Blood Gas Interpretation Review

for Pandemic
Blood Gases
• Important diagnostic tool
• Reveals:
1. acid-base balance
2. oxygenation status
**arterial gases only**
3. abnormalities of ventilation

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Acid- base balance
• The body is designed for optimum performance at a
specific pH level
• Cell division
• Metabolism

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Components of Acid- Base Balance
• pH- measures the bloods acidity
– Normal range 7.35- 7.45
– Overall H+ from both respiratory and metabolic factors
• pCO2- partial pressure of carbon dioxide in the blood
– Normal range 35-45 mmHg
– Snapshot of adequacy of alveolar ventilation
• HCO3- the amount of bicarbonate in the blood
– Normal range 22- 26 mEq/L

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 Acid – Base Balance

Bicarbonate – carbonic acid buffer equation

(H+)(HCO3) (H2CO3) (CO2)(H2O)

It’s not that complicated!

pH 1 7 14

Acidic Neutral Alkaline

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 Acid – Base Balance

• Lungs • Kidneys
• Respiratory • Metabolic
• CO2 (acid) • HCO3 ( base/alkaline)

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 Making sense of it…
pH
7.35 – 7.45

Respiratory Metabolic

CO2=Acidosis HCO3=Acidosis

CO2=Alkalosis HCO3=Alkalosis

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 Interpretation: 4 steps

• Normal Values
– pH 7.35 – 7.45
– pCO2 35 – 45 mmHg
– HCO3 22 - 26 mEq/L

• Evaluate each component as Acid or Base

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 Step 1…

• Evaluate pH and determine acidosis or

alkalosis
7.35 7.40 7.45

Acid Normal Base

Acidosis Alkalosis

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 Step 2…

• Evaluate pCO2 (respiratory)

35 40 45

Base Normal Acid

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 Step 3…

• Evaluate HCO3 (metabolic)

22 24 26

Acid Normal Base

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 Step 4…

• Determine which regulatory system is responsible for

the imbalance by checking to see which component
matches the pH.
– If pH and pCO2 match = respiratory

– If pH and HCO3 match = metabolic

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ABG Analysis

pH pCO2 HCO3
Resp. Acidosis A A N
(<7.35) (>45) (22-26)
Resp. B B N
Alkalosis (>7.45) (<35) (22-26)
Metabolic A N A
Acidosis (<7.35) (35-45) (<22)
Metabolic B N B
Alkalosis (>7.45) (35-45) (>26)

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Let’s practice…
pH pCO2 HCO3
A A N Respiratory Acidosis
7.26 55 23
B N B Metabolic Alkalosis
7.54 43 39
N N N Normal
7.39 41 25
B B N Respiratory Alkalosis
7.51 29 24
A N A Metabolic Acidosis
7.29 40 17
A A A Mixed Acidosis
7.28 61 18

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 Compensation

• When an acid – base imbalance exists, over time the

body attempts to compensate.

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 Understanding Compensation

• Uncompensated – the alternate system has not attempted to

adjust (remains within normal range), and the pH remains
abnormal
• Example
– pH 7.30 A
– pCO2 60 A
– HCO3 25 N
Uncompensated Respiratory Acidosis

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 Understanding Compensation

• Partial Compensation – the alternate system is trying to create

a balanced environment and bring the pH back within normal
limits, but hasn’t yet succeeded.
• Example
– pH 7.34 A
– pCO2 59 A
– HCO3 28 B
Partially Compensated Respiratory Acidosis

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 Understanding Compensation

• Fully Compensated – the alternate system has adjusted enough

to restore balance and normalize the pH
• Example
– pH 7.36 N (but slightly A)
– pCO2 58 A
– HCO3 31 B
Compensated Respiratory Acidosis

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Let’s Practice Compensation…

pH pCO2 HCO3
Metabolic Alkalosis partially
B A B compensated
7.51 49 40
A A N Respiratory Acidosis uncompensated

7.29 53 22
Metabolic Acidosis fully compensated
N B A
7.37 25 18
N A B Respiratory Acidosis fully compensated

7.35 65 28
Respiratory Alkalosis partially
B B A compensated
7.46 22 20 Respiratory Acidosis partially
A A B compensated
7.34 52 27

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 A Final Step…

• Determine level of oxygenation

(arterial samples only)
• Normal = 80 – 100 mmHg
• Mild hypoxemia = 60 – 80 mmHg
• Moderate hypoxemia = 40 – 60 mmHg
• Severe hypoxemia = less than 40 mmHg

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 Respiratory Acidosis

• Excessive CO2 retention

• Causes
– Airway obstruction
– Depression of respiratory drive
• Sedatives, analgesics
• Head trauma
– Respiratory muscle weakness resulting from muscle disease
or chest wall abnormalities
– Decreased lung surface area participating in gas exchange

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 Respiratory Acidosis

• Clues
– Confusion, restlessness
– Headache, dizziness
– Lethargy
– Dyspnea
– Tachycardia
– Dysrhythmias
– Coma leading to death

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 Respiratory Acidosis

• Solutions
– Improve ventilation
• Ensure adequate airway; positioning,
suctioning
• Encourage deep breathing and coughing
• Frequent repositioning
• Chest physio/ postural drainage
• Bronchodilators
• Decrease sedation/analgesia
• Oxygen therapy

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 Respiratory Alkalosis

• Excessive CO2 loss due to hyperventilation

• Causes
– CNS injury: brainstem lesions, salicylate overdose, Reye’s
Syndrome, hepatic encephalopathy
– Aggressive mechanical ventilation
– Anxiety, fear or pain
– Hypoxia
– Fever
– Congestive heart failure

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 Respiratory Alkalosis

• Clues
– Light headedness
– Confusion
– Decreased concentration
– Tingling fingers and toes
– Syncope
– Tetany

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 Respiratory Alkalosis

• Solutions
– Decrease respiratory rate and depth
• Sedation/analgesia as appropriate
• Rebreather mask
• Paper bag
• Emotional support/encourage patient to slow
breathing
• Calm, soothing environment

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 Metabolic Acidosis

• Excessive HCO3 loss, or acid gain

• Causes
– Diabetic ketoacidosis
– Sepsis/shock
– Diarrhea (fluid losses below gastric sphincter)
– Renal Failure
– Poison ingestion
– Starvation
– Dehydration

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 Metabolic Acidosis

• Clues
– Stupor
– Restlessness
– Kussmaul’s respirations (air hunger)
– Seizures
– Coma leading to death

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 Metabolic Acidosis

• Solutions
– Replace HCO3 while treating underlying cause
– Monitor intake and output
– Monitor electrolytes, especially K+
– Seizure precautions

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 Metabolic Alkalosis

• HCO3 retention, or loss of extracellular acid,

• Causes
– GI losses above gastric sphincter
• Vomiting
• Nasogastric suction
– Antacids
– Diuretic therapy causing electrolyte loss

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 Metabolic Alkalosis

• Clues
– Weakness, dizziness
– Disorientation
– Hypoventilation
– Muscle twitching
– Tetany

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 Metabolic Alkalosis

• Solutions
– Control vomiting
– Replace GI losses
– Eliminate overuse of antacids
– Monitor intake and output
– Monitor electrolytes

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