571 Ledge Road, Macedonia, OH 44056 Telephone (800) 990-2629 Fax (800) 990-2585

David W. Woodruff, MSN, RN- BC, CNS, CMSRN, CEN

6 Easy Steps to
ABG Analysis
E-Booklet
1997-2012 Ed4Nurses, Inc. All rights reserved
6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 1
!"#$%&" (% ()" * "+,- ,("., (% +/0 +1+#-,2,3
!"# %&'(% )* )++%,-../ 012/ ,23!4/ 421/ 452
nurses ofLen have dlfflculLy lnLerpreLlng arLerlal blood gases (A8Cs). Confuslon ofLen
beglns wlLh Lrylng Lo remember many random rules and lacklng a sLandardlzed
approach Lo A8Cs. ln addlLlon, nurses ofLen aLLempL Lo analyze Loo many componenLs
of Lhe A8C aL Lhe same Llme. 1he resulL ls ofLen confuslon and an lncorrecL dlagnosls.
1herefore, Lhe 6 Lasy SLeps Lo A8C Analysls" were developed Lo provlde nurses wlLh an
accuraLe and sysLemaLlc meLhod of easlly lnLerpreLlng arLerlal blood gases.
1he 6 Lasy SLeps Lo A8C Analysls" are llsLed below for easy reference, and wlll be
explalned ln more deLall ln Lhe secLlons LhaL follow. LasLly, examples wlll be presenLed
wlLh a sysLemaLlc revlew of perLlnenL flndlngs.
(45 * "678 ,95:7 9; +/0 +<6=87>7?
1. ls Lhe pP normal?
2. ls Lhe CC2 normal?
3. ls Lhe PCC3 normal?
4. MaLch Lhe CC2 or Lhe PCC3 wlLh Lhe pP
5. uoes Lhe CC2 or Lhe PCC3 go Lhe opposlLe dlrecLlon of Lhe pP?
6. Are Lhe pC2 and Lhe C2 saLuraLlon normal?

ln order for our analysls Lo be effecLlve, noLes wlll have Lo be wrlLLen nexL Lo Lhe resulLs
on our lab sllp. AlLernaLely, Lhe A8C resulLs can be Lranscrlbed onLo anoLher paper for
analysls (see example one below for Lhe formaL).

