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ABG Interpretation

   Steven Podnos MD
Why Do ABG’s?

1) Check oxygenation

2) Check the pH (acid base balance)

3) Ventilatory Status

4) Determine the treatment
Basic ABG Components

          • pH

          • PaCO2

          • HCO3

          • PaO2
pH


• Normal pH is maintained by balancing the
  H2CO3 (carbonic acid) and HCO3- (bicarb)

• Normal blood pH = 7.35-7.45

• pH < 7.35 = acidosis

• Ph > 7.45 = alkalosis
PaCO2


• CO2 has several forms in the blood.

• Like oxygen, some is dissolved directly into the plasma. The
  PaCO2 is the measurement of the partial pressure of carbon
  dioxide dissolved in the plasma. It is measured in mm Hg
  (millimeters of mercury).

• The rest is found in the red blood cells on a hemoglobin
  molecule.
Buffer System


               Carbonic Acid - Bicarbonate Buffer System


         CO2 + H2O <--> H2CO3 <--> (HCO3-) + (H+)
carbon dioxide + water   <--> carbonic acid   <-->   bicarbonate + hydrogen ion


                         NOTE THAT “CO2” on Lyte panel is HCO3
• Note: The two headed arrows indicate that the process is reversible
Acid/Base-General Considerations

PH = Increased - Alkalosis
     Decreased - Acidosis

PCO2 = Increased – Acidosis
      Decreased – Alkalosis

HCO3 = Increased – Alkalosis
      Decrease - Acidosis
Acid Base Balance


• Understanding the cause of an acid-base imbalance is the
  key to treating it.

• The Respiratory component of acid base balance affects the
  pH within minutes.

• The Metabolic component of acid base balance can take
  days to affect pH.
A. Metabolic Acidosis

• Results from renal failure, Lactic
  acidosis, DKA

        B. Respiratory Acidosis
          Hypoventilation
• Results from respiratory failure, instrinsic or
  extrinsic.
C. Metabolic Alkalosis

• Results from Gastric Suction, vomiting,


        D. Respiratory Alkalosis
            Hyperventilation
• Results from Head Trauma, Fever,
  Emotions, Salicylate Ingestion, Shock
  at an early stage
PaO2


• About 3% of the body's oxygen is dissolved in the plasma.

• PaO2 is a measurement of the partial pressure of oxygen
  dissolved in the plasma only. It is measured in mm Hg.

• The PaO2 does not tell us about the body's total oxygen
  content, but it does indicate how much oxygen was
  available in the alveoli to dissolve in the blood.
Oxygen and Hemoglobin


• CO2's affinity for hemoglobin is much less than O2's
  affinity for hemoglobin.

• When CO2 and O2 are both available, hemoglobin will
  accept oxygen rather than CO2.

• In the oxygen rich environment of the
  alveoli, hemoglobin carries oxygen.

• Oxygenated blood then travels through the body.
SaO2


• The remainder of the body's oxygen is carried attached
  to hemoglobin molecules.

• SaO2, or oxygen saturation, measures the degree to
  which oxygen is bound to hemoglobin.

• Sa02 is expressed as a percentage.
Abg interpretation
OxyHemoglobin Dissociation Curve


• This curve describes the relationship between available
  oxygen and amount of oxygen carried by hemoglobin.
• Oxygen-Hemoglobin affinity changes with:
   • variation in pH    *CO2      *temperature           *2,3,-DPG

• Once the PaO2 reaches 60 mm Hg the curve indicates that
  there is little change in saturation above this point.
   – So, PaO2 of 60 or more is usually considered adequate.
   – At PaO2 of less than 60 even small changes will greatly reduce the
     SaO2.
Steps to ABG Interpretation


1) Determine Acidosis or Alkalosis.


2) Evaluate the Respiratory Mechanism


3) Evaluate the Metabolic Mechanism
Normal ABG Values



              Norms       Quick Reference
• pH =        7.35-7.45   7.4   (+/- 0.5)
• PaCO2 =     35-45       40    (+/- 5)
• HCO3 =      22-26       24    (+/- 2)
• PaO2 =      80-100      90    (+/- 10)
• SaO2 =      94-100      97    (+/- 3)
STEP 1

Step 1.
   Use pH to determine                       ph
   Acidosis or Alkalosis.

                              < 7.35     7.35-7.45     > 7.45


                                          Normal or
                             Acidosis                 Alkalosis
                                        Compensated
STEP # 2

Step 2.                               PaCO2
   Use PaCO2 to
   look at the         < 35           35 -45          > 45
   Respiratory
   Mechanism
                  • Tends toward                 • Tends toward
                    alkalosis        Normal        acidosis
                  • Causes high        or        • Causes low
                    pH             Compensated     pH
                  • Neutralizes                  • Neutralizes
                    low pH                         high pH
STEP 3

Step 3.                                 HCO3
Use HCO3 to look
  at the                < 22           22-26          > 26
  Metabolic
  Mechanism
                   • Tends toward               • Tends toward
                     acidosis         Normal    alkalosis
                   • Causes low         or      Causes high
                     pH             Compensated   pH
                   • Neutralizes                • Neutralizes
                     high pH                      low pH
Interpretation

