ABG’S
Normal values
pH: 7.35 – 7.45 The acid-base balance of the blood.
Acidotic
Alkalotic
|__|__|__|__|__|__|__|__|__|__|
pH: 7.35
7.40
7.45
(Absolute Normal)
PaCO2: 35 – 45 This represents respiratory. Carbon dioxide in the arterial blood that is
controlled by respirations.
>45 = Acidotic
<35 = Basic
HCO3: 22 – 26 This represents metabolic. (Bi-carbonate levels) Concentration that is controlled
via the kidneys.
>26 = Basic
< 22 = Acidic
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ABG Tic-Toe – Respiratory Acidosis (Partially Compensated)
pH:7.23 (Acidic *Deciding factor*.)
PaCO2: 50 (Acidic.)
HCO3: 30 (Trying to balance both.)
Acid
pH
PaCO2
Normal
Base
HCO3
ABG Tic-Toe – Respiratory Alkalosis (Full compensation)
pH:7.42 (WNL, but it leans towards the alkalotic side.)
PaCO2: 32 (Alkalotic.)
HCO3: 18 (Trying to fix the imbalance.)
Acid
HCO3
Normal
pH
Base
PaCO2
ABG Tic-Toe – Metabolic Acidosis (Full compensation)
pH:7.37 (WNL but leans towards the acidic side.)
PaCO2: 33 (Trying to fix the imbalance.)
HCO3: 17 (Acidic.)
Acid
Normal
HCO3
pH
Base
PaCO2
ABG Tic-Toe – Respiratory Acidosis (Uncompensated)
pH:7.22 (Acidic *Deciding factor*.)
PaCO2: 49 (Acidic.)
HCO3: 24 (WNL. Not trying to compensate.)
Acid
pH
PaCO2
Normal
HCO3
Base
Respiratory Acidosis – Retention of CO2 by the Lungs
Causes:
- COPD
- Barbiturate OD (Medications that cause you to relax or feel drowsy. They are also used for treating
epilepsy as well as seizures, insomnia and other conditions as well. These medications will also help
someone fall asleep quickly and pleasantly which is great for pre-anesthesia sedation and anxiety
reduction.)
- Chest wall abnormality
- Severe Pneumothorax
- Atelectasis (Complete or partial collapse of a lung or a section of a lung.)
- Guillain – Barre Syndrome (Immune system attacks the nerves.)
- Pneumonia.
-Asthma.
Signs and Symptoms:
- Rapid shallow respirations
- Decreased BP w/vasodilation. (Hypotension)
- Headache
- Hyperkalemia (K+)
- Dysrhythmias (Due to increase K+ levels)
- Drowsiness (Somnolence – Strong desire to sleep or feeling of drowsiness)
- Disorientation/Confusion
- Muscle Weakness and Hyperreflexia
-Dyspnea (Difficult or labored breathing)
- Hypoventilation Hypoxia
(CNS depression, Pulmonary Edema, Respiratory Arrest, Airway Obstruction)
Treatment:
- Increase the Respirations
- Repositioning of the patient
- Maintain a patent airway
- Mechanical ventilation
(Increase the RR (Respiration Rate), Increase the Vt (Tidal Volume))
Respiratory Alkalosis – Loss of CO2 from the Lungs
Causes:
- Hyperventilation
- Hypoxia
- Brain Injury
- Anxiety
- Fever
- Mechanical Hyperventilation
- Pneumothorax
- Pulmonary Embolism
- Salicylate poisoning (Aspirin)
Signs and Symptoms:
- Seizures
- Palpations
- Perspiration / diaphoresis
- Deep Rapid Breathing
- Hyperventilation
- Tachycardia
- Hypokalemia (K+)
- Numbness and Tingling of Extremities
- Lethargy and Confusion
- Lightheadedness
- Nausea, Vomiting
- Decreased Blood Pressure
Treatment:
- Decrease the Respiration Rate
- Administer sedatives
- Rebreather mask
- Mechanical ventilation
(Lower RR (Respiration Rate), Sedate, Lower Vt (Tidal Volume))
Metabolic Acidosis – Low in Acid or High in Base
Causes:
- Increased Acid Gain
(Shock, Ketoacidosis *DKA)
-Decreased Acid Elimination
(Renal Failure)
- Decreased Bicarbonate Production
(Dehydration, Liver Failure)
- Increased Bicarbonate Elimination
(Diarrhea, Fistulas - an abnormal connection between an organ, vessel, or intestine and another
organ, vessel or intestine, or the skin)
-Severe Burns.
Signs and Symptoms:
- Kussmaul Respirations (Compensatory Hyperventilation)
- Low BP
- Muscle Twitching
- Warm, Flushed Skin (Vasodilation)
- Decreased muscle tone
- Decreased Reflexes (w/ confusion and drowsiness)
-Nausea, Vomiting
-Malaise
-Tachypnea
-Hypotension
-Confusion
Treatment:
- Improve oxygenation
- Treat Cause
(DKA, Diarrhea, Renal Failure)
Metabolic Alkalosis – Too much acid, not enough Bicarbonate
Causes:
- Severe Vomiting.
- Gastric Suction.
- Diuretic Therapy.
- K+ Deficit.
- Excessive *NaHCO3 Sodium Bicarbonate Intake* + antacids
- Excessive Mineralocorticoids.
- Decreased *H+ Acid* (NG Suctioning, Prolonged Vomiting, Hypercortisolism)
Signs and Symptoms:
- CNS Excitation.
- Twitching.
-Decreased Respirations.
- Restlessness.
- Dysrhythmias (Tachycardia from Low K+).
- Compensatory Hypoventilation.
- Confusion.
- Nausea / Vomiting / Diarrhea
- Dizziness with increased irritability.
- Increased anxiety / seizures.
- Tremors / Muscle Cramps / Paresthesia in Fingers and Toes. (Low Serum Ca++)
Treatment:
- Saline Infusion
- Potassium Replacement.
- Magnesium Replacement.
- Hydrochloric Acid Infusion.
- Stopping the Medications that caused the condition.