6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 2
1678 9# &:;<=>7 6?7 8@
1he flrsL sLep ln analyzlng A8Cs ls Lo look aL Lhe pP. normal blood pP ls 7.4, plus or
mlnus 0.03, formlng Lhe range 7.33 Lo 7.43. lf blood pP falls below 7.33 lL ls acldlc. lf
blood pP rlses above 7.43, lL ls alkaloLlc. lf lL falls lnLo Lhe normal range, label whaL slde
of 7.4 lL falls on. Lower Lhan 7.4 ls normal/acldlc, hlgher Lhan 7.4 ls normal/alkaloLlc.
Label lL.
1678A# &:;<=>7 6?7 4+A
1he second sLep ls Lo examlne Lhe pCC2. normal pCC2 levels are 33-43mmPg. 8elow
33 ls alkaloLlc, above 43 ls acldlc. Label lL.
1678 B# &:;<=>7 6?7 @4+B
1he Lhlrd sLep ls Lo look aL Lhe PCC3 level. A normal PCC3 level ls 22-26 mLq/L. lf Lhe
PCC3 ls below 22, Lhe paLlenL ls acldoLlc. lf Lhe PCC3 ls above 26, Lhe paLlenL ls
alkaloLlc. Label lL.
1678 C# 0;6D? 6?7 4+A EF 6?7 @4+B GH6? 6?7 8@
nexL maLch elLher Lhe pCC2 or Lhe PCC3 wlLh Lhe pP Lo deLermlne Lhe acld-base
dlsorder. lor example, lf Lhe pP ls acldoLlc, and Lhe CC2 ls acldoLlc, Lhen Lhe acld-base
dlsLurbance ls belng caused by Lhe resplraLory sysLem. 1herefore, we call lL a
resplraLory acldosls. Powever, lf Lhe pP ls alkaloLlc and Lhe PCC3 ls alkaloLlc, Lhe acld-
base dlsLurbance ls belng caused by Lhe meLabollc (or renal) sysLem. 1herefore, lL wlll
be a meLabollc alkalosls.
1678 I# %E7J 6?7 4+A EF @4+B KE 6?7 E88EJH67 LHF7D6HE: EM 6?7 8@N
llfLh, does elLher Lhe CC2 or PCC3 go ln Lhe opposlLe dlrecLlon of Lhe pP? lf so, Lhere ls
compensaLlon by LhaL sysLem. lor example, Lhe pP ls acldoLlc, Lhe CC2 ls acldoLlc, and
Lhe PCC3 ls alkaloLlc. 1he CC2 maLches Lhe pP maklng Lhe prlmary acld-base dlsorder
resplraLory acldosls. 1he PCC3 ls opposlLe of Lhe pP and would be evldence of
compensaLlon from Lhe meLabollc sysLem.
1678 O# &:;<=>7 6?7 8+A ;:L 6?7 +A J;6PF;6HE:*
llnally, evaluaLe Lhe aC2 and C2 saL. lf Lhey are below normal Lhere ls evldence of
hypoxemla.
6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 3
2EFQ;< ';<P7J (AL sea level)# ,;:K7#
pP 7.33-7.43
pCC2 33-43 mmPg
pC2 80-100 mmPg
C2 SaLuraLlon 93-100
PCC3- 22-26 mLq/L
8ase Lxcess + or - 2















6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 4
#%%@ +( ()" $)+A( /"#%! (% B"("A&21" ()" "C+#D+(2%1 %E +/1%A&+#
C+#D",?
Test Normal ! Value " Value
pH 7.35-7.45 Acidosis Alkalosis
pCO2 35-45 Alkalosis Acidosis
HCO3 22-26 Acidosis Alkalosis
pO2 80-100 Hypoxemia O2 Therapy
SaO2 95-100% Hypoxemia
noLlce LhaL lf Lhe pP ls lower Lhan 7.33 lL lndlcaLes acldosls, lf Lhe pP ls hlgher Lhan 7.43
lL lndlcaLes alkalosls. 1he PCC3 ls also acldoLlc lf lL ls low: less Lhan 22 lndlcaLes acldosls.
lf Lhe PCC3 ls hlgher Lhan 26 lL lndlcaLes alkalosls. Powever, lf Lhe CC2 ls lower Lhan 33
lL lndlcaLes alkalosls, and lf Lhe CC2 ls hlgher Lhan 43 lL lndlcaLes acldosls.
Cne way Lo remember Lhls relaLlonshlp ls Lo use Lhe acronym A%&".
AesplraLory %pposlLe
&eLabollc "qual
1he CC2 ls Lhe resplraLory componenL of Lhe A8C, and lf lL ls low and Lhe pP ls hlgh Lhe
paLlenL would have a resplraLory alkalosls. 1hey move ln !""!#$%& dlrecLlons Lo maLch.
1he PCC3 ls Lhe meLabollc componenL of Lhe A8C. lf Lhe PCC3 ls low and Lhe pP ls low
Lhe paLlenL would have meLabollc acldosls. 1hey move ln Lhe #()& dlrecLlon Lo maLch.
6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 3
S1L 3 8LlL8S 1C CCMLnSA1lCn. CompensaLlon ls Lhe aLLempL by Lhe body Lo
malnLaln homeosLasls by correcLlng Lhe pP. 1he opposlLe sysLem wlll do Lhls.
1he componenL of Lhe resplraLory sysLem LhaL balances Lhe pP ls Lhe dlssolved carbon
dloxlde (CC2) LhaL ls produced by cellular processes and removed by Lhe lungs.
1he componenL of Lhe renal sysLem LhaL balances Lhe pP ls Lhe dlssolved blcarbonaLe
(PCC3) produced by Lhe kldneys. 1he kldneys also help conLrol pP by ellmlnaLlng
hydrogen (P+) lons. 1he way Lhe Lwo sysLems lnLeracL ls Lhrough Lhe formaLlon of
carbonlc acld (P2CC3). MovemenL Lhrough Lhe carbonlc acld sysLem ls fluld and
consLanL. WhaL Lhls means ls LhaL waLer (P2C) can comblne wlLh CC2 and form
carbonlc acld. lf necessary, carbonlc acld (P2CC3) can Lhen break up Lo form hydrogen
lons (P+) and blcarbonaLe (PCC3). 1hls sysLem works ln boLh dlrecLlons. 8y balanclng
back and forLh, a normal pP ls achleved.
1he resplraLory sysLem balances Lhe pP by lncreaslng or decreaslng Lhe resplraLory raLe,
Lhereby manlpulaLlng Lhe CC2 level. lasL and deep breaLhlng blows off" CC2.
Conversely, slow and shallow breaLhlng reLalns" CC2.
1he renal sysLem balances pP by produclng PCC3 or by ellmlnaLlng hydrogen lons (P+).
1he renal sysLem wlll reflecL changes ln meLabollc acLlvlLy wlLhln Lhe body. lor example,
a paLlenL ln shock wlll undergo anaeroblc meLabollsm, whlch produces lacLlc acld. 1he
producLlon of lacLlc acld wlll blnd or use up avallable PCC3 and wlll be manlfesLed by a
decrease ln Lhe PCC3 level. 1herefore, Lhe PCC3 level ls an lndlcaLor of meLabollc acld-
base balance.



