BASIC ARTERIAL BLOOD GAS (ABG)

INTERPRETATION

By: Jesus Mario A Lopez Jr., R.N., R.T.R.P.

Terminology
Acids- substances that donate free H+ ions, a
pH value of <7.0 is considered acidic
Bases substances that remove H+ ions from
the solution, a pH value of >7.0 is
considered alkaline
Buffers weak acids or weak bases that
accept or donate H+ ions to prevent the
wide fluctuation of pH in the body so the
normal metabolism can continue

Terminology
pH (puissance Hydrogen)- symbol for the
logarithm of the reciprocal of the hydrogen ion
concentration.
PaCO2- Partial pressure of Carbon Dioxide,

arterial

PaO2 Partial pressure of Oxygen,

arterial

HCO3 Bicarbonate
BE/BD Base Excess/Base Deficit
SpO2 Pulse Oxymetry

Terminology
Henderson-Hasselbalch equation - is a method of

calculating the pH of a buffer system. In medicine, it is

used to calculate any one of the three parameters of acidbase balance: pH, PaCO2, or bicarbonate.

- As long as the ratio of carbonic acid (H2CO3) to bicarbonate

(HCO3 ) is approximately 1:20, the pH of blood is normal.
It is this ratio that determines the blood pH, rather than the
absolute values of each

Terminology
A-a Gradient- indicates whether gas transfer is normal and
gives an idea of how well oxygen is moving from the alveoli to
the arterial blood. It helps to distinguish hypoventilation from
other causes such as V/Q mismatch, shunting, and/or
diffusion abnormalities

Terminology

Terminology

Terminology
An easier and less complicated method to predict shunting is the
PaO2/FiO2 (P/F) ratio. It is calculated thus:
PaO2 FiO2
Using the criteria from the previous example:
90 0.21
PaO2/FiO2 ratio = 428 torr
Normal is 286 torr; lower indicates a shunt.
ARTERIAL O2 CONTENT (Ca02) -is primarily determined by the amount
of hemoglobin in arterial blood that is saturated with oxygen:
CaO2 = (Hgb 1.39 SaO2) + (0.003 PaO2)
A quicker way to estimate this value:
Hgb 1.39 SaO2
Normal value: 15 to 24 volume percentage

Terminology
BASEEXCESS/DEFICIT
Th e base excess/defi cit is a calculated number that represents the
amount of base that must be added to restore the blood to a normal pH of
7.4 (Normal range = 2 to +2 mEq/L).
Base excess is a positive number and signifies metabolic alkalosis.
Base deficit is a negative number and signifies metabolic acidosis

Electrodes
pH electrode (Sanz electrode) mercury electrode
- Quantifies the relative acidity and alkalinity of a blood
solution by potential difference across a pH-sensitive
glass membrane.
CO2 electrode (Severinghaus electrode) silver chloride
electrode.
- Measures PaC02 by allowing C02 gas to undergo a
chemical reaction to produce hydrogen ions
O2 electrode (The Clark electrode) silver electrode
- measures oxygen by electron consumption.

Directly measured values:

- pH electrode
- CO2
- PaO2

Calculated values:
- Sa02
- HC03

Calibration:
- Is performed by inserting solutions or gases with known
values (one low value and one high value)
- It assures the consistency and accuracy of the electrode
within their limits; however theres no assurance that the
gases and solutions being used as calibration references
are correct and consistent, external QC must be
accomplished.
* - refer to Instructional Manual of a particular ABG machine

Calibration:
Levy-Jennings Charts
- For detecting a machine that is out-of-range, the SD
range is used
- Values remain within 2 standard deviations of the mean

A Quality Management System for

Healthcare.
The
Quality System Essentials (QSE)
1. Documents and records 7. Information management
2. Organization
8. Nonconforming
management
event
3. Personnel
9. Assessment
4. Equipment
10. Continual improvement
5. Purchasing and inventory 11. Customer focus
6. Process management
12. Facilities and safety

Point of Care Testing (POCT):

- is any type of monitoring done at bed side.
1 Arterial Blood Gas
2 Pulse Oxymetry
3 Blood Glucose
4 Serum Electrolytes
- monitoring at bedside reduces turn-around time
- results are comparable with actual laboratory testing
- are subject to same QC as laboratory based devices.

Common Arterial Blood Gas Puncture

Sites

Obtaining ABG Puncture Sites

Adult

Child (> 24
months)

Neonate(< 12
months)

1* - Radial A.
2* - Brachial A.
3* - Dorsalis
Pedis A.

1* - Radial A.
2* - Brachial A.

1* Radial A.
2* Umbilical V.
3* Capilliary
and Heel Stick
samples
(opitional)

4* - Posterior
Tibial A.

