ARTERIAL BLOOD
GAS
Yrah Damiene M. Fernandez
Clinical Clerk
Batch 2016
Arterial Blood Gas
Can be used to assess gas exchange and acid base status
Provide immediate information about electrolytes
Aids in establishing a diagnosis
Helps guide treatment plan
Aids in ventilator management
Normal values:
pH - 7.35 - 7.45
PaCO2 - 35-45 mmHg
PaO2 - 80-100 mmHg
HCO3 - 21-27
O2sat - 95-100%
Base Excess - +/-2 mEq/L
COMPONENTS
Of the ABG
PH
Logarithmic scale of the concentration of H ions in a solution
Bodys pH is between 7.35-7.45
Achieved through buffering and excretion of acids
Buffers: plasma proteins and bicarbonate (extracellular) and proteins,
phosphate and hemoglobin (intracellularl)
H ions are excreted via the kidney and CO2 via the lungs, H ions is
regulated by changes in ventilation which is controlled by
concentration of CO2
Partial Pressures
Way of assessing the number of molecules of a particular gas in a
mixture of gases
Henrys law: when a gas is dissolved in a liquid the partial pressures
within the liquid is the same as in the gas in contact with the liquid
PaO2- measures pressure of O2 dissolved in the blood and how well
O2 is move from the airspace of the lungs into the blood
PaCO2- pressure of CO2 dissolved in the blood and how well CO2 is
able to move out of the body
HCO3
Produced by the kidneys and acts as a buffer to maintain a
normal pH
if there are additional acids in the blood the level of HCO3
will fall as ions are used to buffer these acids.
Compensation
pH is closely controlled in the human body
The body will never overcompensate as the drivers for compensation
cease as the pH returns to normal.
Respiratory Compensation
If a metabolic acidosis develops the change is sensed by
chemoreceptors centrally in the medulla oblongata and peripherally in
the carotid bodies
Body responds by increasing the depth and rate of respiration
therefore increasing the excretion of CO2
Metabolic Compensation
In response to respiratory acidosis, the kidneys will start to
retain more HCO3 in order to correct the pH
Logistics
When to order an arterial line --
Need for continuous BP monitoring
Need for multiple ABGs
Where to place -- the options
Radial
Femoral
Brachial
Dorsalis Pedis
Axillary
Acid Base Balance
The body produces acids daily
15,000 mmol CO2
50-100 mEq Nonvolatile acids
The lungs and kidneys attempt to maintain balance
Acid Base Balance
Assessment of status via bicarbonate-carbon dioxide buffer system
CO2 + H2O <--> H2CO3 <--> HCO3- + H+
ph = 6.10 + log ([HCO3] / [0.03 x PCO2])
The Terms
ACIDS BASES
Acidemia Alkalemia
Acidosis Alkalosis
Respiratory Respiratory
CO2 CO2
Metabolic Metabolic
HCO3 HCO3
Respiratory Acidosis
ph, CO2, Ventilation
Causes
CNS depression
Pleural disease
COPD/ARDS
Musculoskeletal disorders
Compensation for metabolic alkalosis
Respiratory Acidosis
Acute vs Chronic
Acute - little kidney involvement. Buffering via titration via Hb for example
pH by 0.08 for 10mmHg in CO2
Chronic - Renal compensation via synthesis and retention of HCO3 (Cl to
balance charges hypochloremia)
pH by 0.03 for 10mmHg in CO2
Respiratory Alkalosis
pH, CO2, Ventilation
CO2 HCO3 (Cl to balance charges hyperchloremia)
Causes
Intracerebral hemorrhage
Salicylate and Progesterone drug usage
Anxiety lung compliance
Cirrhosis of the liver
Sepsis
Respiratory Alkalosis
Acute vs. Chronic
Acute - HCO3 by 2 mEq/L for every 10mmHg in PCO2
Chronic - Ratio increases to 4 mEq/L of HCO3 for every 10mmHg in PCO2
Decreased bicarb reabsorption and decreased ammonium excretion to
normalize pH
Metabolic Acidosis
pH, HCO3
12-24 hours for complete activation of respiratory compensation
PCO2 by 1.2mmHg for every 1 mEq/L HCO3
The degree of compensation is assessed via the Winters Formula
PCO2 = 1.5(HCO3) +8 2
The Causes
Metabolic Gap Acidosis Non Gap Metabolic Acidosis
M - Methanol Hyperalimentation
U - Uremia Acetazolamide
D - DKA RTA (Calculate urine anion
P - Paraldehyde gap)
I - INH Diarrhea
L - Lactic Acidosis Pancreatic Fistula
E - Ehylene Glycol
S - Salicylate
Metabolic Alkalosis
pH, HCO3
PCO2 by 0.7 for every 1mEq/L in HCO3
Causes
Vomiting
Diuretics
Chronic diarrhea
Hypokalemia
Renal Failure
Mixed Acid-Base Disorders
Patients may have two or more acid-base disorders at one time
Delta Gap
Delta HCO3 = HCO3 + Change in anion gap
>24 = metabolic alkalosis
The Steps
Start with the pH
Note the PCO2
Calculate anion gap
Determine compensation
Sample Problem #1
An ill-appearing alcoholic male presents with nausea and vomiting.
ABG - 7.4 / 41 / 85 / 22
Na- 137 / K- 3.8 / Cl- 90 / HCO3- 22
Sample Problem #1
Anion Gap = 137 - (90 + 22) = 25
anion gap metabolic acidosis
Winters Formula = 1.5(22) + 8 2
= 39 2
compensated
Delta Gap = 25 - 10 = 15
15 + 22 = 37
metabolic alkalosis
Sample Problem #2
22 year old female presents for attempted overdose. She has taken an unknown
amount of Midol containing aspirin, cinnamedrine, and caffeine. On exam she is
experiencing respiratory distress.
Sample Problem #2
ABG - 7.47 / 19 / 123 / 14
Na- 145 / K- 3.6 / Cl- 109 / HCO3- 17
ASA level - 38.2 mg/dL
Sample Problem #2
Anion Gap = 145 - (109 + 17) = 19
anion gap metabolic acidosis
Winters Formula = 1.5 (17) + 8 2
= 34 2
uncompensated
Delta Gap = 19 - 10 = 9
9 + 17 = 26
no metabolic alkalosis
Sample Problem #3
47 year old male experienced crush injury at construction site.
ABG - 7.3 / 32 / 96 / 15
Na- 135 / K-5 / Cl- 98 / HCO3- 15 / BUN- 38 / Cr- 1.7
CK- 42, 346
Sample Problem #3
Anion Gap = 135 - (98 + 15) = 22
anion gap metabolic acidosis
Winters Formula = 1.5 (15) + 8 2
= 30 2
compensated
Delta Gap = 22 - 10 = 12
12 + 15 = 27
mild metabolic alkalosis
Sample Problem #4
1 month old male presents with projectile emesis x 2 days.
ABG - 7.49 / 40 / 98 / 30
Na- 140 / K- 2.9 / Cl- 92 / HCO3- 32
Sample Problem #4
Metabolic Alkalosis, hypochloremic
Winters Formula = 1.5 (30) + 8 2
= 53 2
uncompensated