6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 6
8alance musL always be achleved by Lhe opposlng sysLem. lf an adulL were on one slde
of a seesaw and a small chlld on Lhe oLher, we would expecL Lhe chlld's slde of Lhe
seesaw Lo go up and Lhe adulL's slde Lo go down. We cannoL make Lhe chlld go down by
addlng anoLher adulL Lo Lhe adulL's slde. ln Lhe same way, our body regulaLes pP by
uslng Lhe opposlng sysLem Lo balance pP. So lf Lhe pP ls ouL of balance because of a
resplraLory dlsorder, lL wlll be Lhe renal sysLem LhaL makes Lhe correcLlons Lo balance
Lhe pP. Conversely, lf Lhe renal sysLem ls Lo blame for Lhe pP dlsorder, Lhe resplraLory
sysLem wlll have Lo compensaLe. 1hls process ls called compensaLlon.
CompensaLlon may noL always be compleLe. CompleLe compensaLlon reLurns Lhe pP
balance Lo normal. 1here are Llmes when Lhe lmbalance ls Loo large for compensaLlon
Lo resLore Lhe pP Lo normal. 1hls ls called parLlal compensaLlon.
Llke Lhe seesaw, compensaLlon musL come from Lhe opposlLe sysLem. SLep 3 looks
analyzes compensaLlon by looklng for Lhe sysLem LhaL ls golng Lhe opposlLe dlrecLlon of
Lhe pP.
Lxamples wlLh compensaLlon wlll be presenLed laLer.