5* - Femoral A.

4* - Brachial A.

30-40

Radial

90

Femoral

40-60
10-20

Dorsalis P. & Posterior T.

Brachial

Modified Allens Test

Sampling Hazards
-

Disruption of blood flow (e.g.

Hematoma)
Clotting
Bleeding
Vessel spasm
Fistulas
Masectomy(Radical, Bilateral, etc.)
Tissue trauma
Under Anticoagulant Therapy
Poor skin healing (underlying dse.)

Sampling Problems
-

Air Bubbles
* PaCo2
* Pa02 or
* pH
Improper cooling (> 1 hr.)
* PaCo2
* Pa02
* pH
Too much heparin
*pH
* Pa02
* PaCo2

Factors may affect ABG accuracy

results
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Origin of the sample

Type of Heparin used (e.g. 1,000 i.u. vs Ca ++ Li )
Accuracy of the ABG Machine (e.g. cartridge vs. solution)
Post suctioning (< 30 mins.)
Nebulization (after?)
Movement (e.g.Turning)
Medications (I.V.F.)
Activity/Procedures
Handling of sample (10 mins @ 37C; 1hr on slush ice)
Agitation of sample (roll not shake syringe!!!!)
Skill of the operator

Normal Values:
Parameters

Range

Absolute

Venous

7.35-7.45

7.40

7.31-7.41

PaCO2

35-45 mmHg

40 mmHg

41-51 mmHg

PaO2

80-100 mmHg

95 mmHg

37-43 mmHg

HCO3

22-26 mmHg

24 mEq/L

22-26 mEq/L

-2 to +2
mEq/L

0 mEq/L

-2 to +2
mEq/L

> 95%

98%

68-75 %

pH

BE/BD
O2 Sat %

pH - <7.35=Acidotic
>7.45=Alkalotic
HCO3 - <22mEq/L=Acidotic
>26mEq/L=Alkalotic
BE/BD - <-2 Acidotic
>+2 Alkalotic
PaCO2 - > 45mmHg=Acidotic
< 35mmHg=Alkatotic

Organs involved in ABG

Respiratory Component = Lungs PaCO2
- minutes to compensate
Metabolic Component = Kidneys HCO3
- days/weeks to compensate

Primary and Compensatory response

for acid-base disorders:
Primary Event

Compensatory Response

PaCO2

HCO3

PaCO2

HCO3

Arterial Oxygenation Status (PaO2)

With Hypoxemia @ R.A.

With Hypoxemia @ O2

More than adequate Oxygenation

Overcorrected oxygenation
= > 100mmHg
Corrected oxygenation
= 80-100mmHg
Uncorrected/inadequate
oxygenation
= <80mmHg

= >100mmHg
Normal/adequate Oxygenation

= 80-100mmHg
Mild Hypoxemia
= 60-79mmHg
Moderate Hypoxemia
= 40-59mmHg
Severe Hypoxemia
= < 40mmHg

* Note for individuals over age of 60 y/o, 1mmHg should be subtracted

from the lower limits of mild and moderate hypoxemia for each year over
60 y/o. At any age a PaO2 < 40mmHg indicates severe hypoxemia, and a
PaO2 of <60-65mmHg is always considered hypoxemic.

Pulse Oxymetry

ABGs

-Non-invasive
-Continuous
-O2 saturation
(SaO2)

-Invasive
-Intermittent
-Partial pressure of O2

-Measures Oxygenation

-Measures

only!!!

Pa02,

pH, PaC02, HCO3

Gold standard

-Bed side monitoring(1 whole minute)

Monitoring of O2 & CO2 status

ABG analysis (Confirmatory!!!)

Pulse oximetry (least)
EtCO2 monitoring (spot check/transport vent)
Capillary gas determination(neonates only, very
rare)

Transcutaneous monitoring

Steps in ABG Interpretation:

1.
2.

3.
4.

Determine the pH
Determine whether respiratory or
metabolic in origin
Determine the compensation
Determine the Oxygenation Status

________
3

_______ _______ ________

1

Interpretation: Partially Compensated Respiratory

Acidosis w/ uncorrected oxygenation

ABG: RESPIRATORY ACIDOSIS

Causes (mainly airway obstruction & resp. depression)
Respiratory
Acute upper airway obstruction
Atelectasis
COPD (e.g. Asthma, Bronchiectasis, Bronchitis, Emphysema)
Severe diffuse airway obstruction (acute or chronic)
Massive pulmonary edema
Hypoventilation

Nonrespiratory
Drug overdose (e.g. Sedatives, narcotics, anesthetics )
Spinal cord trauma
Neuromuscular disease
Head trauma
Thoracic trauma
Gross obesity (e.g. Pickwickan syndrome)

