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Arterial Blood Gases

Acid-Base Balance


Arterial partial pressure of oxygen (PaO2)

Measures the amount of oxygen dissolved in the plasma Value is directly dependent upon the alveolar oxygen pressure (PAO2) Measures the amount of CO2 dissolved in the plasma The negative logarithm of the hydrogen ion concentration

Arterial pressure of carbon dioxide (PaCO2)


Components, cont

Bicarbonate (HCO3-)

Calculated from the CO2 and pH using the HendersonHasselbach equation Allows assessment of the metabolic component of acidbase balance Reflects A measure of the amount of acid or alkali that must be added to a sample under standard conditions to return the pH to 7.4 Calculated from the pH and PaCO2


Total CO2

Base excess (or deficit)

Interpreting ABGs

Assess pH:

normal, alkalotic, acidotic PaCO2 >45 = respiratory acidosis PaCO2 <35 = respiratory alkalosis HCO3 > 28 = metabolic alkalosis HCO3 < 22 = metabolic acidosis

Assess the respiratory component


Assess the metabolic component


Determine if there is metabolic or respiratory compensation occurring

Anion Gap
The difference between the main positive and negative ions  (Na + K) (Cl + HCO3)  Normal is 10-18  Increased anion gap indicates an accumulation of organic acids (ketoacids, lactic acid, other acids)

Acid-Base Balance

Intracellular enzymes function best when the pH is 7.25 7.45 Most metabolic processes produce acids Acid production increases with dx:

Lactic acid from ischemia/anaerobic metabolism Ketoacids from diabetes Methanol from alcohol ingestion


Renal/respiratory/liver failure decrease acid removal from the body Loss of acid occurs with vomiting/NG suctioning Loss of bicarb occurs with diarrhea

Disorders of Acid-Base Balance

Metabolic acidosis

With a normal anion gap


bicarb loss  Loss of bicarb from the gut  Decreased renal hydrogen ion secretion

Increased anion gap (acid accumulation)



Type A: sepsis, cardiac arrest, hypotension, methanol Type B: insulin deficiency, decreased hepatic metabolism


insulin deficiency, starvation  Exogenous acids: salicylates

Disorders, cont

Metabolic alkalosis
Hydrogen ion loss: vomiting, renal loss, diuretics, hypokalemia, low Cl states  Bicarb gain: sodium bicarb administration, citrate administration

Respiratory acidosis
Airway obstruction, pneumonia, ARDS, PE  Respiratory muscle weakness  Trauma  Respiratory depression

Disorders, cont

Respiratory alkalosis
High levels of anxiety or pain  Altitude  Excessive mechanical ventilation  Respiratory stimulants/salicylate overdose  Pulmonary embolism, asthma, edema

Control of acid-base balance

The body prevents pH changes by regulating 2 pathways for eliminating acid

Respiratory  Renal

100 times more acid equivalents are expired each day in the form of CO2 than are excreted by the kidney  Buffers bind or release hydrogen ion according to the pH to limit the change in pH that occurs when acid is added to the blood

Main body buffers

CO2 combines with water to form carbonic acid which dissociates into bicarb and hydrogen ion  CO2 + H2O = H2CO3 = HCO3- + H+  The normal ratio of bicarb to CO2 is 20:1as long as this ratio remains 20:1, the pH will be 7.4


Especially deoxygenated Hb

Relationship between pH, PaCO2, HCO3

When CO2 changes persist, pH is slowly corrected by renal compensation (retention or elimination of bicarb)  Metabolic changes can be corrected by respiratory compensation but metabolic alkalosis is not compensated as it would require a drop in ventilation  Mixed conditions (acidosis or alkalosis) can occur