ABG  

Made  Easy

Dr.  Vishal  Gupta

ICU  Fellow
Nepean  Hospital
 Benefits  of  ABG

∗ To  establish  the  severity  of  an  oxygenation  abnormality

∗ To  evaluate  hyper-­ or  hypoventilation

∗ To  determine  acid-­base  status,  particularly  in  patients  with  metabolic  

acidosis

∗ To  track  the  application  of  mechanical  ventilation  in  a  critically  ill  

patient
 Practical  Approach  to  ABG

1. History
2. What is the Oxygenation status
3. What is the pH? Acidemia or Alkalemia?
4. What is the primary disorder present?
5. Is there appropriate compensation?
6. Is the compensation acute or chronic?
7. Is there an anion gap?
8. If there is a AG check the delta gap?
9. What is the differential for the clinical processes?
 Oxygenation  Status

1. P/F  ratio
2. A-­‐a  gradient

Normal  Lungs Sick  Lungs

Hypoventilation V/Q  mismatch

Subnormal  PiO2 Shunt

Other
Respiratory  Disorders
Metabolic  Disorder
Metabolic  Disorder
Metabolic  Disorder
Interesting  ABGs
1).  A  29-­‐year-­‐old  female  is  admitted  to  ICU  extubated following  an  emergency  
appendicectomy and  failure  to  progress.  Comment  on  the  ABG  data  that  was  taken  
on  admission  to  ICU:

FiO2 0.4
pH 7.33
pCO2 42 mm Hg
pO2 110 mm Hg
Bicarbonate 22.0
Base Excess - 3.9

2).  A  29-­‐year-­‐old  female  is  admitted  to  ICU  extubated following  an  emergency  Caesarian
section  at  38  weeks  gestation  for  pre-­‐eclampsia and  failure  to  progress.  Comment  on  
the  ABG  data  that  was  taken  on  admission  to  ICU:

FiO2 0.4
pH 7.33
pCO2 42 mm Hg
pO2 110 mm Hg
Bicarbonate 22.0
Base Excess - 3.9

3).  A  72  year  old  lady  with  a  
background  of  CCF,  who  
underwent  a  laparotomy  and  
adhesiolysis in  the  context  of  a  
subacute  small  bowel  obstruction.  
Following  the  laparotomy,  patient  
was  extubated and  brought  to  
recovery.  ABG  was  done,  as  
patient`s  breathing    was  found  to  
be  shallow  &  rapid
4).  After   being  discovered  at  his  rural  
property   in  an  unconscious  state,  this  
elderly  gentleman  was  intubated  and  
brought  to  the  ICU.  Airway  ulceration  
was  noted  by  the  rescuers.  Apparently  
he  intentionally  drank  an  unknown  
amount  of  some  unknown  smelly  liquid.

S.  Osmolality  :  362,  Urea  12,  Albumin  40

5).  A  65-­‐year-­‐old  male  presented  
to  ED  with  fever  &  productive  
cough.  On  examination,  
tachycardiac,  hypotensive  &  
dehydrated.  Patient  was  
resuscitated  with  4  lts of  IV  fluid  
but  he  remained  hypotensive  &  
required  vasopressors.
6).  A  24-­‐year-­‐old  female  with  a  
history  of  depression  presents  
with  seizures  and  decreased  
consciousness. The  following  
ABG  was  taken  on  FiO2  0.3.  
7).  A  46-­‐year-­‐old  male  
presents  with  vomiting  for  
the  past  five  days.  His  
arterial  blood  gas  result  on  
room  air  is  shown  below:
8).  The  following  results  were  
obtained  from  a  23-­‐year-­‐old  
female  admitted  with  severe  
asthma.
9).  The  following  data  are  from  
the  arterial   blood  gas  analysis  of  
a  71-­‐year-­‐old  male  with  
necrotising fasciitis:
10).  A  35-­‐year-­‐old  male  has  
presented  to  the  Emergency  
Department  with  weakness  
and  constipation.  Whilst  in  the  
Emergency  Department  he  
had  the  following  results:
11).  A  79  year  old  lady  
with  history  of  AF  
admitted  with  nausea,  
vomiting  &  abdominal  
pain  and  found  to  be  in  
severe  shock.  
12).  No  History  available
 References

∗ Acid  Base  physiology  :  Kerry  Brandis

∗ CICM
∗ Alex  Psirides (Wellington   ICU)  :  Diagrams
∗ Deranged  physiology
Thanks