6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 7
1%! #"(F, .D( ()" * ,("., 21(% +$(2%1 !2() +1 "G+&.#"?
pP 7.27 acldoLlc
CC2 33 acldoLlc
pC2 30 low
C2 saL. 79 low
PCC3 24 normal

,95: H? 1he pP ls less Lhan 7.33, Lherefore ls acldoLlc.
,95: I? 1he CC2 ls greaLer Lhan 43, and ls Lherefore acldoLlc.
,95: J? 1he PCC3 ls normal.
,95: K? 1he CC2 maLches Lhe pP, because Lhey are boLh acldoLlc. 1herefore Lhe
lmbalance ls resplraLory acldosls. lL ls acldoLlc because Lhe pP ls acldoLlc, lL ls
resplraLory because Lhe CC2 maLches Lhe pP.
,95: L? 1he PCC3 ls normal, Lherefore Lhere ls no compensaLlon. lf Lhe PCC3 ls
alkaloLlc (opposlLe dlrecLlon) Lhen compensaLlon would be presenL.
,95: *? LasLly, Lhe aC2 and C2 saL are low lndlcaLlng hypoxemla.
1he full dlagnosls for Lhls blood gas ls:
uncompensaLed resplraLory acldosls wlLh hypoxemla.
1hls paLlenL has an acuLe resplraLory dlsorder.

6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 8
)"A"F, +1%()"A "G+&.#"?
pP 7.32 alkaloLlc
CC2 29 alkaloLlc
pC2 100 normal
C2 saL. 98 normal
PCC3 23 normal
,95: H? 1he pP ls greaLer Lhan 7.43, Lherefore ls alkaloLlc.
,95: I? 1he CC2 ls less Lhan 33, and ls Lherefore alkaloLlc.
,95: J? 1he PCC3 ls normal.
,95: K? 1he CC2 maLches Lhe pP, because Lhey are boLh alkaloLlc. 1herefore Lhe
lmbalance ls resplraLory alkalosls. lL ls alkaloLlc because Lhe pP ls alkaloLlc, lL ls
resplraLory because Lhe CC2 maLches Lhe pP.
,95: L? 1he PCC3 ls normal, Lherefore Lhere ls no compensaLlon. lf Lhe PCC3 ls acldoLlc
(opposlLe dlrecLlon) Lhen compensaLlon would be presenL.
,95: *? LasLly, Lhe aC2 and C2 saL are normal lndlcaLlng normal oxygenaLlon.
1he full dlagnosls for Lhls blood gas ls:
uncompensaLed resplraLory alkalosls.
1hls paLlenL ls probably hypervenLllaLlng.

6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 9
)"A" 2, +1%()"A "G+&.#"?
pP 7.18 acldoLlc
CC2 44 normal
pC2 92 normal
C2 saL. 93 normal
PCC3 16 acldoLlc
,95: H? 1he pP ls less Lhan 7.33, Lherefore ls acldoLlc.
,95: I? 1he CC2 ls normal.
,95: J? 1he PCC3 ls less Lhan 22, and ls Lherefore acldoLlc.
,95: K? 1he PCC3 maLches Lhe pP, because Lhey are boLh acldoLlc. 1herefore Lhe
lmbalance ls meLabollc acldosls. lL ls acldoLlc because Lhe pP ls acldoLlc, lL ls meLabollc
because Lhe PCC3 maLches Lhe pP.
,95: L? 1he CC2 ls normal, Lherefore Lhere ls no compensaLlon. lf Lhe CC2 ls alkaloLlc
(opposlLe dlrecLlon) Lhen compensaLlon would be presenL.
,95: *? LasLly, Lhe aC2 and C2 saL are normal lndlcaLlng normal oxygenaLlon.
1he full dlagnosls for Lhls blood gas ls:
uncompensaLed meLabollc acldosls.
1hls paLlenL probably has an acuLe meLabollc dlsorder such as ukA.

