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HOW TO INTERPRET ABG's

I.

Introduction:
Arterial Blood Gases: gives us information about:
--- acid-base balance (pH 7.4)
--- alveolar ventilation
--- oxygenation
Includes:
--- pH (Hydrogen ion concentration)
--- Pa02: partial pres. of 02 in arterial blood
--- PaC02: partial pres. of C02 in arterial blood
--- HC03 (bicarbonate)
--- 02 saturation: % of hgb. in the arterial blood that is saturated with 02
(normal: 95-100%)
pH: hydrogen ion concentration:
Acids: donate H ions
Bases: accept H ions
If increased numbers of Hydrogen ions: acidic with a lower pH
If decreased numbers of Hydrogen ions: alkalotic with a higher pH
Normal pH of the blood: 7.35-7.45
If less than 7.35: acidic
If more than 7.45: alkalotic

II.

Maintaining Acid/Base Balance: balance between amt. of acids and bases in the blood.
To maintain pH between 7.35-7.45
A. Chemical buffers in the serum
Bicarbonate: carbonic acid
B. Lungs: control C02
(C02 is an acid)
RESPIRATORY
C. Kidneys: can excrete H ions or conserve bicarbonate.
Act slowly.
METABOLIC

III.
Normal ABG's
Again, ABG's indicate acid base balance, ventilation, and oxygenation.
pH: 7.35-7.45 (7.4)
PaC02: 35-45
Pa02: 80-100
HC03: 22-26
Types of ABG abnormalities
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
IV.

How to Interpret ABG's


** Know the normals
** Remember that PaC02 is an acid; controlled by lungs
-- If PaC02 is > 45 --- too much acid --- lower pH
-- If PaC02 is < 35 --- too little acid --- higher pH
** Remember that HC03 is a base; controlled by kidneys
-- if HC03 is > 26 --- too much base --- higher pH
-- if HC03 is < 22 --- too little base --- lower pH
A. Step 1: Evaluate each number separately.
Ask yourself: Is this a normal value or does it indicate acidity or alkalinity?
B. Step 2: Determine the cause of the imbalance.
Look at the pH. Is it acidosis or alkalosis?
If the pH is within normal range but the PaCO2 or HCO3 is abnormal, then use 7.4 as
your cutoff point.
For ex.: pH 7.35-7.4 = acidosis
pH 7.40-7.45 = alkalosis
C. Determine if the problem is respiratory or metabolic.
All you have to do is check the PaCO2 and HC03 levels to see which one has the
same acid-base status as the pH: which value "MATCHES" the pH.
PaCO2: regulated by the lung. Value indicates respiratory status.
HCO3: regulated by the kidneys. Value indicates metabolic status.
D. Determine the extent of compensation.
Compensation may be absent, partial, or complete.
To determine:
1. Absent: look at the value (PaCO2 or HCO3) that DOES NOT match the acidbase status of the pt's pH. If that value is within normal limits, then NO
compensation has occurred.

2. Partial: if the value that DOES NOT MATCH the pH is above or below the
normal range and the pH is also above or below the normal range, then partial
compensation exists.
3. Complete: This exists when the value that DOES NOT MATCH the pH is above
or below normal range and the pH is within the normal range (7.35-7.45). This
tells you that one of the systems (respiratory or metabolic) has compensated for
problems in the affected system.
V.

Abnormalities
A. Respiratory acidosis
pH < 7.35; PaC02 > 45
(too much C02 = too much acid = acidosis)
1. Causes
Resp. failure, resp. arrest, pulmonary edema, COPD, pneumonia, pneumothorax,
atelectasis, overdose, aspiration
2. s/s:
a. if sudden onset: Increased HR, decreased LOC; feeling of fullness in head;
dysrhythmias
b. if chronic: weakness, dull HA
3. tx
a. Improve ventilation (CPT, TCDB, suction, 02)
b. assess v/s, BS
c. monitor ABG
B. Respiratory alkalosis
pH > 7.45; PaC02 < 35
too little C02 = too little acid = alkalosis
1. Causes: HYPERVENTILATION
pain, anxiety, hypoxemia, ventilators
2. s/s:
lightheadedness, unable to concentrate; numbness, tingling: tinnitus
3. tx: the cause
a. slow breaths
b. use paper bag
C. Metabolic acidosis
pH < 7.35; HC03 < 22
Too little HC03 = too little base = acidosis
1. causes
diabetic ketoacidosis (DKA); starvation (ketoacidosis), lactic acidosis (arrest);
renal failure; diarrhea; ASA poisoning
2. s/s

Changes in LOC (Confusion, drowsiness); HA; N&V; Kussmaul's respirations;


dysrhythmias
3. tx: the cause
bicarbonate; I&O; wt.; ABG's; v/s; monitor for dysrhythmias; seizure precautions
D. Metabolic alkalosis
pH > 7.45; HC03 > 26
Too much HC03 = too much base = alkalosis
1. causes:
vomiting, NGT; diuretics; antacids, too much bicarb
2. s/s
tingling; dizziness, bradypnea; hypertonic muscles; dysrhythmias
3. tx:
restore fld. vol.; lytes; monitor v/s; I&O; monitor ABG's
Practice:
Mr. Simpson, 74, admitted to ICU after a CVA. On the 3rd day, he seems more lethargic than
before. Breath sounds are decreased over the lower lobes.
His ABG's are:
pH 7.33
PaC02 55
HCO3 29
PaO2 57
Step 1:

Evaluate each number


pH: decreased ---- acidosis
PaCO2: increased ---- acidosis
HCO3: increased ---- alkalosis
PaO2 decreased ---- hypoxemia

Step 2:

Determine the cause of the imbalance: acidosis

Step 3:

Is the problem respiratory or metabolic?


The PaCO2 (respiratory component) matches the acid-base status of the pH: both
indicating acidity. Therefore, Mr. Simpson's imbalance is resp. acidosis.

Step 4:

The increased HCO3 indicates compensation but the pH is below 7.35 so it's only
Partial Compensation.

Answer: Respiratory acidosis with partial compensation

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3/2014