Arterial Blood Gas

Interpretation

Madeline Gervase, RN,MSN,CCRN,FNP

Union County College
Blood Gas Components

 Oxygen level
 Carbon Dioxide Level
 pH
 Bicarbonate level
ABG Analysis

 pH: 7.35-7.45
 PaCO2: 35-45mmHg
 HCO3: 22-26/28 mEq/L
 PaO2: > 80mmHg
 Oxygen Saturation >95%
Analysis
 pH =Alkalosis

 pH =Acidosis

Normal values 7.35-7.45

Analysis

 PaCO2 = Respiratory

 PaCO2 = Respiratory

Normal value 35-45mmHg

Analysis
 HCO3 = Metabolic

 HCO3 = Metabolic

Normal values 22-26/28 mEq/L

 Comparison Chart

pH PaCO2 HCO3
Resp Acid.

Resp Alk.

Metab Acid

Metab Alk
 Respiratory Acidosis

Any disease process which decreases the

ability of the lungs to exchange CO2 for
oxygen.
 Increased K+

 Pneumonia

 Asthma

 CHF
Respiratory Acidosis

pH PaCO2
Respiratory Alkalosis
Anything which greatly increases
respiratory rate.

 Fever
 Pain
 Anxiety
 Overvenitilation with a mechanical venitalator
 Decreased K+
Respiratory Alkalosis
pH PaCO2
 Metabolic Acidosis
Anything which increases the
accumulation of acids or decreases the
amount of bicarbonate in the body.
Renal failure
Loss of bases from diarrhea
Increased K+
Diuretic therapy which causes HCO3 loss
Metabolic Acidosis
pH HCO3
Metabolic Alkalosis
Anything which decreases H ions in
The body or increases bicarbonate.
Prolonged vomiting
Metabolic Alkalosis

pH HCO3
Determining ABG’s
 First, Look at the pH.
 It can be high >7.45 (alkalosis)
 It can be low <7.35 (acidosis)
 It can be normal 7.35- 7.45 (normal)
Determining ABG’s
 A normal pH may indicate perfectly
normal blood gases, or it may be an
indication of a compensated imbalance.
 A compensated imbalance is one in
which the body has been able to correct
the pH by either respiratory or
metabolic changes (depending on the
primary problem)
Example of compensation
 Pt. With primary metabolic acidosis
starts out with a low bicarbonate level
but a normal carbon dioxide level. Soon
afterward, the lungs try to compensate
for the imbalance by exhaling large
amounts of carbon dioxide.
(hyperventilation)
 Determine Primary Cause
of Disturbance

 Evaluate the PaCo2 & HCO3 in relation to

the pH.
 PaCo2 – 35-45mmHg
 HCO3 – 22-26 mEq/L
 Interpreting ABG’s
 pH > 7.45 (alkalosis) and the PaCO2 is,
< 35 mmHg, the primary disturbance is respiratory
alkalosis. This occurs when a pt. hyperventilates
and “blows off” too much carbon dioxide.

 pH > 7.45 (alkalosis) and the HCO2 is > 26

mEq/L, the primary disturbance is metabolic
alkalosis. This situation occurs when the body
gains too much bicarbonate, an alkaline
substance.
Interpreting ABG’s
 pH <7.35 (acidosis) and the PaCO2 is >
40mmHg, the primary disturbance is
respiratory acidosis. This situation
occurs when a patient hypoventilates
and thus retains too much carbon
dioxide, an acidic substance.
Interpreting ABG’s
 pH < 7.35 (acidosis) and the HCO3 is
< 22mEq/L, the primary disturbance is
metabolic acidosis. This situation
occurs when the body’s bicarbonate
level drops , either because of direct
bicarbonate loss or because of gains of
acids such as lactic acid or ketones.
Determine if compensation
has begun
 This is done by looking at the value
other than the primary disorder. If it is
moving in the same direction as the
primary value, compensation is
underway.
 Examples
 Consider the following gases:
pH PaCO2 HCO3
1)7.20 60mmHg 24mEq/L
2)7.33 60mmHg 37mEq/L
1) indicates acute respiratory acidosis without
compensation (the PaCO2 is high, the HCO3 is
normal).
2) Indicates chronic respiratory acidosis,
compensation has taken place; that is HCO3
has elevated to an appropriate level to balance
the high PaCo2 ands produce a normal pH.
 Example of compensation
 A patient with primary respiratory acidosis
starts out with a high carbon dioxide level;
soon afterward, the kidneys attempt to
compensate by retaining bicarbonate. If
the compensatory maneuver is able to
restore the bicarbonate to carbonic acid
ratio back to 20:1, full compensation (and
thus normal pH) will be achieved.