Arterial Blood Gas Analysis

Oliver Christian I. Arenas, M.D.

Department of Internal Medicine
Manila Adventist Medical Center
 Purposes of Performing Blood Gas
Analysis

• Identify specific acid-base disturbances

• Provides information on oxygenation
• Provides information on alveolar ventilation
• Usually based on an arterial blood sample
 ABG Procedure

• Arterial blood for blood gas analysis is usually

extracted by a phlebotomist, nurse, or
respiratory therapist
• Blood may be taken from an easily accessible
artery typically the radial artery, but during
unusual or emergency situations the brachial
artery or femoral artery may be used, or out
of an arterial line.
• The syringe is pre-packaged and contains a
small amount of heparin, to prevent
coagulation or needs to be heparinized, 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.
 Important
• 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 should not be iced and should always
be analyzed within 30 minutes.
 Acid-Base Balance
Acid-base balance is crucial to effective
functioning of body systems.
• Acids
– Substances that lose ions, ie. H+
– All acids are positively charged
• Bases
– Substances that accept ions, ie. HCO3-
– All bases are negatively charged
• Plasma pH – an inverse indicator of hydrogen
ion concentration in blood. Normal values
7.35 - 7.45.
– An increase in H+ decreases pH. There is an
increase in acidity.
– A decrease in H+ increases pH. There is a
decrease in acidity (increase in alkalinity).
– pH below 6.8 or above 7.8 is incompatible with
life.
Three Systems Which Maintain
Normal Serum pH
• Buffer systems
• Lungs
• Kidneys
 Buffer Systems

• Blood buffer systems

– Proteins
– Inorganic phosphates
– Hemoglobin
• Bicarbonate-carbonic acid buffer system
– Normally 20 parts bicarbonate (HCO3-) to one part
carbonic acid (H2CO3)
– When CO2 is dissolved in water, it becomes
carbonic acid (CO2+H2O  H2CO3  H+ +
HCO3-)
– Kidneys and lungs are the major regulating organs
 Lungs’ Role In Acid-Base
Regulation

• Fast to respond
• Respond to changes in CO2 levels
• Rise in serum CO2 levels causes a
decreased pH. This results in
hyperventilation to compensate
• Fall in serum CO2 levels causes an
increased pH. This results in
hypoventilation to compensate
Kidneys’ Role In Acid-Base Regulation

• Slow to respond
• Either excrete or reabsorb HCO3- or H+ to
compensate
 Levels of Compensation

• Uncompensated – pH is abnormal - buffer

systems and regulatory mechanisms have not
begun to correct imbalance
• Partially compensated – pH is abnormal but
buffers and regulatory mechanisms have
begun to respond
• Compensated – pH is normal. Acid and base
components are abnormal but balanced
 Indicators for Determination of Acid-
Base State

• pH – normal value 7.35-7.45

– Gain acid or lose base, become more acid
– Gain base or lose acid, become more alkaline
• PaCO2 – normal value 35-45 mmHg
– Partial pressure of CO2 in arterial blood
– Lungs responsible for controlling excretion or
retention of CO2 through ventilation
– Elevated PaCO2 is caused by hypoventilation
– Decreased PaCO2 is caused by hyperventilation
• HCO3 – normal value 22 to 26 mEq/L
– Represents renal or metabolic component
– Influenced by metabolic processes
– Decreased with acidosis, increased with alkalosis
• Base excess – normal value + 2mEq/L
– Indirect reflection of bicarbonate concentration
– Base deficit or excess acid if < -2mEq/L
– Base excess or acid deficit if > 2mEq/L
 Indicators of Oxygenation Status

• PaO2 – normal value 80-100 mmHg

– Partial pressure of O2 dissolved in arterial blood
– Hypoxemia – levels < 80mmHg
• SaO2 – normal value > 95%
– Percentage of oxygen combined with Hgb compared
with amount it could carry
• Hgb – normal value 12 – 15 g/dL for women; 13.5
– 17g/dL for men.
– Major carrier of O2 in the blood
– Has an affinity or attraction for O2 molecules
 The Affinity of Hgb for O2 Can
Change
• Increased affinity
– O2 bonds more easily with Hgb
– Hgb does not want to give O2 up
– Oxyhemoglobin curve shifts to the left
• Decreased affinity
– O2 does not bind easily with Hgb
– Hgb gives up O2 more easily
– Oxyhemoglobin curve shifts to the right
 Factors That Affect the Oxyhemoglobin
Dissociation Curve