        High pH                     Low pH


    Alkalosis                   Acidosis

High HCO3     Low PaCO2    High PaCO2    Low HCO3


Metabolic                  Respiratory
             Respiratory                 Metabolic
Compensation

• “Compensation" is the body's normal response to normalize
  pH
   – By neutralizing the opposite acid base mechanism.
• Example: If the pH is high because of respiratory alkalosis
  (low CO2):
   – Alkaline HCO3- will decrease to neutralize the pH.
   – In this case, the abnormal bicarb is not a metabolic problem; it is a
     metabolic solution to a respiratory problem.
• It is important to determine which is the cause and which is
  the effect.
• If you treat the compensatory abnormality, you make the pH
  even more abnormal.
Combined Disturbances


• A “Combined Disturbance” occurs when the PaCO2 and
  HCO3- both alter the pH in the same direction.

• A high PaCO2 and low HCO3- (acidosis).

• Low PaCO2 and high HCO3- (alkalosis).

• RARE
Question
• If the pH is 7.30, the PaCO2 is 50, and the
  HCO3 is 24 what is the likely diagnosis?
Question 1


• If the pH is 7.30, the PaCO2 is 50, and the
  HCO3 is 24 what is the likely diagnosis?


      Acute uncompensated RESPIRATORY
  ACIDOSIS
Question




If the pH is 7.49, the PaCO2 is
25, and the HCO3 is 22 what is the
likely diagnosis?
Question #2


• If the pH is 7.49, the PaCO2 is 25, and the
  HCO3 is 22 what is the likely diagnosis?


        ACUTE RESPIRATORY ALKALOSIS,
Question
• If the the pH is 7.56, the PaCO2 is 39, and the
  HCO3 is 38, what is the likely diagnosis?
Question # 3


• If the the pH is 7.56, the PaCO2 is 39, and
  the HCO3 is 38, what is the likely diagnosis?

        METABOLIC ALKALOSIS
Question
• If the pH is 7.35, the PaCO2 is 25, and the
  HCO3 is 9, what is the likely diagnosis?
Question # 4


• If the pH is 7.35, the PaCO2 is 25, and the
  HCO3 is 9, what is the likely diagnosis?

  COMPENSTATED METABOLIC ACIDOSIS
Question
• If the pH is 7.30, the PaCO2 is 25, and the
  HCO3 is 9, what is the likely diagnosis?
Question # 5


• If the pH is 7.30, the PaCO2 is 25, and the
  HCO3 is 9, what is the likely diagnosis?

