Easy Way To Learn ABGs
Easy Way To Learn ABGs
Easy Way To Learn ABGs
E-Booklet
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1997-2012 Ed4Nurses, Inc. All rights reserved
Nurses often have difficulty interpreting arterial blood gases (ABGs). Confusion often begins with trying to remember many random rules and lacking a standardized approach to ABGs. In addition, nurses often attempt to analyze too many components of the ABG at the same time. The result is often confusion and an incorrect diagnosis. Therefore, the 6 Easy Steps to ABG Analysis were developed to provide nurses with an accurate and systematic method of easily interpreting arterial blood gases. The 6 Easy Steps to ABG Analysis are listed below for easy reference, and will be explained in more detail in the sections that follow. Lastly, examples will be presented with a systematic review of pertinent findings.
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Step
5:
Does
the
CO2
or
HCO3
go
the
opposite
direction
of
the
pH?
Fifth,
does
either
the
CO2
or
HCO3
go
in
the
opposite
direction
of
the
pH?
If
so,
there
is
compensation
by
that
system.
For
example,
the
pH
is
acidotic,
the
CO2
is
acidotic,
and
the
HCO3
is
alkalotic.
The
CO2
matches
the
pH
making
the
primary
acid-base
disorder
respiratory
acidosis.
The
HCO3
is
opposite
of
the
pH
and
would
be
evidence
of
compensation
from
the
metabolic
system.
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Notice that if the pH is lower than 7.35 it indicates acidosis, if the pH is higher than 7.45 it indicates alkalosis. The HCO3 is also acidotic if it is low: less than 22 indicates acidosis. If the HCO3 is higher than 26 it indicates alkalosis. However, if the CO2 is lower than 35 it indicates alkalosis, and if the CO2 is higher than 45 it indicates acidosis. One way to remember this relationship is to use the acronym ROME. Respiratory Opposite Metabolic Equal The CO2 is the respiratory component of the ABG, and if it is low and the pH is high the patient would have a respiratory alkalosis. They move in opposite directions to match. The HCO3 is the metabolic component of the ABG. If the HCO3 is low and the pH is low the patient would have metabolic acidosis. They move in the same direction to match.
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STEP 5 R EFERS T O C OMPENSATION. Compensation is the attempt by the body to maintain homeostasis by correcting the pH. The opposite system will do this. The component of the respiratory system that balances the pH is the dissolved carbon dioxide (CO2) that is produced by cellular processes and removed by the lungs. The component of the renal system that balances the pH is the dissolved bicarbonate (HCO3) produced by the kidneys. The kidneys also help control pH by eliminating hydrogen (H+) ions. The way the two systems interact is through the formation of carbonic acid (H2CO3). Movement through the carbonic acid system is fluid and constant. What this means is that water (H2O) can combine with CO2 and form carbonic acid. If necessary, carbonic acid (H2CO3) can then break up to form hydrogen ions (H+) and bicarbonate (HCO3). This system works in both directions. By balancing back and forth, a normal pH is achieved. The respiratory system balances the pH by increasing or decreasing the respiratory rate, thereby manipulating the CO2 level. Fast and deep breathing blows off CO2. Conversely, slow and shallow breathing retains CO2. The renal system balances pH by producing HCO3 or by eliminating hydrogen ions (H+). The renal system will reflect changes in metabolic activity within the body. For example, a patient in shock will undergo anaerobic metabolism, which produces lactic acid. The production of lactic acid will bind or use up available HCO3 and will be manifested by a decrease in the HCO3 level. Therefore, the HCO3 level is an indicator of metabolic acid- base balance.
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5
Balance must always be achieved by the opposing system. If an adult were on one side of a seesaw and a small child on the other, we would expect the childs side of the seesaw to go up and the adults side to go down. We cannot make the child go down by adding another adult to the adults side. In the same way, our body regulates pH by using the opposing system to balance pH. So if the pH is out of balance because of a respiratory disorder, it will be the renal system that makes the corrections to balance the pH. Conversely, if the renal system is to blame for the pH disorder, the respiratory system will have to compensate. This process is called compensation. Compensation may not always be complete. Complete compensation returns the pH balance to normal. There are times when the imbalance is too large for compensation to restore the pH to normal. This is called partial compensation. Like the seesaw, compensation must come from the opposite system. Step 5 looks analyzes compensation by looking for the system that is going the opposite direction of the pH. Examples with compensation will be presented later.
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7.27 53 50 79% 24
Step 1: The pH is less than 7.35, therefore is acidotic. Step 2: The CO2 is greater than 45, and is therefore acidotic. Step 3: The HCO3 is normal. Step 4: The CO2 matches the pH, because they are both acidotic. Therefore the imbalance is respiratory acidosis. It is acidotic because the pH is acidotic, it is respiratory because the CO2 matches the pH. Step 5: The HCO3 is normal, therefore there is no compensation. If the HCO3 is alkalotic (opposite direction) then compensation would be present. Step 6: Lastly, the PaO2 and O2 sat are low indicating hypoxemia. The full diagnosis for this blood gas is: Uncompensated respiratory acidosis with hypoxemia. This patient has an acute respiratory disorder.
