Arterial Blood Gas Analysis

Vanessa Klee MSIV

What is an ABG?
‡ The Components
‡ pH / PaCO2 / PaO2 / HCO3 / O2sat / BE

‡ Desired Ranges
‡ ‡ ‡ ‡ ‡ ‡ pH - 7.35 - 7.45 PaCO2 - 35-45 mmHg PaO2 - 80-100 mmHg HCO3 - 21-27 O2sat - 95-100% Base Excess - +/-2 mEq/L

Why Order an ABG? ‡ ‡ ‡ ‡ Aids in establishing a diagnosis Helps guide treatment plan Aids in ventilator management Improvement in acid/base management allows for optimal function of medications ‡ Acid/base status may alter electrolyte levels critical to patient status/care .

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 .

+ H+ ‡ ph = 6.03 x PCO2]) .10 + log ([HCO3] / [0.Acid Base Balance ‡ Assessment of status via bicarbonatecarbon dioxide buffer system ‡ CO2 + H2O <--> H2CO3 <--> HCO3.

The Terms ‡ ACIDS ‡ Acidemia ‡ Acidosis ‡ Respiratory oCO2 ‡ Metabolic qHCO3 ‡ BASES ‡ Alkalemia ‡ Alkalosis ‡ Respiratory qCO2 ‡ Metabolic oHCO3 .

qVentilation ‡ Causes ‡ ‡ ‡ ‡ ‡ CNS depression Pleural disease COPD/ARDS Musculoskeletal disorders Compensation for metabolic alkalosis . oCO2.Respiratory Acidosis ‡ qph.

Respiratory Acidosis ‡ Acute vs Chronic ‡ Acute .03 for 10mmHg oin CO2 .Renal compensation via synthesis and retention of HCO3 (qCl to balance charges hypochloremia) ‡ pH qby 0.little kidney involvement.08 for 10mmHg o in CO2 ‡ Chronic . Buffering via titration via Hb for example ‡ pH qby 0.

qCO2. oVentilation ‡ q CO2 q HCO3 (oCl to balance charges hyperchloremia) ‡ Causes ‡ ‡ ‡ ‡ ‡ Intracerebral hemorrhage Salicylate and Progesterone drug usage Anxiety qlung compliance Cirrhosis of the liver Sepsis .Respiratory Alkalosis ‡ opH.

Ratio increases to 4 mEq/L of HCO3 for every 10mmHg q in PCO2 ‡ Decreased bicarb reabsorption and decreased ammonium excretion to normalize pH .qHCO3 by 2 mEq/L for every 10mmHg q in PCO2 ‡ Chronic .Respiratory Alkalosis ‡ Acute vs. Chronic ‡ Acute .

2mmHg for every 1 mEq/L qHCO3 ‡ The degree of compensation is assessed via the Winter¶s Formula PCO2 = 1. qHCO3 ‡ 12-24 hours for complete activation of respiratory compensation ‡ qPCO2 by 1.5(HCO3) +8 s 2 .Metabolic Acidosis ‡ qpH.

Lactic Acidosis E .Methanol U .Salicylate ‡ Non Gap Metabolic Acidosis ‡ Hyperalimentation ‡ Acetazolamide ‡ RTA (Calculate urine anion gap) ‡ Diarrhea ‡ Pancreatic Fistula .Paraldehyde I .The Causes ‡ Metabolic Gap Acidosis ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ M .Ehylene Glycol S .Uremia D .DKA P .INH L .

Metabolic Alkalosis ‡ opH. oHCO3 ‡ oPCO2 by 0.7 for every 1mEq/L o in HCO3 ‡ Causes ‡ ‡ ‡ ‡ ‡ Vomiting Diuretics Chronic diarrhea Hypokalemia Renal Failure .

Mixed Acid-Base Disorders ‡ Patients may have two or more acidbase 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 .

8 / Cl.90 / HCO3.3.22 .4 / 41 / 85 / 22 ‡ Na. ‡ ABG .Sample Problem #1 ‡ An ill-appearing alcoholic male presents with nausea and vomiting.137 / K.7.

10 = 15 15 + 22 = 37 metabolic alkalosis .(90 + 22) = 25 anion gap metabolic acidosis ‡ Winters Formula = 1.5(22) + 8 s 2 = 39 s 2 compensated ‡ Delta Gap = 25 .Sample Problem #1 ‡ Anion Gap = 137 .

Sample Problem #2 ‡ 22 year old female presents for attempted overdose. . On exam she is experiencing respiratory distress. and caffeine. She has taken an unknown amount of Midol containing aspirin. cinnamedrine.

47 / 19 / 123 / 14 ‡ Na.2 mg/dL .6 / Cl.3.Sample Problem #2 ‡ ABG .38.7.145 / K.17 ‡ ASA level .109 / HCO3.

5 (17) + 8 s 2 = 34 s 2 uncompensated ‡ Delta Gap = 19 .Sample Problem #2 ‡ Anion Gap = 145 .(109 + 17) = 19 anion gap metabolic acidosis ‡ Winters Formula = 1.10 = 9 9 + 17 = 26 no metabolic alkalosis .

3 / 32 / 96 / 15 ‡ Na.7.98 / HCO3. ‡ ABG . 346 .Sample Problem #3 ‡ 47 year old male experienced crush injury at construction site.15 / BUN.38 / Cr.135 / K-5 / Cl.42.7 ‡ CK.1.

10 = 12 12 + 15 = 27 mild metabolic alkalosis .(98 + 15) = 22 anion gap metabolic acidosis ‡ Winters Formula = 1.Sample Problem #3 ‡ Anion Gap = 135 .5 (15) + 8 s 2 = 30 s 2 compensated ‡ Delta Gap = 22 .

9 / Cl.140 / K. ‡ ABG .92 / HCO3.7.32 .2.Sample Problem #4 ‡ 1 month old male presents with projectile emesis x 2 days.49 / 40 / 98 / 30 ‡ Na.

hypochloremic ‡ Winters Formula = 1.5 (30) + 8 s 2 = 53 s 2 uncompensated .Sample Problem #4 ‡ Metabolic Alkalosis.

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