6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 10
#"(F, (A- +1%()"A?
pP 7.60 alkaloLlc
CC2 37 normal
pC2 92 normal
C2 saL. 98 normal
PCC3 33 alkaloLlc
,95: H? 1he pP ls greaLer Lhan 7.43, Lherefore ls alkaloLlc.
,95: I? 1he CC2 ls normal.
,95: J? 1he PCC3 ls greaLer Lhan 26, and Lherefore ls alkaloLlc.
,95: K? 1he PCC3 maLches Lhe pP, because Lhey are boLh alkaloLlc. 1herefore Lhe
lmbalance ls meLabollc alkalosls. lL ls alkaloLlc because Lhe pP ls alkaloLlc, lL ls meLabollc
because Lhe PCC3 maLches Lhe pP.
,95: L? 1he CC2 ls normal, Lherefore Lhere ls no compensaLlon. lf Lhe CC2 ls acldoLlc
(opposlLe dlrecLlon) Lhen compensaLlon would be presenL.
,95: *? LasLly, Lhe aC2 and C2 saL are normal.
1he full dlagnosls for Lhls blood gas ls:
uncompensaLed meLabollc alkalosls.
1hls paLlenL probably ls loslng sLomach acld from vomlLlng or nC Lube dralnage.

6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 11
%1" #+,( "G+&.#"?
pP 7.30 acldoLlc
CC2 30 alkaloLlc
pC2 68 low
C2 saL. 92 low
PCC3 14 acldoLlc
,95: H? 1he pP ls less Lhan 7.33, Lherefore ls acldoLlc.
,95: I? 1he CC2 ls less Lhan 33, and ls Lherefore alkaloLlc.
,95: J? 1he PCC3 ls less Lhan 22, and Lherefore ls acldoLlc.
,95: K? 1he PCC3 maLches Lhe pP, because Lhey are boLh acldoLlc. 1herefore Lhe
lmbalance ls a meLabollc acldosls. lL ls acldoLlc because Lhe pP ls acldoLlc, lL ls meLabollc
because Lhe PCC3 maLches Lhe pP.
,95: L? 1he CC2 ls alkaloLlc and goes Lhe opposlLe dlrecLlon of Lhe pP, so Lhere ls
compensaLlon. 8ecause Lhe pP ls noL ln Lhe normal range Lhe compensaLlon ls called
parLlal.
,95: *? LasLly, Lhe aC2 and C2 saL are low lndlcaLlng hypoxemla.
1he full dlagnosls for Lhls blood gas ls:
arLlally-compensaLed meLabollc acldosls wlLh hypoxemla.
1here are a number of condlLlons LhaL can cause meLabollc acldosls: renal fallure,
dlarrhea, polsonlngs, dlabeLlc keLoacldosls, and shock, Lo name a few. 1hls paLlenL ls
probably ln shock, because hls meLabollc acldosls assoclaLed wlLh poor oxygenaLlon.

6 Lasy SLeps Lo A8C Analysls
1997-2011 Ld4nurses, lnc.
www.Ld4nurses.com 12
R@&2S "+- .+, -1(2T R@5 UO 5&1" 1R5V1 R+ &!T &2&W"1(1X* S55V R@(1 T-(%5 @&2%"/ &1 (R )(WW !5
'5," @5WV.-W R@5 25YR R(05 "+- @&'5 R+ &2&W"Z5 & !W++% T&1*

1he besL way Lo become proflclenL aL A8Cs ls Lo pracLlce. Analyze all Lhe blood gases
you can geL your hands on.
lf you would llke addlLlonal pracLlce A8Cs or A8C case sLudles vlslL our webslLe aL
www.1he-A8C-SlLe.com.
CeL lnsplraLlon, moLlvaLlon, and nurslng news wlLh Lhe asslon 4 nurslng." llnd ouL
more aL: www.asslon4nurslng.com.














1hls bookleL and all lLs conLenLs are 1997-2011 by Ld4nurses, lnc. All rlghLs reserved.
unauLhorlzed copylng and dlsLrlbuLlon ls prohlblLed.
+MM>9>;<6= N;:>57 ;O P* "678 ,95:7 9; +/0 +<6=87>7Q
N6< R5 ;SM5S5M R8 N;<96N9><T?
Ld4nurses, lnc.
(800) 990-2629
L-mall: sales[ed4nurses.com
Web: www.Ld4nurses.com