ABG Exercises 3

Practice Problems Acid-Base Imbalances
interpretation of Arterial Blood Gases (ABG)

Getting an
arterial blood
gas sample
Ulnar Artery
Radial Artery
Blood Gas Report
Acid-Base Information
•pH
•PCO2
•HCO3 [calculated vs measured]
Oxygenation Information
•PO2 [oxygen tension]
•SO2 [oxygen saturation]
PRIMARY AND SECONDARY ACID-BASE DERANGEMENTS
End-Point: A Constant PCO2/[HCO3- ] Ratio
Acid-Base Disorder Primary Change Compensatory Change
Respiratory acidosis PCO2 up HCO3 up

Respiratory alkalosis PCO2 down HCO3 down
Metabolic acidosis HCO3 down PCO2 down
Metabolic alkalosis HCO3 up PCO2 up
STATES OF COMPENSATION
* PaCO2 30-40mmHg HCO3- 20-24 mmol/L pH 7.36-7.44
Uncompensated  80 mmHg N 22 mmol/L  7.06

Partial Comp.  80 mmHg  36 mmol/L  7.30 Respiratory
Fully Comp.  80 mmHg  48 mmol/L N 7.40 Acidemia
Uncompensated  20 mmHg N 22 mmol/L  7.66

Partial Comp.  20 mmHg  16 mmol/L  7.53 Respiratory
Fully Comp.  20 mmHg  12 mmol/L N 7.40 Alkalemia
Uncompensated N 35 mmHg  12 mmol/L  7.16

Partial Comp.  23 mmHg  12 mmol/L  7.34 Metabolic
Fully Comp.  20 mmHg  11 mmol/L N 7.40 Acidemia
Uncompensated N 35 mmHg  48 mmol/L  7.70

Partial Comp.  60 mmHg  48 mmol/L  7.53 Metabolic
Fully Comp.  80 mmHg  48 mmol/L N 7.40 Alkalemia
Steps for interpretation of ABG
1. Know normal values of pH, (PCO2), and (HCO3-).
2. Look at the patient's ABG's to determine what's abnormal
high or low.
3. Correlate the abnormal values of PCO2 and HCO3- to
the abnormality of pH.
4. Name the disorder, the cause, and the source of any
compensation.
Steps
1- Normal values for ABG's:
pH range 7.35 - 7.45
PCO2 40 mm Hg
HCO3- 24 mEq/L
2- Evalutate the patient's ABG's:

is the pH normal? Is it too high or too low? Is it acidosis or
alkalosis?
Is the HCO3- normal? Is it too high or too low? Will it cause
acidosis or alkalosis? Will it correct acidosis or alkalosis?
Is the CO2 normal? Is it too high or too low? Will it cause
acidosis or alkalosis? Will it correct acidosis or alkalosis?
3-Correlate the abnormal values:
 If only one of the two parameters (CO2 or HCO3-) is
abnormal, then its value should be consistent with the pH
(for example, if the CO2 is high, since that causes a drop in
pH, the pH should be low).
If both of the parameter are abnormal, then usually one is

CAUSING the problem, and the other is trying to
CORRECT (COMPENSATE FOR) the problem.
(For example, if the CO2 is high, and is causing the pH
imbalance, then the pH must be low, since CO2 behaves as an
acid. If HCO3- level is also abnormal, then usually it will be
high, to compensate for the low pH, since it is a base.)
4- Name the disorder:
Respiratory acidosis (with or without renal compensation)
Respiratory alkalosis(with or without renal compensation)
Metabolic acidosis (with or without respiratory compensation)
Metabolic alkalosis (with or without respiratory compensation)
5- Suggest a possible cause.

For example, a cause of chronic respiratory acidosis is
emphysema.
Practice Problem 1
ABG's: pH 7.31 PCO2 55 mm Hg HCO3- 28 mEq/L
Normal values for ABG's: pH range 7.35 - 7.45 PCO2

35 - 45 mm Hg HCO3-, 24 - 28 mEq/L
pH is too low - acidosis; PCO2 is too high, would
cause acidosis or correct alkalosis; HCO3- is normal,
neither causing nor correcting imbalance
high PCO2 is correlated with low pH, which is
consistent with patient's report because PCO 2 is
causing the problem, this is respiratory acidosis;
because bicarbonate is normal, there is no
compensation
Practice Problem 2
pH– low = acidosis

PCO2 – high = respiratory acidosis
HCO3 - high = renal compensation
Practice Problem 3

PCO2 – normal; no compensation
HCO3 - low = metabolic acidosis
Practice Problem 4

PCO2 – low = respiratory compensation
HCO3 - low = metabolic acidosis
Practice Problem 5
pH– high = alkalosis

PCO2 – low = respiratory alkalosis
HCO3 - normal; no compensation
Practice Problem 6

PCO2 – low = respiratory alkalosis
HCO3 - low = renal compensation
Practice Problem 7

PCO2 – normal; no compensation
HCO3 – high = metabolic alkalosis
Practice Problem 8

PCO2 – high = respiratory compensation
HCO3 – high = metabolic alkalosis

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Practice Problems Acid-Base Imbalances

interpretation of Arterial Blood Gases (ABG)

End-Point: A Constant PCO2/[HCO3- ] Ratio

Acid-Base Disorder Primary Change Compensatory Change

Respiratory acidosis PCO2 up HCO3 up

Uncompensated  80 mmHg N 22 mmol/L  7.06

Uncompensated  20 mmHg N 22 mmol/L  7.66

Uncompensated N 35 mmHg  12 mmol/L  7.16

Uncompensated N 35 mmHg  48 mmol/L  7.70

2- Evalutate the patient's ABG's:

If both of the parameter are abnormal, then usually one is

5- Suggest a possible cause.

Normal values for ABG's: pH range 7.35 - 7.45 PCO2

pH– low = acidosis

pH– low = acidosis

pH– low = acidosis

pH– high = alkalosis

pH– high = alkalosis

pH– high = alkalosis

pH– high = alkalosis

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