What is ABG?
Before ABG sampling perform an ALLENS Test
ABG Stand for Arterial Blood Gas. Analysis of the ABG to know O2 & CO2 concentration in the blood to diagnose the disease. 6 Easy Steps to ABG AnalysisAfter ABG Analysis we found 4 situation & its causes
- Respiratory Acidosis ⇛ Hypo-ventilation, retention of CO2 into blood & tissue.
- Respiratory Alkalosis ⇛ Hyperventilation.
- Metabolic Acidosis ⇛ Severe diarrhea or DKA & excessive use of aspirin.
- Metabolic Alkalosis ⇛ Excessive vomiting, diuretic, gastric aspiration.
Nurses often have difficulty analysis of arterial blood gases (ABGs). Trying to remember many random rules and lacking a standardized approach to ABGs. Also, nurses often attempt to analyze too many components of the ABG at the same time. The result is often confusion and an incorrect diagnosis. Therefore, the “6 Easy Steps to ABG Analysis” was developed to provide nurses with an accurate and systematic method of easily interpreting arterial blood gases.
The “6 Easy Steps to ABG Analysis” are listed below for easy reference and will be explained in more detail in the sections that follow. Only we have remembered The 6 Easy Steps to Analysis ABG.
- 1. Is pH normal?
- 2. Is CO2 normal?
- 3. Is the HCO3 normal?
- 4. Match the CO2 or the HCO3 with pH
- 5. Does the CO2 or the HCO3 go the opposite direction of the pH?
- 6. Are the pO2 and the O2 saturation normal?
In order for our analysis to be effective, notes will have to be written next to the results on our lab slip. Alternately, the ABG results can be transcribed onto another paper for analysis (see example one below for the format).
Step 1: Analyze the pH
The first step in analyzing ABGs is to look at the pH. Normal blood pH is 7.4, plus or minus 0.05, forming the range 7.35 to 7.45. If blood pH falls below 7.35 it is acidic. blood pH rises above 7.45, it is alkalotic. If it falls into the normal range, label what side of 7.4 it falls on. Lower than 7.4 is normal/acidic, higher than 7.4 is normal/alkalotic Label it.
Step2: Analyze the CO2
The second step is to examine the pCO2. Normal pCO2 levels are 35-45mmHg. Below 35 is alkalotic, above 45 is acidic. Label it.
Step 3: Analyze the HCO3
The third step is to look at the HCO3 level. A normal HCO3 level is 21-27 mEq/L. If the HCO3 is below 21, the patient is acidotic. If the HCO3 is above 27, the patient is alkalotic. Label it.
Step 4: Match the CO2 or the HCO3 with the pH
Next match either the pCO2 or the HCO3 with the pH to determine the acid-base disorder. For example, if the pH is acidotic, and the CO2 is acidotic, then the acid-base disturbance is being caused by the respiratory system. Therefore, we call it a respiratory acidosis. However, if the pH is alkalotic and the HCO3 is alkalotic, the acid-base disturbance is being caused by the metabolic (or renal) system. Therefore, it will be a metabolic alkalosis.
Step 5: Does the CO2 or HCO3 go in the opposite direction of the pH?
Fifth, does either the CO2 or HCO3 go in the opposite direction of the pH? If so, there is compensation by that system. For example, the pH is acidotic, the CO2 is acidotic, and the HCO3 is alkalotic. The CO2 matches the pH making the primary acid-base disorder respiratory acidosis. The HCO3 is the opposite of the pH and would be evidence of compensation from the metabolic system.
Step 6: Analyze the pO2 and O2 saturation.
Finally, evaluate the PaO2 and O2 sat. If they are below normal there is evidence of hypoxemia. Normal Values (At sea level): Range: pH 7.35-7.45 pCO2 35-45 mmHg pO2 80-100 mmHg O2 Saturation 94-100% HCO3- 21-27 mEq/L Base Excess + or – 3
Anion Gap Formula
AG = (Na + + k +)- (Cl- +HCO3-) (Major Cations – Major Anions)Normal = 10-15 mEq/L
LOOK AT THE CHART BELOW TO DETERMINE THE EVALUATION OF ABNORMAL VALUES:
|Respiratory Acidosis||⇩||⇧||⇩/ N|
|Respiratory Alkalosis||⇧||⇩||⇧/ N|
|Metabolic Acidosis||⇩||⇩ / N||⇩|
|Metabolic Alkalosis||⇧||⇧ / N||⇧|
Notice that if the pH is lower than 7.35 it indicates acidosis if the pH is higher than 7.45 it indicates alkalosis. The HCO3 is also acidotic if it is low: less than 21 indicates acidosis. If the HCO3 is higher than 27 it indicates alkalosis. However, if the CO2 is lower than 35 it indicates alkalosis, and if the CO2 is higher than 45 it indicates acidosis. One way to remember this relationship is to use the acronym ROME.
