

High pH + Low pCO2 Calculated compensation Metabolic
Acidosis

Compensation: Secondary
Decrease of HCO3 <
HCO3 should Decrease metabolic
Calculated compensation
Alkalosis
SAMPLE CASE
For Steps 1, 2, 3
Basic steps in ABG interpretation:
Determine the primary acid base disorder

Determine if the compensation is

appropriate

Check for secondary acid-base disorder

A 5 y/o male was admitted due to Asthma.
An ABG was requested and revealed:

pH= 7. 36
pCO2= 28 mmHg
HCO3= 14 mEq/L
 A 5 y/o male was admitted due to Asthma.
An ABG was requested and revealed:
Determine the primary acid
base disorder pH= 7. 36
pCO2= 28 mmHg
HCO3= 14 mEq/L

pH 7.36 ACIDOTIC
(7.4)

pCO2 METABOLIC
28 mmHg ALKALOTIC
(40) ACIDOSIS

HCO3 14 mEq/L ACIDOTIC

(24)
 A 5 y/o male was admitted due to Asthma.
An ABG was requested and revealed:
Determine if the compensation is pH= 7. 36
appropriate pCO2= 28 mmHg
HCO3= 14 mEq/L
PRIMARY DISORDER Physiologic Expected Compensatory Value
Compensation
Metabolic Acidosis pCO2 should pCO2 = (1.5 x HCO3) +8 ± 2
Low pH + Low HCO3 decrease

Expected Compensatory Value

pCO2 = (1.5 x HCO3) +8 ± 2 (1.5 X 14) + 8 ± 2= 27-31 COMPENSATED

 Check for secondary acid-base disorder

Expected Compensatory Value

pCO2 = (1.5 x HCO3) +8 ± 2 (1.5 X 14) + 8 ± 2= 27-31 COMPENSATED

NO SECONDARY ACID BASE DISORDER

 Check for oxygenation status

• Partial pressure of oxygen in arterial blood or PaO2

• Measure of dissolved oxygen in arterial blood plasma

HYPOXEMIA:
Low PaO2 – Blood Gas Analysis
SaO2 – amount of oxygen bound to hemoglobin
Check for oxygenation status
 Check for oxygenation status

SEVERITY OF PaO2 Value Estimated Sp02

HYPOXEMIA
MILD HYPOXEMIA 60-79 mmHg 90-94%

MODERATE HYPOXEMIA 40-59 mmHg 75-89%

SEVERE HYPOXEMIA <40 mmHg <75%

SAMPLE CASE
 pH? ACIDOTIC
pH 7.27 pCO2? ACIDOTIC
HCO3? ACIDOTIC
pO2 131
Changes in pCO2 Changes in HCO3
pCO2 42.8
ΔpCO2 = (pCO2 – 40) ΔHCO3 = (24-HCO3)
40 24
BEecf -7.2
ΔpCO2 = (42.8– 40) HCO3 = (24-19.9)
HCO3 19.9 40 24
=0.07 = 0.17

tCO2 21.2
HCO3 > pCO2
SO2 98.5 0.17>0.07 METABOLIC ACIDOSIS
 Expected Compensatory
Value
pH 7.27 COMPENSATED? pCO2 = (1.5 x HCO3)
+8 ± 2
pO2 131
PRIMARY DISORDER Physiologic
pCO2 Metabolic Acidosis Compensation
42.8
Low pH + Low HCO3
pCO2 should
BEecf -7.2 decrease

HCO3 19.9 Expected Compensatory Value

pCO2 = (1.5 x HCO3) +8 ± 2 (1.5 X 19.9) + 8 ± 2=

tCO2 21.2
35.85- 39.5
SO2 98.5
 Expected Compensatory
Value
pH 7.27 pCO2 = (1.5 x HCO3) +8 ± (1.5 X 19.9) + 8 ± 2=
2 35.85- 39.85
pO2 131
pCO2 42.8 pCO2> Expected compensation
BEecf -7.2 42 > 37.85
UNCOMPENSATED
HCO3 19.9
tCO2 21.2
Respiratory Acidosis
SO2 98.5
 pH 7.27
Metabolic Acidosis with
pO2 131 concomitant Respiratory Acidosis
pCO2 42.8 With Adequate Oxygenation

BEecf -7.2
HCO3 19.9
tCO2 21.2
SO2 98.5
SAMPLE CASE
 pH? ACIDOTIC
pH 7.29 pCO2? ACIDOTIC
HCO3? ALKALOSIS
pO2 132.1
pCO2 70.4
Respiratory Acidosis
BEecf 7.7
HCO3 34.5
tCO2 36.6 COMPENSATED?
SO2 98.5
 COMPENSATED?

Expected Compensatory Value

PRIMARY DISORDER Physiologic
Compensation
Respiratory Acidosis
Low pH + High pCO2 Acute: HCO3 increases by 1
HCO3 should increase mEq/L for each 10 mmHg
pH: 7.29 increase in pCO2
pCO2: 70.4 HCO3: 34.5 Chronic: HCO3 increases by 3.5
mEq/L for each 10 mmHg
increase in pCO2
 Expected Compensatory Value

pH: 7.29
pCO2: 70.4
Acute: HCO3 increases by 1
mEq/L for each 10 mmHg HCO3: 34.5
increase in pCO2
Chronic: HCO3 increases by 3.5
mEq/L for each 10 mmHg
increase in pCO2
Partially Compensated
Chronic Respiratory
Acidosis
References:
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