Al-Safwa University College

Nursing Department
Critical Care Nursing

Lecture 9

Arterial Blood Gases(ABGs)

Dr. Wael Lazim Al-Maliki
 Lecture outline
• Arterial Blood Gases.
• Components of ABGs.
• ABGs Interpretations.
• Draw Arterial Blood Gases.
• Acid-Base Balance & Imbalances.
• Respiratory Acidosis.
• Respiratory Alkalosis.
• Metabolic Acidosis.
• Metabolic Alkalosis.
 Definition
Arterial Blood Gases: Is a laboratory test to monitor the
patient’s acid-base balance. Unlike other blood samples obtained
through a vein, a blood sample from an arterial blood gas (ABG) is
taken from an artery (commonly on radial or brachial artery).
 Components of ABGs
1. pH (Potential of Hydrogen): Is the concentration of hydrogen ions
and determines the acidity or alkalinity of body fluids. A pH equal or
less than 7.35 indicates acidosis and a pH greater than 7.45 indicates
alkalosis. The normal ABG level for pH is 7.35 to 7.45.
2. PaCO2 (Partial Pressure of Carbon Dioxide): Shows the adequacy of
the gas exchange between the alveoli and the external environment.
The normal range is 35 to 45 mmHg (respiratory determinant).
3. PaO2 (Partial Pressure of Oxygen): Indicates the amount of oxygen
available to bind with hemoglobin. The normal range is 75 to 100
mmHg.
 Components of ABGs
4. SO2 (Oxygen Saturation): Measured in percentage, is the
amount of oxygen in the blood that combines with hemoglobin.
The normal range is 94–100%.
5. HCO3 (Bicarbonate): Is an alkaline substance that comprises
over half of the total buffer base in the blood. The normal range
is 22 to 26 mEq/L (metabolic determinant).
6. BE (Base Excess): Is routinely checked with HCO3 value. A base
excess of less than –2 is acidosis and greater than +2 is
alkalosis. The normal range is –2 to +2 mmol/L
 How to draw Arterial Blood Gas?
1. Arterial blood is usually drawn via the brachial or radial artery.
2. Inform that client about the procedure and that there is no food or fluid
restriction imposed.
3. Note if the client is taking anticoagulant therapy or aspirin as this may affect
results.
4. Note if the client is receiving oxygen therapy (flow rate, type of
administration device), and the client’s current temperature.
5. Using a heparinized needle and syringe, collect 1 to 5 mL of arterial blood.
6. Apply pressure to the puncture site for 5 minutes or longer.
7. Put the syringe with arterial blood in an ice-water bag to minimize the
metabolic activity of the sample.
8. Deliver the blood sample immediately to the laboratory.
 Acid-Base Balance and Imbalances
• Acid-base imbalances develop when a person’s normal homeostatic
mechanisms are dysfunctional or overwhelmed. One type of acid-base
imbalance is acidosis wherein the blood is relatively too acidic (low pH). The
body produces two types of acid, therefore, there are two types of acidosis:
respiratory acidosis and metabolic acidosis. On the contrary, alkalosis is a
condition wherein the blood is relatively too basic (high pH), there are also two
types of alkalosis: respiratory alkalosis and metabolic alkalosis.
• When acid-base imbalances occur, the body activates its compensatory
mechanisms (the lungs and kidneys) to help normalize the blood pH. The
kidneys compensate for respiratory acid-base imbalances while the respiratory
system compensates for metabolic acid-base imbalances. This does not correct
the root cause of the problem, if the underlying condition is not corrected,
these systems will fail.
 Interpreting Arterial Blood Gas Imbalances
Interpreting arterial blood gases is used to detect respiratory acidosis or
alkalosis, or metabolic acidosis or alkalosis during an acute illness. To determine
the type of ABGs the key components are checked (pH, PaCO2, HCO3).
The best and fun way of interpreting ABG is by using the (tic-tac-toe) method
below:
1. Based on the given ABG values, determine if values interpret Acidosis
or Alkalosis.
2. Second, we need to determine if values define Metabolic or
Respiratory.
3. Lastly, we need to determine the compensation if it is: Fully
Compensated, Partially Compensated, or Uncompensated.
 Interpreting Arterial Blood Gas Imbalances
• Ask yourself the following questions to help you start interpreting the values….
• Question 1: Is this acidosis or alkalosis?
• Remember the normal values of pH for acidotic vs alkalotic.
• Question 2: Is this a respiratory or metabolic problem?
• PaCO2 represents a RESPIRATORY problem
• HCO3 represents a METABOLIC problem
• Question 3: Is it uncompensated, partially, or fully compensated?
• Look at the pH: is it normal or abnormal?
• If the pH is ABNORMAL: it is either uncompensated or partially
compensated…it will NEVER be fully compensated
• If the pH is NORMAL: it is fully compensated because the body has
corrected the problem
 Respiratory Acidosis
• Respiratory acidosis: is a condition that occurs when breathing is
inadequate (alveolar hypoventilation) and the lungs are unable to
excrete enough CO2 causing PaCO2 or respiratory acid builds up.
• The extra CO2 combines with water to form carbonic acid, causing a
state of acidosis a common occurrence in emphysema.
• The kidneys activate its compensatory process (albeit slow, often 24
hours or more) by increasing the excretion of metabolic acids
through urination, which increases blood bicarbonate.
 Types of Respiratory Acidosis
• There are two forms of respiratory acidosis: Acute and Chronic.
1. Acute respiratory acidosis. This form of respiratory acidosis
occurs immediately. Left untreated, symptoms will get
progressively worse. It’s a medical emergency and can become
life-threatening.
2. Chronic respiratory acidosis. This form of respiratory acidosis
develops through time. It doesn’t cause symptoms. Instead, the
body adapts to the increased acidity. For example, the kidneys
produce more bicarbonate to help maintain balance. Developing
another illness may cause chronic respiratory acidosis to worsen
and become acute respiratory acidosis.
 Causes of Respiratory Acidosis
1. CNS depression 8. Bronchial obstruction and atelectasis
2. Head trauma 9. Severe pulmonary infections
3. Oversedation 10.Heart failure
4. Anesthesia 11.Pulmonary edema
5. High cord injury 12.Massive pulmonary embolus
6. Pneumothorax 13.Myasthenia gravis
7. Hypoventilation 14.Multiple sclerosis
 Signs and Symptoms of Respiratory Acidosis
1. Dyspnea
2. Respiratory distress
3. Headache
4. Dysrhythmias
5. Restlessness
6. Decreased responsiveness.
8. Altered level of consciousness (Lethargy, Drowsiness, Confusion,
Disorientation, and Coma)
9. Tremors.
10. Asterixis.
 Management of Respiratory Acidosis
1. Provide mechanical ventilation through oxygen
supplementation.