ROME – Respiratory Opposite Metabolic Equal
The CO2 is the respiratory component of the ABG, and if it is low and the pH is high the patient would have respiratory alkalosis. They move in opposite directions to match.
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.
STEP 5 REFERS TO COMPENSATION. Compensation is the attempt by the body to maintain homeostasis by correcting the pH. The opposite system will do this.
Component of the respiratory system that balances the pH is the dissolved carbon dioxide (CO2) that is produced by cellular processes and removed by the lungs.
The component of the renal system that balances the pH is the dissolved bicarbonate (HCO3) produced by the kidneys. The kidneys also help control pH by eliminating hydrogen (H+) ions. The way the two systems interact is through the formation of carbonic acid (H2CO3). Movement through the carbonic acid system is fluid and constant. What this means is that water (H2O) can combine with CO2 and form carbonic acid. If necessary, carbonic acid (H2CO3) can then break up to form hydrogen ions (H+) and bicarbonate (HCO3). This system works in both directions. By balancing back and forth, a normal pH is achieved.
The respiratory system balances the pH by increasing or decreasing the respiratory rate, thereby manipulating the CO2 level. Fast and deep breathing “blows off” CO2. Conversely, slow and shallow breathing “retains” CO2.
The renal system balances pH by producing HCO3 or by eliminating hydrogen ions (H+). The renal system will reflect changes in metabolic activity within the body. For example, a patient in shock will undergo anaerobic metabolism, which produces lactic acid. The production of lactic acid will bind or use up available HCO3 and will be manifested by a decrease in the HCO3 level. Therefore, the HCO3 level is an indicator of metabolic acid-base balance. The balance must be achieved by the opposing system. Our body regulates pH by using the opposing system to balance pH. So if the pH is out of balance because of a respiratory disorder, it will be the renal system that makes the corrections to balance the pH. Conversely, if the renal system is to blame for the pH disorder, the respiratory system will have to compensate. This process is called compensation.
Compensation may not always be complete. Complete compensation returns the pH balance to normal. There are times when the imbalance is too large for compensation to restore the pH to normal. This is called partial compensation. Like the seesaw, compensation must come from the opposite system. Step 5 looks to analyze compensation by looking for the system that is going in the opposite direction of the pH.
Now see the Examples how to apply the 6 steps
pH 7.27 acidotic, CO2 53 acidotic, pO2 50 low, O2 sat. 79% low, HCO3 24 normal
- 6 Step to analysis
- 1: The pH is less than 7.35, therefore it is acidotic.
- 2: The CO2 is greater than 45 and is therefore acidotic.
- 3: The HCO3 is normal.
- 4: The CO2 matches the pH because they are both acidotic. Therefore the imbalance is respiratory acidosis. It is acidotic because the pH is acidotic, it is respiratory because the CO2 matches the pH.
- 5: The HCO3 is normal, therefore there is no compensation. If the HCO3 is alkalotic (opposite direction) then compensation would be present.
- 6: Lastly, the PaO2 and O2 sat are low indicating hypoxemia.
The full diagnosis for this blood gas is Uncompensated respiratory acidosis with hypoxemia.⇛ This patient has an acute respiratory disorder.
pH 7.55 alkalotic, CO2 27 alkalotic, pO2 99 normals, O2 sat. 98% normal, HCO3 22 normal
- 6 Step to analysis
- 1: The pH is greater than 7.45, therefore it is alkalotic.
- 2: The CO2 is less than 35 and is therefore alkalotic.
- 3: The HCO3 is normal.
- 4: The CO2 matches the pH because they are both alkalotic. Therefore the imbalance is respiratory alkalosis. It is alkalotic because the pH is alkalotic; it is respiratory because the CO2 matches the pH.
- 5: The HCO3 is normal, therefore there is no compensation. If the HCO3 is acidotic (opposite direction) then compensation would be present.
- 6: Lastly, the PaO2 and O2 sat are normal indicating normal oxygenation.
The full diagnosis for this blood gas is Uncompensated respiratory alkalosis. ⇛ This patient is probably hyperventilating.
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