• Left Shift • Right Shift

– Alkalosis – Acidosis
– Hypothermia – Hyperthermia
– Hypocarbia – Hypercarbia
– Decreased 2,3 DPG – Increased 2,3 DPG
 Acid–Base Balance
Determination
• Evaluate pH
• Evaluate PaCO2
• Evaluate HCO3-
• Determine if with compensation
 Evaluation of Oxygenation Status

• Evaluate PaO2
• Evaluate SaO2
• Evaluate Hgb
 Four General Classes of Acid-Base
Imbalances

• Respiratory alkalosis
• Respiratory acidosis
• Metabolic alkalosis
• Metabolic acidosis
Uncompensated Respiratory Alkalosis

• Criteria – pH > 7.45; PaCO2< 35mmHg

• Causes
– Fear
– Pain
– Fever
– Early salicylate intoxication
– Hypoxemia
– Central nervous system tumors
• Clinical manifestations
– Lightheadedness
– Paresthesia
– Decreased concentration
– Tachycardia and other dysrhythmias
– Tetany
• Medical management
– Slow deep breathing
– Relieve pain
– Correct hypoxemia
Uncompensated Respiratory Acidosis

• Criteria - pH<7.35; PaCO2>45mmHg

• Causes
– Pulmonary edema
– Pneumothorax
– Massive pulmonary embolus
– Severe pulmonary infection
– Neuromuscular disorders
– Chronic pulmonary diseases
– Oversedation
• Clinical manifestations
– Dyspnea
– Restlessness
– Tachycardia and other dysrhythmias
– Elevated blood pressure
– Confusion
– Drowsiness
– Hyperkalemia
• Medical management
– Diagnostic tests to determine cause
– Pulmonary hygiene
– Adequate hydration
– High Fowler’s position
– Mechanical ventilation
– Bronchodilators, antibiotics
– Supplemental oxygen
 Uncompensated Metabolic
Alkalosis

• Criteria – pH >7.45; HCO3->26 mEq/L

• Causes
– Vomiting, NG suction
– Hypokalemia
– Diuretics
– Hyperaldosteronism
– Cushing’s syndrome
– Excessive use of bicarbonate
• Clinical manifestations
– Dizziness
– Lethargy
– Tetany
– Decreased respirations
– Atrial tachycardia and other dysrhythmias
– Paralytic ileus
– Hypoxemia
– Seizures, coma
• Medical management
– Restore fluid volume with NaCl
– Carbonic anhydrase inhibitors
 Uncompensated Metabolic
Acidosis

• Criteria – pH<7.35; HCO3-< 22mEq/L

• Causes
– Renal failure
– Ketoacidosis
– Anerobic metabolism
– Starvation
– Late phase of salicylate intoxication
– Diarrhea
– Intestinal fistula
• Clinical manifestations
– Headache
– Confusion
– Lethargy
– Hyperventilation
– Warm, flushed skin
– Hyperkalemia
– Nausea, vomiting
– Dysrhythmias
• Medical management
– Administer bicarbonate cautiously
– Monitor K+ closely
– Monitor Ca+ levels
 Case 1
• 54 y/o suffered an acute anterior wall MI and
is now in cardiogenic shock. ABG as listed:
• pH = 7.27
• PaCO2 = 38 mm Hg
• HCO3 = 14 meq/L
 Case 2
• 72 y/o with COPD, hospitalized with
pneumonia. ABG as follows..
• pH = 7.39
• PaCO2 = 60 mmHg
• HCO3 = 34 meq/L
 Case 3
• 20 y/o developed ARF after aminoglycoside
therapy. ABG as listed..
• pH = 7.36
• PaCO2 = 30 mmHg
• HCO3 = 16 meq/L
 Case 4
• 53 y/o, sustained major trauma in a VA. She
has NGT in place that drained 1500 ml in the
last 24 hours. ABG showed..
• pH = 7.53
• paCO2 = 42 mmHg
• HCO3 = 34 meq/L
More likely than not a simple imbalance
is the cause, and this approach to
interpret ABG’s will help you identify it
quickly and confidently..
THANK YOU FOR LISTENING