        PARTIALLY COMPENSTATED
           METABOLIC ACIDOSIS

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Abg interpretation

  • 1. ABG Interpretation Steven Podnos MD
  • 2. Why Do ABG’s? 1) Check oxygenation 2) Check the pH (acid base balance) 3) Ventilatory Status 4) Determine the treatment
  • 3. Basic ABG Components • pH • PaCO2 • HCO3 • PaO2
  • 4. pH • Normal pH is maintained by balancing the H2CO3 (carbonic acid) and HCO3- (bicarb) • Normal blood pH = 7.35-7.45 • pH < 7.35 = acidosis • Ph > 7.45 = alkalosis
  • 5. PaCO2 • CO2 has several forms in the blood. • Like oxygen, some is dissolved directly into the plasma. The PaCO2 is the measurement of the partial pressure of carbon dioxide dissolved in the plasma. It is measured in mm Hg (millimeters of mercury). • The rest is found in the red blood cells on a hemoglobin molecule.
  • 6. Buffer System Carbonic Acid - Bicarbonate Buffer System CO2 + H2O <--> H2CO3 <--> (HCO3-) + (H+) carbon dioxide + water <--> carbonic acid <--> bicarbonate + hydrogen ion NOTE THAT “CO2” on Lyte panel is HCO3 • Note: The two headed arrows indicate that the process is reversible
  • 7. Acid/Base-General Considerations PH = Increased - Alkalosis Decreased - Acidosis PCO2 = Increased – Acidosis Decreased – Alkalosis HCO3 = Increased – Alkalosis Decrease - Acidosis
  • 8. Acid Base Balance • Understanding the cause of an acid-base imbalance is the key to treating it. • The Respiratory component of acid base balance affects the pH within minutes. • The Metabolic component of acid base balance can take days to affect pH.
  • 9. A. Metabolic Acidosis • Results from renal failure, Lactic acidosis, DKA B. Respiratory Acidosis Hypoventilation • Results from respiratory failure, instrinsic or extrinsic.
  • 10. C. Metabolic Alkalosis • Results from Gastric Suction, vomiting, D. Respiratory Alkalosis Hyperventilation • Results from Head Trauma, Fever, Emotions, Salicylate Ingestion, Shock at an early stage
  • 11. PaO2 • About 3% of the body's oxygen is dissolved in the plasma. • PaO2 is a measurement of the partial pressure of oxygen dissolved in the plasma only. It is measured in mm Hg. • The PaO2 does not tell us about the body's total oxygen content, but it does indicate how much oxygen was available in the alveoli to dissolve in the blood.
  • 12. Oxygen and Hemoglobin • CO2's affinity for hemoglobin is much less than O2's affinity for hemoglobin. • When CO2 and O2 are both available, hemoglobin will accept oxygen rather than CO2. • In the oxygen rich environment of the alveoli, hemoglobin carries oxygen. • Oxygenated blood then travels through the body.
  • 13. SaO2 • The remainder of the body's oxygen is carried attached to hemoglobin molecules. • SaO2, or oxygen saturation, measures the degree to which oxygen is bound to hemoglobin. • Sa02 is expressed as a percentage.
  • 15. OxyHemoglobin Dissociation Curve • This curve describes the relationship between available oxygen and amount of oxygen carried by hemoglobin. • Oxygen-Hemoglobin affinity changes with: • variation in pH *CO2 *temperature *2,3,-DPG • Once the PaO2 reaches 60 mm Hg the curve indicates that there is little change in saturation above this point. – So, PaO2 of 60 or more is usually considered adequate. – At PaO2 of less than 60 even small changes will greatly reduce the SaO2.
  • 16. Steps to ABG Interpretation 1) Determine Acidosis or Alkalosis. 2) Evaluate the Respiratory Mechanism 3) Evaluate the Metabolic Mechanism
  • 17. Normal ABG Values Norms Quick Reference • pH = 7.35-7.45 7.4 (+/- 0.5) • PaCO2 = 35-45 40 (+/- 5) • HCO3 = 22-26 24 (+/- 2) • PaO2 = 80-100 90 (+/- 10) • SaO2 = 94-100 97 (+/- 3)
  • 18. STEP 1 Step 1. Use pH to determine ph Acidosis or Alkalosis. < 7.35 7.35-7.45 > 7.45 Normal or Acidosis Alkalosis Compensated
  • 19. STEP # 2 Step 2. PaCO2 Use PaCO2 to look at the < 35 35 -45 > 45 Respiratory Mechanism • Tends toward • Tends toward alkalosis Normal acidosis • Causes high or • Causes low pH Compensated pH • Neutralizes • Neutralizes low pH high pH
  • 20. STEP 3 Step 3. HCO3 Use HCO3 to look at the < 22 22-26 > 26 Metabolic Mechanism • Tends toward • Tends toward acidosis Normal alkalosis • Causes low or Causes high pH Compensated pH • Neutralizes • Neutralizes high pH low pH
  • 21. Interpretation High pH Low pH Alkalosis Acidosis High HCO3 Low PaCO2 High PaCO2 Low HCO3 Metabolic Respiratory Respiratory Metabolic
  • 22. Compensation • “Compensation" is the body's normal response to normalize pH – By neutralizing the opposite acid base mechanism. • Example: If the pH is high because of respiratory alkalosis (low CO2): – Alkaline HCO3- will decrease to neutralize the pH. – In this case, the abnormal bicarb is not a metabolic problem; it is a metabolic solution to a respiratory problem. • It is important to determine which is the cause and which is the effect. • If you treat the compensatory abnormality, you make the pH even more abnormal.
  • 23. Combined Disturbances • A “Combined Disturbance” occurs when the PaCO2 and HCO3- both alter the pH in the same direction. • A high PaCO2 and low HCO3- (acidosis). • Low PaCO2 and high HCO3- (alkalosis). • RARE
  • 24. Question • If the pH is 7.30, the PaCO2 is 50, and the HCO3 is 24 what is the likely diagnosis?
  • 25. Question 1 • If the pH is 7.30, the PaCO2 is 50, and the HCO3 is 24 what is the likely diagnosis? Acute uncompensated RESPIRATORY ACIDOSIS
  • 26. Question If the pH is 7.49, the PaCO2 is 25, and the HCO3 is 22 what is the likely diagnosis?
  • 27. Question #2 • If the pH is 7.49, the PaCO2 is 25, and the HCO3 is 22 what is the likely diagnosis? ACUTE RESPIRATORY ALKALOSIS,
  • 28. Question • If the the pH is 7.56, the PaCO2 is 39, and the HCO3 is 38, what is the likely diagnosis?
  • 29. Question # 3 • If the the pH is 7.56, the PaCO2 is 39, and the HCO3 is 38, what is the likely diagnosis? METABOLIC ALKALOSIS
  • 30. Question • If the pH is 7.35, the PaCO2 is 25, and the HCO3 is 9, what is the likely diagnosis?
  • 31. Question # 4 • If the pH is 7.35, the PaCO2 is 25, and the HCO3 is 9, what is the likely diagnosis? COMPENSTATED METABOLIC ACIDOSIS
  • 32. Question • If the pH is 7.30, the PaCO2 is 25, and the HCO3 is 9, what is the likely diagnosis?
  • 33. Question # 5 • If the pH is 7.30, the PaCO2 is 25, and the HCO3 is 9, what is the likely diagnosis? PARTIALLY COMPENSTATED METABOLIC ACIDOSIS