Arterial Blood

Gas
Analysis
 COMMON
TERMINOLOGIES
 ACIDS: Acid is a substance which when dissolved
in water undergoes or splits into a hydrogen ion and
anion.

BASES: Base is a substance which undergoes

dissociation in water to give a hydroxyl ion and a
cation.

SALTS: Salt is a substance which when dissolved in

water dissociate to release a cation and anion neither
of which is a hydrogen ion nor a hydroxyl ion.
 PH
PH is the hydrogen ion concentration in
any solution.
1___________7___________14
Acid Base

Normal Blood PH- 7.35 – 7.45 mEq/L

 BUFFER
Buffer is a substance which is capable of
converting strong acid into weak acid and
strong base into weak base & does not
undergo rapid ionisation & thereby does
not contribute to alteration of pH.
 Buffer system
 Primary Chemical buffer
1 Bicarbonate
2 Phosphate
3 Protein

 Secondary Physiological
Respiration ( lungs )
Renal system
W hat is an ABG?

An arterial blood gas (ABG) test

measures oxygen and carbon dioxide levels
in blood. It also measures body’s acid- base
(pH) level, which is normally balanced when
healthy.
• The Components
• pH / PaCO 2 / PaO 2 / HCO 3 / O 2 s at / BE
• Desired Ranges
• pH - 7.35 - 7.45
• PaCO - 3 5 - 4 5
2

• PaO - 80-100
2

• HCO - 21-27
3

• O s at - 95-100%
2

• Base Excess - + / - 2 mEq/L

 W hy O rder 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
medicat ions
• Acid/ base st atus may alte r
elect r oly te levels criti cal to patient
status/care
 Logistic
s
The options for ABG sample
• Radial
• Femoral
• Brachial
• Dorsalis Pedis
 Acid Base Balance
• The body produces acids daily
• 15,000 mmol CO 2

• The lungs and kidneys at t empt

t o maintain balance
 Acid Base Balance
• Assessment of st at us via
bicarbonat e- carbon dioxide
buff er system
• CO + H O <--> H CO <--> HCO + H
2 2 2 3 3
- +
 The Terms
• ACIDS • BASES
• Acidemia • Alkalemia
• Acidosis • Alkalosis
• Respiratory • Respiratory
CO2 CO2
• Metabolic • Metabolic
HCO3 HCO3
 Respiratory
Acidosis
• ph, CO 2, Ventilation
• Causes
• CNS depression
• Pleural disease
• COPD/ARDS
• Musculoskeletal disorders
• Compensation for metabolic alkalosis
 Respiratory
Acidosis
• Acute vs Chronic
• Acute - little kidney involvement.
Buffering via titration via Hb for example
• pH by 0.08 for 10mmHg  in CO 2

• Chronic - Renal compensation via

synthesis and retention of HCO3 (Cl to
balance charges ➜ hypochloremia)
• pH by 0.03 for 10mmHg in CO2
 Respirat ory
Alkalosis
• pH, CO 2, Ventilation

• Causes
• Intracerebral hemorrhage
• Salicylate and Progesterone drug usage
• Anxiety ➜ lung compliance
• Cirrhosis of the liver
• Sepsis
 Respirat ory
Alkalosis
• Acute vs. Chronic
• Acute - HCO by 2 mEq/L for every
3

10mmHg  in PCO2
• Chronic - Ratio increases to 4 mEq/L of
HCO3 for every 10mmHg  in PCO2
 Metabolic
Acidosis
• pH, HCO 3

• PCO2 by 1.2mmHg for every 1

mEq/L
HCO3
 Meta bolic
Alkalosis
• pH, HCO 3

• PCO by 0.7 for every 1mEq/L  in HCO

2 3

• Causes
• Vomiting
• Diuretics
• Chronic diarrhea
• Hypokalemia
• Renal Failure
 Easy to understand
ROME
PH PCO2 HCO3

Respiratory NORMAL
Acidosis

Respiratory NORMAL
Alkalosis

Metabolic NORMAL
Acidosis

Metabolic NORMAL
Alkalosis
 COMPENSATION
PH PCO2 HCO3
Respiratory NORMAL
Acidosis

Respiratory NORMAL
Alkalosis

Metabolic NORMAL
Acidosis

Metabolic NORMAL
Alkalosis
 The S t eps
• S ta r t with the pH
• Note the PCO 2
• Note the HCO3
• Determine
compensation
 Examples 1
If the pH is 7.30, the PaCO2 is 50, and the
HCO3 is 24 what is the likely diagnosis?
 Answer
Acute uncompensated RESPIRATORY
ACIDOSIS
 Example 2
If the pH is 7.49, the PaCO2 is

25, and the HCO3 is 22 what is the likely

diagnosis?
 Answer
ACUTE RESPIRATORY ALKALOSIS
Example 3
• If the pH is 7.56, the PaCO2 is 39, and
the HCO3 is 38, what is the likely
diagnosis?
 Answer
METABOLIC ALKALOSIS
Example 4
• If the pH is 7.35, the PaCO2 is 25, and the
HCO3 is 9, what is the likely diagnosis?
 Answer
COMPENSTATED METABOLIC ACIDOSIS
Example 5
• If the pH is 7.30, the PaCO2 is 25, and the
HCO3 is 9, what is the likely diagnosis?
 Answer
PARTIALLY COMPENSTATED METABOLIC
ACIDOSIS