ARTERIAL BLOOD GAS

ANALYSIS

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ARTERIAL BLOOD - GAS - ANALYSIS

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 Definition
Purpose
Indication
Information provided by ABG
Normal values
When ABG is ordered
Acidosis and alkalosis
Extraction
Factors affecting ABG

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ABG
Blood gas analysis, also called arterial blood

gas (ABG) analysis, is a test which measures

the amount of oxygen (O2) and carbon dioxide
(CO2) in the blood, as well as the acidity (PH)
of the blood.

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PURPOSE
An ABG is typically requested to determine the PH

of the blood and the partial pressure of the oxygen

(PaO2) and partial pressure of the carbon dioxide (
Pa Co2) within it.
An ABG analysis evaluate how effectively the lung

are delivering the oxygen to the blood and how

efficiently they are eliminating carbon dioxide from
it.
The test also indicate how well the lungs and kidneys
are interacting to maintain normal blood PH ( acid
base balance).

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 If the PH become deranged, normal cell

mechanism is affected.
In addition, the acid base component of the

test provides information on kidney function

too.

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 Blood gas studies are usually done to assess

respiratory disease and other condition that may
affect the lungs, and to manage patients receiving
oxygen therapy ( respiratory therapy).
It is used to assess the effectiveness of the
gaseous exchange and ventilation, be it
spontaneous or mechanical.

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 ABG allows patients metabolic status to be

assessed too, giving an indication of how they

are copying with their illness.
It would therefore seem logical to request an
ABG on any patient who is or has the potential
to become critically ill.
This includes patients in critical care areas and
those on wards who trigger early warning
scoring systems.
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Indications for ABG;

(1) Severe respiratory or metabolic disorders

(2) Clinical features of hypoxia or hypercapnia
(3) Shock
(4) Sepsis
(5) Decreased cardiac output
(6) Renal failure
(7) Ideally any baby on oxygen therapy
(8) Inborn errors of metabolism

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Information provided by an ABG;

PaO2;
This is the partial pressure of the oxygen

dissolved within the arterial blood and will

determine oxygen binding to haemoglobin
(SaO2).
Normally low reading indicate hypoxia.
Normal values; 9.3 13.3 kpa or 80 100
mmHg.

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 PaCo2;
this is the partial pressure of carbon dioxide
dissolved with in the arterial blood. It is used to
assess the effectiveness of ventilation. A high
PaCo2 (respiratory acidosis) indicates under
ventilation, a low PaCo2 ( respiratory alkalosis)
indicate hyper or over ventilation.
Normal values; 4.7 to 6.0 kpa or 35 45 mmhg,
although in chronic pulmonary diseases it may be
considerably higher and still normal for that
patient.
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 SaO2
Oxygen saturation measures how much of the

haemoglobin in the red cells is carrying

oxygen. Although similar to SpO2 ( measured
by pulse oximeter), it is more accurate.
Normal values; 97% and above, although
levels above 90% are often acceptable in
critically ill patients.
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 PH
The PH measures hydrogen ions (H+) in

blood.
Normal values; 7.35 7.45
A PH less than 7.35 is called acid and PH
greater than 7.45 is called basic alkaline).

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 HCO3- ( bicarbonate)
Bicarbonate is a chemical (buffer) that keeps the PH of

blood from becoming too acidic or too basic and indicate

whether a metabolic problem is present (such as keto
acidosis).
A low HCO3- indicate metabolic acidosis and a high value
indicate metabolic alkalosis.
HCO3 levels can also become abnormal when the kidneys
are working to cobensate for a respiratory issues to
normalize the blood PH.
Normal value; 22 26 mmol/l

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BASE EXCESS
Base excess is used for the assessment of the

metabolic component of acid base disorders,

and indicate whether the patient has metabolic
acidosis or metabolic alkalosis.

