Arterial Blood Gases Interpretation
Arerial Blood Gases
• Important diagnostic tool
• Reveals:
1. acid-base balance
2. oxygenation status
**arterial gases only**
3. abnormalities of ventilation
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Acid- base balance
• The body is designed for optimum performance at a
specific pH level
• Cell division
• Metabolism
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Components of Acid- Base Balance
• pH- measures the bloods acidity
– Normal range 7.35- 7.45
– Overall H+ from both respiratory and metabolic factors
• pCO2- partial pressure of carbon dioxide in the blood
– Normal range 35-45 mmHg
– Snapshot of adequacy of alveolar ventilation
• HCO3- the amount of bicarbonate in the blood
– Normal range 22- 26 mEq/L
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Acid – Base Balance
• Lungs • Kidneys
• Respiratory • Metabolic
• CO2 (acid) • HCO3 ( base/alkaline)
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Making sense of it…
pH
7.35 – 7.45
Respiratory Metabolic
CO2=Acidosis HCO3=Acidosis
CO2=Alkalosis HCO3=Alkalosis
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Interpretation: 4 steps
• Normal Values
– pH 7.35 – 7.45
– pCO2 35 – 45 mmHg
– HCO3 22 - 26 mEq/L
• Evaluate each component as Acid or Base
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Step 1…
• Evaluate pH and determine acidosis or
alkalosis
7.35 7.40 7.45
Acid Normal Base
Acidosis Alkalosis
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Step 2…
• Evaluate pCO2 (respiratory)
35 40 45
Base Normal Acid
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Step 3…
• Evaluate HCO3 (metabolic)
22 24 26
Acid Normal Base
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Step 4…
• Determine which regulatory system is responsible for
the imbalance by checking to see which component
matches the pH.
– If pH and pCO2 match = respiratory
– If pH and HCO3 match = metabolic
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ABG Analysis
pH pCO2 HCO3
Resp. Acidosis A A N
(<7.35) (>45) (22-26)
Resp. B B N
Alkalosis (>7.45) (<35) (22-26)
Metabolic A N A
Acidosis (<7.35) (35-45) (<22)
Metabolic B N B
Alkalosis (>7.45) (35-45) (>26)
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Compensation
• When an acid – base imbalance exists, over time the
body attempts to compensate.
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Understanding Compensation
• Uncompensated – the alternate system has not attempted to
adjust (remains within normal range), and the pH remains
abnormal
• Example
– pH 7.30 A
– pCO2 60 A
– HCO3 25 N
Uncompensated Respiratory Acidosis
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Understanding Compensation
• Partial Compensation – the alternate system is trying to create a
balanced environment and bring the pH back within normal
limits, but hasn’t yet succeeded.
• Example
– pH 7.34 A
– pCO2 59 A
– HCO3 28 B
Partially Compensated Respiratory Acidosis
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Understanding Compensation
• Fully Compensated – the alternate system has adjusted enough
to restore balance and normalize the pH
• Example
– pH 7.36 N (but slightly A)
– pCO2 58 A
– HCO3 31 B
Compensated Respiratory Acidosis
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A Final Step…
• Determine level of oxygenation
(arterial samples only)
• Normal = 80 – 100 mmHg
• Mild hypoxemia = 60 – 80 mmHg
• Moderate hypoxemia = 40 – 60 mmHg
• Severe hypoxemia = less than 40 mmHg
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Respiratory Acidosis
• Excessive CO2 retention
• Causes
– Airway obstruction
– Depression of respiratory drive
• Sedatives, analgesics
• Head trauma
– Respiratory muscle weakness resulting from muscle disease
or chest wall abnormalities
– Decreased lung surface area participating in gas exchange
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Respiratory Acidosis
• Clues
– Confusion, restlessness
– Headache, dizziness
– Lethargy
– Dyspnea
– Tachycardia
– Dysrhythmias
– Coma leading to death
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Respiratory Acidosis
• Solutions
– Improve ventilation
• Ensure adequate airway; positioning,
suctioning
• Encourage deep breathing and coughing
• Frequent repositioning
• Chest physio/ postural drainage
• Bronchodilators
• Decrease sedation/analgesia
• Oxygen therapy
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Respiratory Alkalosis
• Excessive CO2 loss due to hyperventilation
• Causes
– CNS injury: brainstem lesions, salicylate overdose, Reye’s
Syndrome, hepatic encephalopathy
– Aggressive mechanical ventilation
– Anxiety, fear or pain
– Hypoxia
– Fever
– Congestive heart failure
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Respiratory Alkalosis
• Clues
– Light headedness
– Confusion
– Decreased concentration
– Tingling fingers and toes
– Syncope
– Tetany
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Respiratory Alkalosis
• Solutions
– Decrease respiratory rate and depth
• Sedation/analgesia as appropriate
• Rebreather mask
• Paper bag
• Emotional support/encourage patient to slow
breathing
• Calm, soothing environment
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Metabolic Acidosis
• Excessive HCO3 loss, or acid gain
• Causes
– Diabetic ketoacidosis
– Sepsis/shock
– Diarrhea (fluid losses below gastric sphincter)
– Renal Failure
– Poison ingestion
– Starvation
– Dehydration
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Metabolic Acidosis
• Clues
– Stupor
– Restlessness
– Kussmaul’s respirations (air hunger)
– Seizures
– Coma leading to death
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Metabolic Acidosis
• Solutions
– Replace HCO3 while treating underlying cause
– Monitor intake and output
– Monitor electrolytes, especially K+
– Seizure precautions
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Metabolic Alkalosis
• HCO3 retention, or loss of extracellular acid,
• Causes
– GI losses above gastric sphincter
• Vomiting
• Nasogastric suction
– Antacids
– Diuretic therapy causing electrolyte loss
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Metabolic Alkalosis
• Clues
– Weakness, dizziness
– Disorientation
– Hypoventilation
– Muscle twitching
– Tetany
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Metabolic Alkalosis
• Solutions
– Control vomiting
– Replace GI losses
– Eliminate overuse of antacids
– Monitor intake and output
– Monitor electrolytes
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