Arterial Blood Gases
Analysis
ADULT HEALTH II
6 steps to ABG analysis
Analyze each value individually to determine if
there are any abnormalities
1. Is the pH normal?
2. Is the CO2 normal?
3. Is the HCO3 normal?
4. Match the CO2 or HCO3 with the pH
5. Does the CO2 or HCO3 go the opposite direction of
the pH?
6. Are the PaO2 and O2 saturation normal?
Normal ABG Values
pH 7.35-7.45
paCO2 35-45 mmHg
paO2 80-100 mmHg
HCO3- 22-26 mEq/L
SpO2 95-100%
STEP 1: Analyze the pH
Normal Value of blood pH is 7.35- 7.45
A value below 7.35 will be ACIDIC
A value above 7.45 will be ALKALOTIC
Memory tip: the pH moves from A → B, acid →
base (acidic to basic) or acidodic to alkalotic
STEP 2: Analyze the CO2
Normal CO2 levels are 35-45 mmHg
Any value below 35 is alkalotic
Any value above 45 is acidic
STEP 3: Analyze the HCO3-
Normal HCO3- is 22-26 mEq/L
If the value is below 22 it is ACIDIC
If the value is above 26 it is ALKALOTIC
Remember the HCO3- follows with the pH in
relation to acid/base
STEP 4: Match the CO2 or
HCO3 with the pH
Match either the CO2 or the HCO3 with the pH to
determine the acid-base disorder
For example if the pH is acidic and the CO2 is
acidic then it is a disturbance related to the
respiratory system → so this would be called
respiratory acidosis
On the contrary if the pH is alkalotic and the
HCO3- is alkalotic then the disturbance would be
related to the metabolic system → labeled as
metabolic alkalosis
MNEMONIC: ROME
RESPIRATORY OPPOSITE
The CO2 is the respiratory component of the ABG,
and if it is low and the pH is high the patient would
have a respiratory alkalosis. They move in opposite
directions to match
METABOLIC EQUAL
The HCO3 is the metabolic component of the ABG. If
the HCO3 is low and the pH is low the patient would
have metabolic acidosis. They move in the same
direction to match
https://www.youtube.com/watch?v=vTQpj97TWWg
STEP 5: Does the HCO3- or
CO2 go in the opposite
direction of the pH?
This step is to determine if there is any
compensation occurring in either system as an
attempt to correct the disturbance
For example if the pH is acidodic and the CO2 is
acidodic but the HCO3- is alkalotic then the
acid/base disorder is labeled as respiratory
acidosis with compensation from the metabolic
system represented by the increase in HCO3-
STEP 6: Analyze the SpO2
and paO2
PaO2 is a measurement of the partial pressure of
oxygen in arterial blood while the oxygen saturation
(spO2) is the percent of hemoglobin binding sites
in the blood that are carrying oxygen
if fully saturated a HgB molecule can carry 4 O2
molecules
If either SpO2 or paO2 are below normal there is
evidence of hypoxemia
A paO2 of 60 mmHg corresponds to an spO2 of 90%
PRACTICE
Normal value Your patient
pH 7.35-7.45 7.27
CO2 35-35 53
HCO3- 22-26 24
paO2 80-100 50
O2 sat 90-100% 79%
ANSWER
pH is acidic
CO2 is acidic
HCO3 is normal
paO2 is low
SpO2 is low
The full diagnosis for this blood gas is:
Uncompensated respiratory acidosis with
hypoxemia.
This patient has an acute respiratory disorder
CASE STUDY 1
Mr. Worried is a 52-year-old widow. He is retired and living
alone. He enters the ED complaining of shortness of breath
and tingling in fingers. His breathing is shallow and rapid. He
denies diabetes; blood sugar is normal. There are no EKG
changes. He has no significant respiratory or cardiac history.
He takes several antianxiety medications. He says he has had
anxiety attacks before. While being worked up for chest pain
an ABG is done:
ABG results are:
pH= 7.48
PaCO2= 28
HCO3= 22
PaO2= 85
CASE STUDY 2
Mrs. Puffer is a 35-year-old single mother, just getting off the
night shift. She reports to the ED in the early morning with
shortness of breath. She has cyanosis of the lips. She has
had a productive cough for 2 weeks. Her temperature is
102.2, blood pressure 110/76, heart rate 108, respirations
32, rapid and shallow. Pulse Oximetry shows 84%. Breath
sounds are diminished in both bases, with coarse rhonchi in
the upper lobes. Chest X-ray indicates bilateral pneumonia.
ABG results are:
pH= 7.44
PaCO2= 28
HCO3= 24
PaO2= 54
CASE STUDY 3
You are the critical care nurse about to receive Mr.
Sweet, a 24-year-old DKA (diabetic ketoacidosis) patient
from the ED. The medical diagnosis tells you to expect
acidosis. In report you learn that his blood glucose on
arrival was 780. He has been started on an insulin drip
and has received one amp of bicarb. You will be doing
finger stick blood sugars every hour.
ABG results are:
pH= 7.33
PaCO2= 25
HCO3=12
PaO2= 89
REFERENCES
Whitten, C. (2015). Whats the difference between
oxygen saturation and paO2?
https://airwayjedi.com/2015/12/09/whats-the-
difference-between-oxygen-saturation-and-pao2/
Woodruff, D.W. (2011). Six easy steps to ABG Analysis
. ED4nurses.com, Ohio.
https://herzing.blackboard.com/bbcswebdav/pid-
5299257-dt-content-rid-11795236_1/courses/06-
2132-A-PN108-1/ABGebook.pdf
Rncensus.(2005). ABG Case Studies.
http://www.rnceus.com/abgs/abgpt.html
