Arterial blood gas
Arterial blood gas
An arterial blood gas (ABG) is a blood test that is performed using blood from an artery. It involves puncturing an artery with a thin needle and syringe and drawing a small volume of blood. The most common puncture site is the radial artery at the wrist, but sometimes the femoral artery in the groin or other sites are used. The blood can also be drawn from an arterial catheter. The test is used to determine the pH of the blood, the partial pressure of carbon dioxide and oxygen, and the bicarbonate level. Many blood gas analyzers will also report concentrations of lactate, hemoglobin, several electrolytes, oxyhemoglobin, carboxyhemoglobin and methemoglobin. ABG testing is mainly used in pulmonology, to determine gas exchange levels in the blood related to lung function, but has a variety of applications in other areas of medicine. Combinations of disorders can be complex and difficult to interpret, so calculators  , nomograms, and rules of thumb are commonly used.
Extraction and analysis
Arterial blood for blood gas analysis is usually extracted by a phlebotomist, nurse, or respiratory therapist. Blood is most commonly drawn from the radial artery because it is easily accessible, can be compressed to control bleeding, and has less risk for occlusion. The femoral artery (or less often, the brachial artery) is also used, especially during emergency situations or with children. Blood can also be taken from an arterial catheter already placed in one of these arteries. The syringe is pre-packaged and contains a small amount of heparin, to prevent coagulation or needs to be heparinised, by drawing up a small amount of heparin and squirting it out again. Once the sample is obtained, care is taken to eliminate visible gas bubbles, as these bubbles can dissolve into the sample and cause inaccurate results. The sealed syringe is taken to a blood gas analyzer. If the sample cannot be immediately analyzed, it is chilled in an ice bath in a glass syringe to slow metabolic processes which can cause inaccuracy. Samples drawn in plastic syringes are not iced and are analyzed within 30 minutes. Standard blood tests can also be performed on arterial blood, such as measuring glucose, lactate, hemoglobins, dys-haemoglobins, bilirubin and electrolytes. Calculations The machine used for analysis aspirates this blood from the syringe and measures the pH and the partial pressures of oxygen and carbon dioxide. The bicarbonate concentration is also calculated. These results are usually available for interpretation within five minutes. Much controversy exists about optimal blood gas management of hypothermic patients. Two methods have been used in medicine in the management of blood gases of patients in hypothermia: pH-stat method and alpha-stat method. Recent studies suggest that the α-stat method is superior. • pH-stat: the arterial carbon dioxide tension (paCO2) is maintained at 5.3 kPa (40 mmHg) and the pH is maintained at 7.40 when measured at the actual patient temperature. It is then necessary to add CO2 to the sample to calculate results. • α-stat (alpha-stat): the arterial carbon dioxide tension and the pH are maintained at 5.3 kPa (40mmHg) and 7.40 when measured at +37°C. When a patient is cooled down, the pH-value will increase and the pCO2-value and the pO2-value will decrease with lowering of the temperature if measured at the patients temperature. Both the pH-stat and alpha-stat strategies have theoretical disadvantages. α-stat method is the method of choice for optimal myocardial function the. The pH-stat method may result in loss of autoregulation in the brain (coupling of the cerebral blood flow with the metabolic rate in the brain). By increasing the cerebral blood flow beyond the metabolic requirements, the pH-stat method may lead to cerebral microembolisation and intracranial hypertension.
See above.35.8 to 1. H+ >45) or alkalemic (pH > 7. 
SBCe Base excess
21 to 27 mmol/l −3 to +3 mmol/l
The base excess is used for the assessment of the metabolic component of acid-base disorders. The carbon dioxide partial pressure (PaCO2) indicates a respiratory problem: for a constant metabolic rate. a low PaCO2 (respiratory alkalosis) hyper. the patient is at risk of death and must be oxygenated immediately.3 kPa or 80–100 mmHg 4. An elevated PaCO2 level is desired in some disorders associated with respiratory failure. this is known as permissive hypercapnia. A negative base excess indicates that the patient has metabolic acidosis (primary or secondary to respiratory alkalosis).
