Arterial Blood Gases

Arterial blood gases
An arterial blood gas (ABG) test measures the oxygen and carbon dioxide levels
in your blood as well your blood's pH balance. The sample is taken from an
artery, not a vein Therefore, the ABG test is one of the most common tests
performed on patients in intensive-care units.
The laboratory tests that are used to evaluate acid–base balance are called arterial
blood gases (ABGs).
 When the serum pH level increases above 7.45, the patient has alkalosis
because the blood becomes more alkaline or basic.
Alkalosis is caused by too little acid in the body or too much base. It can
also be divided into two types: respiratory alkalosis and metabolic alkalosis.
 When the serum pH level decrease under 7.30, the patient has acidosis
because the blood becomes more acid .
Acidosis is caused by too more acid in the body. It can also be divided into
two types: respiratory acidosis and metabolic acidosis.
Why take ABG Measure
Arterial blood gas tests can help healthcare providers interpret conditions that
affect your respiratory system, circulatory system and metabolic processes
(how your body transforms the food you eat into energy), especially in
emergency situations.
Deviation from normal pH is Resisted by 2 Mechanisms
1- Lungs the respiratory component that reacts if the buffering system is not
enough and the lungs help my regulating CO2.
2- Kidneys the Metabolic component and is the last mechanism to work and begins
to eliminate acid.
Respiratory Acidosis
the primary cause of this type of acidosis is respiratory problems. Carbon dioxide
is not adequately blown off during expiration(hypoventilation), causing a buildup
of carbon dioxide in the blood. As mentioned earlier, carbon dioxide mixes with
water to create a weak acid in the body, thus increasing the acidity of the blood.
Sign and symptom

The signs and symptoms of respiratory acidosis involve the central nervous system
and the musculoskeletal system. As carbon dioxide increases, mental status is
altered progressing from confusion and lethargy to stupor and coma if not treated.
The lungs are not able to get rid of excess carbon dioxide. Instead respirations
become more depressed and shallow as muscle weakness worsens.
 Treatment of respiratory acidosis is aggressive management of the
underlying respiratory problem
Respiratory Alkalosis
Respiratory alkalosis occurs when there is excessive loss of carbon dioxide through
hyperventilation when they are severely anxious or fearful.
Patients who hyperventilate have rapid shallow respirations, are lightheaded, and
may become confused. The heart rate increases and the pulse becomes weak and
thread.
Respiratory alkalosis is treated by having patients slow their breathing, breathe

through pursed lips, or cover the mouth and one nostril to reduce airflow.
Metabolic Acidosis
Metabolic acidosis can result from too little bicarbonate in the body. Uncontrolled
diabetes mellitus and end-stage renal failure are the two most common causes of
metabolic acidosis resulting from increased fixed acids.
The GI tract is rich in bicarbonate. Patients experiencing severe diarrhea or prolonged
intestinal suction are at high risk for metabolic acidosis as a result of bicarbonate
(base) loss.
depends on causes
1. Record intake and output accurately to monitor renal function
2. Keep sodium bicarbonate ampules handy for emergency administration.
3. For management of vomiting (common to metabolic acidosis), position the patient
to prevent aspiration.
4. Provide good oral hygiene after incidences of vomiting. Use sodium bicarbonate
washes to neutralize acid in the patient’s mouth.
Metabolic Alkalosis
Metabolic alkalosis results from excessive ingestion of bicarbonate or other bases
into the body or loss of acids from the body. Overuse or abuse of antacids or baking
soda (sodium bicarbonate) can lead to metabolic alkalosis. Because the stomach
contains HCL, prolonged vomiting or gastric suction can cause loss of acid and
also lead to metabolic alkalosis.
1. Dilute potassium when giving via I.V. containing potassium salts. Monitor the
infusion rate to prevent damage and watch out for signs of phlebitis.
2. Watch for signs of muscle weakness, tetany or decreased activity. Monitor vital
signs frequently and record intake and output to evaluate respiratory, fluid and
electrolyte status.
Example
A 32-year-old man presents to the emergency department having been found

collapsed by his girlfriend.
pH: 7.25 pCO2: 55 HCO3: 11
Respiratory Acidosis
A 67 year-old man with a history of peptic ulcer disease presents with persistent
vomiting.
pH: 7.56 pCO2: 45 HCO3: 31
Metabolic Alkalosis
A seventeen-year-old girl presents to the emergency department after an

argument with her boyfriend.
pH: 7.46 pCO2: 30 HCO3: 22
Respiratory Alkalosis
A 62 year-old woman with a history of diabetes and a long smoking history
presents to the emergency department with worsening shortness of breath. On
auscultation of the chest there are widespread crackles and you notice moderate
ankle oedema. ABG shows:
pH: 7.20 pCO2: 40 HCO3: 17
Metabolic Alkalosis

Arterial Blood Gases

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Arterial blood gases

Deviation from normal pH is Resisted by 2 Mechanisms

Sign and symptom

Respiratory alkalosis is treated by having patients slow their breathing, breathe

A 32-year-old man presents to the emergency department having been found

pH: 7.25 pCO2: 55 HCO3: 11

pH: 7.56 pCO2: 45 HCO3: 31

A seventeen-year-old girl presents to the emergency department after an

pH: 7.46 pCO2: 30 HCO3: 22

pH: 7.20 pCO2: 40 HCO3: 17

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