ABG: RESPIRATORY ACIDOSIS

S/Sx
RR & depth
HA, visual disturbance,
restlessness, drowsiness, confusion
Diaphoresis
Cyanosis
Hyper K
dysrhythmias (VF)

ABG: RESPIRATORY ACIDOSIS

Tx
Semi-Fowlers,

O2, coughing

Hydration
Suction

secretions
WOF RR distress, hyper K
Antibiotics & other meds as
ordered

Interpretation: Uncompensated Respiratory Alkalosis w/

moderate hypoxemia

ABG: RESPIRATORY ALKALOSIS

Causes (mainly overstimulation of the

respiratory system)
Hyperventilation
Fever
Hypoxia
Hysteria
Overventilation by mech vent.
Pain
Salicylates

ABG: RESPIRATORY ALKALOSIS

S/Sx
RR & depth then RR
HA, light-headedness, vertigo
Hypo Ca: paresthesia, tetany,
convulsion
Hypo K
Muscle weakness or spasms

ABG: RESPIRATORY ALKALOSIS

Tx
Treat underlying cause

Interpretation: Partially compensated metabolic acidosis w/

uncorrected oxygenation

ABG: METABOLIC ACIDOSIS

Causes:

Increase in fixed acids:

Renal failure (distal tubules/retention of H )
+

Type A lactic acidosis (tissue hypoperfusion, e.g. shock, cardiac arrest)

Type B lactic acidosis (no tissue hypoperfusion, e.g. liver failure, DM & DKA,
starvation/malnutrition )
Ingestion of acids (e.g., methanol)

Loss of base (HCO3 ):

Severe Diarrhea
Pancreatic fistula
Renal failure (proximal tubules/loss of HCO3 )
Hyperalimentation

Others:
ASA (aspirin) toxicity
High fat diet
Insufficient CHO metabolism

ABG: METABOLIC ACIDOSIS

S/Sx
RR, Kussmauls respiration
HA, N/V/diarrhea
Fruity-smelling breath
CNS depression
Twitching, convulsion
Hyper K
Dysrhythmias

ABG: METABOLIC ACIDOSIS

Tx
NaHCO3 IV
Sz precaution
For DKA: NS & Regular Insulin
IV
For RF: CHON, calorie diet;
dialysis

Interpretation: Fully compensated Metabolic Alkalosis w/

uncorrected oxygenation

ABG: METABOLIC ALKALOSIS

Causes
Diuretic therapy
Steroid therapy
Hypokalemia or hypochloremia
Excessive vomiting
GI suctioning
Hyperaldosteronism
Excessive NaHCO3 intake
Massive BT (citrate converted to HCO3)

ABG: METABOLIC ALKALOSIS

S/Sx
RR & depth
N/V/diarrhea
Restlessness
Paresthesia, twitching
HypoK, HypoCa
HR, dysrhythmias

ABG: METABOLIC ALKALOSIS

Tx
Treat

underlying cause
K repletion
NaCl IV
Aldosterone inhibitor
ACE inhibitor
Discontinue steroids
Acetazolamide if NS is contraindicated
due to CHF
Dialysis

Interpretation: Uncompensated Respiratory

Alkalosis w/ corrected oxygenation

Interpretation: Normal Acid-Base Balance w/

uncorrected oxygenation

Interpretation: Partially compensated Metabolic

Acidosis w/ moderate hypoxemia

Interpretation: Combined Respiratory and Metabolic

Acidosis w/ over corrected oxygenation

Interpretation: Partially Compensated Metabolic

Alkalosis w/ over corrected oxygenation

Interpretation: Fully Compensated Respiratory

Alkalosis w/ over corrected oxygenation

Interpretation: Partially Compensated Respiratory

Alkalosis w/ over corrected oxygenation

Interpretation: Normal Acid Base Balance w/

uncorrected oxygenation

Interpretation: Combined Respiratory and Metabolic

Acidosis w/ over corrected oxygenation

Interpretation: Partially Compensated Metabolic

Alkalosis w/ mild hypoxemia

Interpretation: Fully compensated Respiratory

Alkalosis w/ adequate oxygenation

Interpretation: Partially Compensated Respiratory

Acidosis w/ uncorrected oxygenation

Interpretation: Normal Acid Base Balance w/

uncorrected oxygenation

Interpretation: Uncompensated Respiratory

Alkalosis w/ adequate oxygenation

Interpretation: Partially compensated Respiratory Acidosis w/

Overcorrected oxygenation

References:

Egans Fundamentals of Respiratory Care

by Kacmarek, Wilkins, Stoller, 10th edition

Essentials in Respiratory Care by

Kacmarek, 3rd edition

Handbook of Blood Gas/AcidBase

Interpretation by Ashfaq Hasan