Analysis of the Arterial Blood Gas

Amber Kennedy
 Learning Outcomes

• Understand reasons for ABG sampling

• Develop method of interpreting the
measurements of the ABG
• Identify what abnormal parameters may
indicate
• Increase knowledge of causes of acid base
imbalance
 Introduction

Why do we do ABGs?

To assess respiratory function

- Hypoxia ?is the Pa02 adequate
- Hypercapnia – are they retaining carbon
dioxide

But we also use them to assess acid base

balance and obtain a real-time information
 Introduction
 Many enzymes are pH sensitive
 pH of arterial plasma is normally 7.36-7.44
 Hydrogen ion concentration 36-44nmol/L
 An arterial blood gas can provide some
basic information of what is happening real
time. e.g. Hb, potassium and indicate
severity of illness
 Anatomy and physiology
 Various mechanisms maintain the pH of
ECF
 Most important involves reaction of
hydrogen with bicarbonate to form carbonic
acid
 Bicarbonate is present in high concentration
in ECF (21-28 mmol/L)
 CO2 and HCO3 are under physiological
control
 Anatomy and physiology
 CO2 is controlled by the lungs (respiratory)
 HCO3 by the kidneys (metabolic)
 These work to maintain homeostasis
 If the pH is out with normal range then the
body tries to compensate by altering the
levels of CO2 or HCO3 to maintain a
neutral pH – i.e. compensate
 Anatomy and physiology
 Respiratory compensation occurs quickly
(15-30mins)
 Respiratory compensation for metabolic
acidosis – rise in ventilatory rate
- reduces CO2
- increases pH
 Systemic alkalosis results in the opposite
mechanism
 Anatomy and physiology
 The kidney excretes acid thus raising
plasma bicarbonate
 It has the ability to do this long term
 Often seen in chronic respiratory failure
 Mechanism takes much longer to be
effective (12-24 hours)
 ABG interpretation
 Base excess (base deficit) shown as BE on
ABG results
 Indication of metabolic acidosis or of
compensated respiratory alkalosis
 It is an indicator of severity of illness
 A BE of -10 or worse indicates severe
illness
 The more negative the number the more
acidotic and therefore the greater the
severity of illness
 ABG interpretation
 CO2 and HCO3 rise and fall in accordance
with what is needing corrected to maintain
homeostasis
 If CO2 rises HCO3 rises
 If CO2 falls HCO3 falls
 The more hydrogen ions – the more
acidotic (low pH)
 The less hydrogen ions the more alkalotic
(high pH)
 ABG interpretation
 When the body has compensated hydrogen
ions within a normal range are seen but
CO2 and HCO3 are outwith their normal
range
 ABG interpretation
Laboratory reference ranges

Hydrogen 35-45nmol/L (pH 7.34-7.44)

PaCO2 4.7 – 6.0kPa
PaO2 11 – 13kPa
HCO3 22 – 26mmol/L
BE -2 to +2
 ABG interpretation
 Pattern of acid base disturbance

 Metabolic acidosis
High hydrogen ions
low HCO3
compensation – low CO2
 ABG interpretation
 Metabolic alkalosis

Hydrogen ions low

HCO3 high
compensation – high CO2
 ABG interpretation
 Respiratory acidosis

Hydrogen ions high

CO2 high
compensation – high HCO3
 ABG interpretation
 Respiratory alkalosis

Hydrogen ions low

CO2 low
compensation HCO3 low
Causes of acid base disturbances
 Respiratory acidosis -
• severe acute asthma
• severe pneumonia
• exacerbation of COPD
• neuromuscular disorders
• CNS ‘depression’ reduced conscious level
Causes of acid base disturbances
 Respiratory alkalosis -
• hyperventilation
• CNS ‘irritation’
• Salicylate poisoning
Causes of acid base disturbances
 Metabolic acidosis -
the result of either production of organic acids
or
 Loss of bicarbonate
 Causes can be remember by the acronym
KUSSSMALE
Causes of acid base disturbances
 Keto-acidosis
 Uraemia
 Salicylate/paracetamol poisoning
 Severe HCO3 loss – GI fistula/diarrhoea
 Starvation
 Methanol
 Alcohol (ethanol)
 Lactic acidosis
 Ethylene glycol
Causes of acid base disturbances
 Metabolic alkalosis
Loss of acid – vomiting
NG suction
Loss of potassium – excess diuretic drugs
hyperaldosteroinsm
Cushing’s syndrome
Liquorice ingestion
excess alkali ingestion
 Conclusion

ABG analysis offers valuable and real time

information

The body aims to maintain homeostasis by

using both respiratory and metabolic
mechanisms

Rise and fall in hydrogen ions will result in rise

and fall in pH