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INTERPRETATION
Michael Kassirer, MD
”Dept. Internal Medicine ”D
TASMC, Israel
ABG Interpretation 1
A/B Physiology
HCO3- + H+ H2CO3 H2O + CO2
Handersson-hasselbalch eq:
pH = 6.1 + Log (HCO3-/(0.3 X pCO2))
pH
7.35-7.45
PaCO2
35-45 mm Hg
PaO2
70-100 mm Hg*
SaO2
93-98%
HCO3-
22-26 mEq/L
%MetHb ABG Interpretation <2.0% 3
ABG Interpretation – 5
steps
Does the patient have an acidosis or an alkalosis:
The pH determines the primary problem!
Mixed disorder can normalize pH
What is the 1º disorder – metabolic or respiratory.
There is no overcompensation!
If both HCO3- and pCO2 can explain the pH change, than a
combined
(mixed) AB disorder is present.
Is there mixed A/B disorder
How is the compensation – appropriate or not.
Is there increased AG
What is the corrected HCO3-
ABG Interpretation 4
Abnormal Values
compensati
1º disorder
on
pH > HCO3 > 26 meq/L paCO2 1º Metabolic
7.45
paCO2 < 35 mm 1º
Alkalosis HCO3
Hg Respiratory
ABG Interpretation 5
Expected Compensation
Metabolic acidosis:
paCO2 = last 2 digits of pH X 100
↓ 1mEq/liter HCO3 ↓ 1-1.5mmHG of paCO2.
Metabolic alkalosis:
paCO2 = 0.7(HCO3) + 20 (±1.5)
↑ 1mEq/liter HCO3 ↑ 0.5-0.7 mmHg of paCO2.
ABG Interpretation 6
Expected Compensation
Respiratory acidosis
Acute:
↓ pH of 0.08 units for every 10mmHg ↑ paCO2
↑ HCO3 of 1mEq/liter per 10 mmHg ↑ paCO2
Chronic:
↓ pH of 0.03 units for every 10mm Hg ↑ paCO2
↑ HCO3 of 3mEq/liter per 10 mmHg ↑ paCO2
ABG Interpretation 11
Summary
Is there any compensation by the
patient? Do the calculations:
* For a 1° respiratory problem, is the pH change
completely accounted for by the change in
pCO2
ABG Interpretation 13
Alveolar ventilation and
pCO2
Fig 1: pCO2 rises rapidly
with diminished alveolar
ventilation, but only mildly
affected by
hyperventilation. This is
why significant alkalosis is
scarcely caused by
respiratory disorder alone.
ABG Interpretation 14