2. Manage hyperkalemia through the use of Kayexalate

(Kayexalate increases fecal potassium excretion through the
binding of potassium in the lumen of the gastrointestinal tract).

3. Maintain adequate hydration. Provide IV

fluids and electrolytes as ordered.
 Respiratory Alkalosis
Respiratory alkalosis: is a condition that result from
hyperventilation since the lungs excrete too much carbonic
acid which increases pH.

Since respiratory alkalosis occurs quickly, the kidneys do not

have time to compensate.
 Causes of Respiratory Alkalosis
1. Pain 7. Fear (Panic attacks)
2. Fever (Hyperthermia) 8. Anxiety and nervousness
3. Hyperventilation 9. CNS lesions(Brainstem damage)
4. Thyrotoxicosis 10.Diabetic ketoacidosis (DKA)
5. Gram-negative 11.Metabolic acidosis.
6. Pregnancy. 12.Salicylate toxicity.
 Signs and Symptoms of Respiratory Alkalosis
1. Sweating.
2. Confusion.
3. Dry mouth.
4. Palpitations.
5. Convulsions.
6. Blurred vision.
7. Hyperventilation.
8. Light-headedness.
9. Paresthesia (Numbness).
10. Signs and symptoms of hypokalemia and hypocalcemia.
 Management of Respiratory Alkalosis
1. Breathe into a paper bag. Breathing through a paper bag fills it with carbon
dioxide helping in inhaling exhaled air back into the lungs.
2. Treat underlying condition:
a. Medications. Administering an opioid pain reliever or anti-anxiety medication to reduce
hyperventilation.
b. Relaxation techniques. Breathing exercises that help relax and breathe from the
diaphragm and abdomen, rather than chest wall.
c. Safety. Stay with the patient.
d. Lavage. After massive aspirin ingestions, aggressive gut decontamination is advisable,
including gastric lavage.
e. Correction of hypokalemia and hypocalcemia.
3. Oxygenation as indicated. Providing oxygen to help keep a person from
hyperventilating.
 Metabolic Acidosis
Metabolic acidosis is when there is a decrease in bicarbonates and a
buildup of lactic acid occurs. This happens in diarrhea, ketosis,
and kidney disorders.

