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ABG Interpretation Guide - pH, pCO2, HCO3, pO2 Values & Acid-Base Imbalances
- 1. ABG Dr. Ghufran Bayan Fellowship of clinical nutrition 2022
- 2. Basic informations about ABG Measurements of acidity or alkalinity of the arterial circulation also measure gases such as oxygen and carbon dioxide.
- 3. 4 important components of ABG • PH: Acidic or alkaline • Paco2: carbon dioxide = acid • Hco3: bicarbonate = base • Pao2: oxygen = hypoxemia or not These numbers should be Memorize 7.35-7.45 35-45 22–26 80-100
- 4. 3 steps ABG interpretation 1. Identify if it is acidosis or alkalosis (pH) Less than 7.35 acidosis More than 7.45 alkalosis 2. Identify if it respiratory or metabolic ( CO2 / HCO3) Concept method: Paco2 respiratory HCO3 metabolic
- 5. Examples: • PH=7.25 paco2=50 HCO3=24 =acidosis = respiratory acidosis =normal • PH=7.56 paco2=28 HCO3=22 =alkalosis = respiratory alkalosis = normal • PH=7.25 paco2=37 HCO3=21 =acidosis = normal =metabolic acidosis • PH=7.56 paco2=40 HCO3=35 =alkalosis = normal = metabolic alkalosis These are examples of uncompensated
- 6. If PH becomes normal and both paco2 and HCO3 abnormal, we have compensation going on that we will talk about it in this step: 3. Identify if it is compensated or uncompensated: compensation either Full Or Partial Compensation.
- 7. Compensation respiratory Acidosis alkalosis HCO3 >26 <22 metabolic acidosis alkalosis co2 <35 >45
- 8. Example of Compensation PH=7.30 .............acidosis co2=50 .........a lot of co2, ass.with acid so we can put resp.acidosis HCO3=49......try to compensate by increasing the base
- 9. If it is partial or complete??? Look at PH, if Compensation enough to bring PH to normal range??No, So it is Partial Compensation
- 10. Another example: PH=7.50........alkalosis Co2=51.......elevated co2 But The problem alkalosis. So, let’s look at bicarbonate: HCO3=41 our value here elevated then we conclude we have metabolic alkalosis compensated by increasing the amount of co2, PH not comeback to normal so it is: Metabolic alkalosis with Partial respiratory Compensation
- 11. • PH=7.35.......normal PH • Co2=49.......elevated which might indicate acidosis • HCO3=30......Also elevated Which Could indicate Alkalosis There are 2 steps to interpret this 1. Knowing patient‘s diagnosis or condition. 2. Acidic side / alkaline side.
- 12. PH= 7.35..... Acidic side 7.35, 7.36, 7.37, 7.38, 7.39 Lower normal PH And even within normal, the body more Acidic than alkaline(Acidic side).....acidosis 7.41, 7.42, 7.43, 7.44, 7.45 Belong to upper half of normal PH and the body in these ranges appears more alkaline than Acidic(Alkaline side).....alkalosis
- 13. Co2 = 49 Elevated so we conclude that acidosis due to elevation in co2 means Respiratory acidosis Then we look at bicarbonate to see whether compensated or not HCO3 = 30 The body compensated with acidosis by increasing the amount of HCO3 Respiratory acidosis with metabolic Compensation. Then, this Compensation Partial or complete?? Back to PH, it is normal so it’s Respiratory acidosis with full Compensation
- 14. Exercises • PH= 7.44 • Co2= 48 • HCO3 = 35 What is your ABG interpretation ?????
- 15. Anion Gap (AG) AG= (Na+ K) _ (Cl+HCO3) if result from 12- 18 ......with normal Anion Gap more than 18 ......with high Anion Gap
- 16. Example • PH=7.25 • HCO3 =17 • Paco2=30 • Na=135 • K=4 • Cl=100
- 17. AG= (Na+ K) _ (Cl+HCO3) AG= (135+4) _ (100+17) AG= 139 _ 117 = 22 Metabolic acidosis with respiratory Compensation and high anion gap