Analyte pH H+ PaO2 Range 7. the bicarbonate concentration in the blood at a CO2 of 5.
A low O2 indicates that the patient is not respiring properly.
. A positive base excess indicates that the patient has metabolic  alkalosis (primary or secondary to respiratory acidosis). HCO3− levels can also become abnormal when the kidneys are working to compensate for a respiratory issue so as to normalize the blood pH. as infants often have elevated lactic acid. The HCO3− ion indicates whether a metabolic problem is present (such as ketoacidosis). and indicates whether the patient has metabolic acidosis or metabolic alkalosis. supplemental oxygen should be administered.Arterial blood gas
Reference ranges and interpretation
These are typical reference ranges. where α=0. PaCO2 levels can also become abnormal when the respiratory system is working to compensate for a metabolic issue so as to normalize the blood pH. and is hypoxemic.3–13. A low HCO3− indicates metabolic acidosis. Lactate level analysis is often featured on blood gas machines in neonatal wards. HCO3− is expressed in millimolar concentration (mM) (mmol/l)  and PCO2 is expressed in kPa This is the sum of oxygen dissolved in plasma and chemically bound to hemoglobin.45 35–45 nmol/l (nM) 9.226 mM/kPa. 
Contamination with room air will result in abnormally low carbon dioxide and (generally) normal oxygen levels. a high HCO3− indicates metabolic alkalosis.45. Delays in analysis (without chilling) may result in inaccurately low oxygen and high carbon dioxide levels as a result of ongoing cellular respiration. full oxygen saturation and 37 degrees Celsius.7–6. At a PaO2 of less than 60 mm Hg. A high PaCO2 (respiratory acidosis) indicates underventilation. although various analysers and laboratories may employ different ranges. 
HPO42− total CO2 (tCO2 (P)c) total O2 (tO2e)
0.33 kPa.5 mM 25 to 30 mmol/l
This is the total amount of CO2.35–7. H+ < 35).or overventilation. the PaCO2  is determined entirely by ventilation. and is the sum of HCO3− and PCO2 by the formula: tCO2 = [HCO3−] + α*PCO2. At a PaO2 of less than 26 mm Hg.0 kPa or 35–45 mmHg Interpretation The pH or H+ indicates if a patient is acidotic (pH < 7.
0 SAAG=1.95 UO=800
PROTEIN/GI/LIVER FUNCTION TESTS: LDH=100 ALP=71 TP=7.2 AF alb=3.36 Mg2+=2.5 CSF/S glu=0.0 CSF: CSF alb=30 CSF glu=60 CSF/S alb=7.4 SOG=60
• Acid-base homeostasis • Anion gap • Mechanical ventilation
• • • • • Alan Grogono's comprehensive guide to acid-base physiology  An online model of arterial blood gas changes with respiration  Online arterial blood gas interpreter  Interactive ABG quiz  RT Corner (Educational Site for RT's and Nurses)  at rtcorner.Arterial blood gas
Pathophysiology sample values BMP/ELECTROLYTES: Na+=140 Cl−=100 BUN=20 / Glu=150 K+=4 CO2=22 PCr=1.6 Alb=4.6 BU=0.0 AST=25 ALT=40 TBIL=0.5
ALVEOLAR GAS: pACO2=36 pAO2=105 OTHER: Ca=9.0 \
ARTERIAL BLOOD GAS: HCO3-=24 paCO2=40 paO2=95 pH=7.01 UAG=5 UCr=60 FENa=0.5 CK=55 PO4=1 BE=−0.0 AG=16 A-a g=10
SERUM OSMOLARITY/RENAL: PMO = 300 PCO=295 POG=5 BUN:Cr=20
URINALYSIS: UNa+=80 UK+=25 UCl−=100 USG=1.
org/ calculators/ oxygencalculator/ oxygencalculator.  Mahoney JJ. luc. 37 (7): 1244–1248. altitude.Arterial blood gas
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