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Step 1: The pH is greater than 7.45, therefore is alkalotic. Step 2: The CO2 is less than 35, and is therefore alkalotic. Step 3: The HCO3 is normal. Step 4: The CO2 matches the pH, because they are both alkalotic. Therefore the imbalance is respiratory alkalosis. It is alkalotic because the pH is alkalotic; it is respiratory because the CO2 matches the pH. Step 5: The HCO3 is normal, therefore there is no compensation. If the HCO3 is acidotic (opposite direction) then compensation would be present. Step 6: Lastly, the PaO2 and O2 sat are normal indicating normal oxygenation. The full diagnosis for this blood gas is: Uncompensated respiratory alkalosis. This patient is probably hyperventilating.
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7.18 44 92 95% 16
Step 1: The pH is less than 7.35, therefore is acidotic. Step 2: The CO2 is normal. Step 3: The HCO3 is less than 22, and is therefore acidotic. Step 4: The HCO3 matches the pH, because they are both acidotic. Therefore the imbalance is metabolic acidosis. It is acidotic because the pH is acidotic, it is metabolic because the HCO3 matches the pH. Step 5: The CO2 is normal, therefore there is no compensation. If the CO2 is alkalotic (opposite direction) then compensation would be present. Step 6: Lastly, the PaO2 and O2 sat are normal indicating normal oxygenation. The full diagnosis for this blood gas is: Uncompensated metabolic acidosis. This patient probably has an acute metabolic disorder such as DKA.
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7.60 37 92 98% 35
Step
1:
The
pH
is
greater
than
7.45,
therefore
is
alkalotic.
Step
2:
The
CO2
is
normal.
Step
3:
The
HCO3
is
greater
than
26,
and
therefore
is
alkalotic.
Step
4:
The
HCO3
matches
the
pH,
because
they
are
both
alkalotic.
Therefore
the
imbalance
is
metabolic
alkalosis.
It
is
alkalotic
because
the
pH
is
alkalotic,
it
is
metabolic
because
the
HCO3
matches
the
pH.
Step
5:
The
CO2
is
normal,
therefore
there
is
no
compensation.
If
the
CO2
is
acidotic
(opposite
direction)
then
compensation
would
be
present.
Step
6:
Lastly,
the
PaO2
and
O2
sat
are
normal.
The
full
diagnosis
for
this
blood
gas
is:
Uncompensated
metabolic
alkalosis.
This
patient
probably
is
losing
stomach
acid
from
vomiting
or
NG
tube
drainage.
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7.30 30 68 92% 14
Step 1: The pH is less than 7.35, therefore is acidotic. Step 2: The CO2 is less than 35, and is therefore alkalotic. Step 3: The HCO3 is less than 22, and therefore is acidotic. Step 4: The HCO3 matches the pH, because they are both acidotic. Therefore the imbalance is a metabolic acidosis. It is acidotic because the pH is acidotic, it is metabolic because the HCO3 matches the pH. Step 5: The CO2 is alkalotic and goes the opposite direction of the pH, so there is compensation. Because the pH is not in the normal range the compensation is called partial. Step 6: Lastly, the PaO2 and O2 sat are low indicating hypoxemia. The full diagnosis for this blood gas is: Partially-compensated metabolic acidosis with hypoxemia. There are a number of conditions that can cause metabolic acidosis: renal failure, diarrhea, poisonings, diabetic ketoacidosis, and shock, to name a few. This patient is probably in shock, because his metabolic acidosis associated with poor oxygenation.
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11
6 Easy Steps to ABG Analysis 1997-2011 Ed4Nurses, Inc. THANK YOU FOR USING THE 6 EASY STEPS TO ABG ANALYSIS. KEEP THIS GUIDE HANDY, AS IT WILL BE VERY HELPFUL THE NEXT TIME YOU HAVE TO ANALYZE A BLOOD GAS.
The best way to become proficient at ABGs is to practice. Analyze all the blood gases you can get your hands on. If you would like additional practice ABGs or ABG case studies visit our website at www.The-ABG-Site.com. Get inspiration, motivation, and nursing news with the Passion 4 Nursing. Find out more at: www.Passion4Nursing.com. Additional copies of 6 Easy Steps to ABG Analysis can be ordered by contacting: Ed4Nurses, Inc. (800) 990-2629 E-mail: [email protected] Web: www.Ed4Nurses.com
This
booklet
and
all
its
contents
are
1997-2011
by
Ed4Nurses,
Inc.
All
rights
reserved.
Unauthorized
copying
and
distribution
is
prohibited.
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12