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 A negative base excess indicate that the

patient has metabolic acidosis (primary or

secondary to respiratory alkalosis).
A positive base excess indicate that the
patient has metabolic alkalosis (primary or
secondary to respiratory acidosis).
Normal values; -3 to +3mmol/l

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NORMAL RESULTS
PaO2
PaCo2
Oxygen content
SaO2
HCO3 PH

; 80 100 mm Hg
; 35 45 mm Hg
; 15 23 %
; 94 100%
; 22 26mmhg
; 7.35 7.45

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WHEN ABG IS ORDERED...?

When you have symptoms of O2 / CO2 or PH

imbalance such as shortness of breath.

Patient who are on oxygen may have their blood
gases measured at intervals to moniter effectivness of
treatment.
Head or neck trauma, injury that may affect breathing.
Checking the blood gases from the umbilical cord of
newborns may uncover respiratory problems as well
as determine the babys acid / base status.
Testing is usually done if a newborns condition
indicates that he / she may be having difficulty in
breathing.

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RESPIRATORY ACIDOSIS
Respiratory acidosis is characterised by a lower PH

and an increased PCO2, and is due to respiratory

depression (not enough O2 and CO2 out).
Causes;

CNS depression
Pleural disease
COPD/ARDS
Musculoskeletal disorders
Compensation for metabolic alkalosis

ph,

CO2,

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Ventilation

RESPIRATORY ALKALOSIS
Respiratory alkalosis, characterised bye a raised PH

and decreased PCO2, is due to over ventilation.

pH

CO2

Ventilation

CAUSES;

Intracerebral hemorrhage
Salicylate and Progesterone drug usage
Anxiety lung compliance
Cirrhosis of the liver
Sepsis

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METABOLIC ACIDOSIS
It is characterised by a lower PH and

decreased HCO3- , the blood is too acidic on a

metabolic / kidney level.
Causes include diabetes, shock, and renal
failure.

pH, HCO3

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CAUSES
Metabolic Gap Acidosis

Acetazolamide
RTA (Calculate urine anion gap)
Diarrhea
Pancreatic Fistula

Non Gap Metabolic Acidosis

M - Methanol
U - Uremia
D - DKA
P - Paraldehyde
I - INH
L - Lactic Acidosis
E - Ehylene Glycol
S - Salicylate

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METABOLIC ALKALOSIS
It is characterised by an elevated PH and increased

HCO3- and is seen in hypokalemia, chronic vomiting

(losing acid from stomach), and sodium bicarbonate
overdose.
Causes

Vomiting
Diuretics
Chronic diarrhea
Hypokalemia
Renal Failure

pH

HCO3
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Extraction;

Arterial blood for blood gas analysis is usually

extracted by a phlebotomist, nurse, respiratory

therapist or Dr.
Blood is most commonly drawn from the
radial artery, because it is easily accessible,
can be compressed to control bleeding and has
less risk for occlusion.

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 The femoral artery (or less often), the brachial

artery is also used, especially during

emergency situations or with children.
Blood can also taken from an arterial catheter
placed in one of these arteries.

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FACTORS AFFECTING ABG

VALUE
Extreme of age; neonatal to geriatrics
Exercise
Pregnancy
Sleep
Change in the body temperature
High altitude

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 Extreme of age;

Neonatal; neonates have many changes

going on in the initial life progress foetal
circulation changes traumatically in the 1st
hours and days of life.
Geriatrics; decreased cardiac out put,

residual volume of lung, breathing capacity

affects ABG.

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 Exercise ;

Increasing activity from rest resulting in

increased O2 consumption in patient with
cardiopulmonary dysfunction. In the normal
population the human body compensate by
increasing O2 consumption to meet the work
load.

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 Pregnancy;

Hormonal and mechanical factors have an

negative affect on cardiopulmonary function.
During last trimester women often observe

shorting of breath and difficulty in taking a

deep breath secondary to diaphragm
encroachment.

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 During sleep;

There is decrease in minute ventilation.

High altitude;

Low barometric pressure associated with

high altitude signifies decreased in the amount
of O2 available to the individual.

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 Change in body temperature;

Increased temperature can increase

metabolism. Therefore increase O2
consumption.

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