It has three main root causes:

1. Increased acid production
2. Loss of bicarbonate
3. A reduced ability of the kidneys to excrete excess acids.
 Causes of Metabolic Acidosis
• Increased acids • Loss of base
1. Starvation 1. Obesity.
2. Chronic Hypoxia. 2. Diarrhea.
3. Salicylate intoxication 3. Dehydration.
4. Anaerobic metabolism 4. Intestinal fistulas
5. Chronic Renal Failure (CRF). 5. Methanol Poisoning.
6. Diabetic Ketoacidosis (DKA).
 Signs and Symptoms of Metabolic Acidosis
1. Coma 9. Jaundice
2. Lethargy 10. Dysrhythmias
3. Headache 11. Lack of appetite
4. Weakness 12. Warm, flushed skin
5. Confusion 13. Kussmaul respiration
6. Restlessness 14. Nausea and vomiting
7. Stupor/coma
8. Disorientation
 Management of Metabolic Acidosis
1. Sodium bicarbonate. Indicated in the treatment of metabolic acidosis which
may occur in severe renal disease, uncontrolled diabetes, circulatory
insufficiency due to shock or severe dehydration, extracorporeal circulation of
blood, cardiac arrest, and severe primary lactic acidosis.
2. Treat the underlying condition.
3. Hydration for diabetic ketoacidosis. The major treatment of this condition is
the initial rehydration.
4. Dialysis for chronic renal failure. The control of metabolic acidosis in
hemodialysis is mainly focused on the supply of bicarbonate during the dialysis
sessions.
5. Use of diuretics.
6. Initiate safety measures.
7. Kayexalate. Kayexalate increases fecal potassium excretion through the binding
of potassium in the lumen of the gastrointestinal tract.
 Metabolic Alkalosis
Metabolic alkalosis: is a condition that occurs when
bicarbonate ion concentration increases, causing an
elevation in blood pH.
This can occur in excessive vomiting, dehydration, or
endocrine disorders.
 Causes of Metabolic Alkalosis
• Gain of base
1. Excess use of bicarbonate
2. Excess ingestion of antacids.
3. Lactate administration in dialysis
• Loss of acids
1. Vomiting
2. Hypokalemia.
3. Hypochloremia.
4. Nasogastric suctioning
5. Administration of diuretics
6. Sodium bicarbonate overdose.
7. Increased levels of aldosterone.
 Signs and Symptoms of Metabolic Alkalosis
1. Tetany. 8. Coma
2. Fatigue. 9. Seizures
3. Diarrhea. 10. Lethargy
4. Peripheral edema. 11. Dizziness
5. Tingling sensation. 12. Agitation
6. Nausea and vomiting. 13. Numbness
7. Depressed respiration. 14. Disorientation
 Management of Metabolic Alkalosis
1. Antiemetic. In the case of vomiting, administer antiemetics, if
possible.
2. Ammonium chloride. Ammonium chloride is a systemic and
urinary acidifying agent that is converted to ammonia and
hydrochloric acid through oxidation by the liver.
3. Acetazolamide (Diamox). Acetazolamide also appears to be safe
and effective in patients with metabolic alkalosis following
treatment of respiratory acidosis from exacerbations of chronic
obstructive pulmonary disease (COPD).
ANY QUESTIONS