Interpreting an arterial blood gas
result
Condition Primary Disturbance
Compensatory Factor
Metabolic Decreased
Decreased PaCO2
Acidosis HCO3
Metabolic Increased
Increased PaCO2
Alkalosis HCO3
Respiratory
Increased PaCO2 Increased HCO3
Acidosis
Respiratory
Decreased PaCO2 Decreased HCO3
Alkalosis
Acid-Base Balance
A pH of 7.0 is neutral.
• Blood is normally slightly basic with a pH range of
7.35 to 7.45
Below < 7.35 the blood is considered acidic
*Changes in body system functions that occur in an
acidic state include a decrease in the force of cardiac
contractions, a decrease in the vascular response to
catecholamines, and a diminished response to the
effects and actions of certain medications.
Above > 7.45 the blood is considered alkaline.
*An alkalotic state interferes with tissue oxygenation
and normal neurological and muscular functioning.
Significant changes in the blood pH above 7.8 or
below 6.8 will interfere with cellular functioning.
Assessing Oxygenation
• Pa02 between 80-100 mmHg is normal
• Pa02 <60 mmHg, hypoxic state exists
• Pa02>100 mmHg, hyperoxic state exists.
• The normal arterial oxygen saturation range is
94% to 100%.
Assessing Ventilatory status.
• PaCO2 of 35-45 is normal
• PaCO2 <35 mmHg causes "alkalosis" (alveolar
hyperventilation or hypocarbia)
• PaCO2 >45 mmHg, is termed "acidosis"
(ventilatory failure or hypercarbia)
Assessing metabolic component
• Bicarbonate between 22-28 mEq/l is within normal
limits.
• Bicarbonate (HCO3-) <22 mEq/l is termed
"acidosis".
• Bicarbonate is >28 mEq/l it is termed "alkalosis".
Assessing pH
Respiratory Acidosis
Respiratory acidosis is caused by the build-up of
carbon dioxide in the blood that results from poor
lung function or slow breathing (respiratory acidosis).
Causes:
• Central nervous system depression related to head
injury or to medications such as narcotics,
sedatives, or anesthesia
• Impaired respiratory muscle function related to
spinal cord injury, neuromuscular diseases, or
neuromuscular blocking drugs
• Pulmonary disorders such as atelectasis,
pneumonia, pneumothorax, pulmonary edema, or
bronchial obstruction
• Massive pulmonary embolus
• Hypoventilation due to pain, chest wall
injury/deformity, or abdominal distension
Metabolic acidosis
Metabolic acidosis is defined as a bicarbonate level
of less than 22 mEq/L with a pH of less than 7.35.
Metabolic acidosis is caused by either a deficit of
base in the bloodstream or an excess of acids, other
than CO2.
Causes:
• Renal failure
• Ketoacidosis caused by diabetes, chronic
alcoholism, malnutrition, fasting
• Anaerobic metabolism or lactic acid build-up such
as in shock
• Lactic acidosis from exogenous toxins such as
carbon monoxide & cyanide poisoning
• toxins metabolized to acids can be caused by
alcohol, methanol, ethylene glycol and salicylates
Respiratory alkalosis
Respiratory alkalosis is defined as a pH greater than
7.45 with a PaCO2 less than 35 mm Hg. Any
condition that causes hyperventilation can result in
respiratory alkalosis.
Causes:
• Psychological responses, such as anxiety or fear
• Pain
• Increased metabolic demands, such as fever,
sepsis, pregnancy, or thyrotoxicosis
• Medications, such as respiratory stimulants.
• Central nervous system lesions
• Low levels of oxygen in the blood
Metabolic alkalosis
Metabolic alkalosis is defined as a bicarbonate level
greater than 26 mEq/liter with a pH greater than
7.45. Either an excess of base or a loss of acid within
the body can cause metabolic alkalosis.
Causes of excess base:
• ingestion of antacids
• excess use of bicarbonate
• use of a lactate in dialysis
Causes of loss of acids:
• vomiting
• gastric suction
• hypochloremia
• excess administration of diuretics
• high levels of aldosterone
Interpretation Guidelines
Step 1: Look at pH - this is the starting point.
1. If within normal range, a normal or compensated state
exists.
2. If outside normal limits, assess whether acidosis or
alkalosis is present. The body never overcompensates.
Whichever state exists on the pH scale is the primary
abnormality.
Example 1
Jane Doe is a 45-year-old female admitted to the
nursing unit with a severe asthma attack. She has
been experiencing increasing shortness of breath
since admission three hours ago. Her arterial blood
gas result is as follows:
pH 7.22
PaCO2 55
HCO3- 25
Follow the steps:
1. Assess the pH. It is low (normal 7.35-7.45)
2. Assess the PaCO2. It is high (normal 35-45) and in
the opposite direction of the pH.
3. Assess the HCO3. It has remained within the
normal range (22-26).
Example 2
John Doe is a 55-year-old male admitted to your
nursing unit with a recurring bowel obstruction. He
has been experiencing intractable vomiting for the
last several hours despite the use of antiemetics.
Here is his arterial blood gas result:
pH 7.50
PaCO2 42
HCO3- 33
Steps:
1. Assess the pH. It is high (normal 7.35-7.45),
therefore, indicating alkalosis.
2. Assess the PaCO2. It is within the normal range
(normal 35-45).
3. Assess the HCO3. It is high (normal 22-26) and
moving in the same direction as the pH.
Alkalosis is present (increased pH) with the HCO3
increased, reflecting a primary metabolic problem.
Treatment of this patient might include the
administration of I.V.fluids and measures to reduce
the excess base.
