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Abg and Its Interpretation

The document discusses the basics of acid-base balance, arterial blood gas (ABG) testing including indications, contraindications, technique, normal values and interpretation. It also presents 4 clinical cases to demonstrate different acid-base disorders and their ABG and clinical findings.

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Ritaja Sathe
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37 views

Abg and Its Interpretation

The document discusses the basics of acid-base balance, arterial blood gas (ABG) testing including indications, contraindications, technique, normal values and interpretation. It also presents 4 clinical cases to demonstrate different acid-base disorders and their ABG and clinical findings.

Uploaded by

Ritaja Sathe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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ACID-BASE BASICS, ARTERIAL

BLOOD GAS (ABG) AND ITS


INTERPRETATION
Dr.Ritaja Sathe

2nd yr M.D.(scholar)

Dept. of Kayachikitsa

C.O.A., BVDU
AGENDA:

• Basics of acid-base balance


• What is ABG?
• Indications
• Contraindications
• Sites
• Complications
• Equipment and technique
• Normal values
• Interpretation
Approx. 15,000 mmol
Catabolism of
of CO2 and 50 to 100
carbohydrates, fats,
mEq of H+ ions
and proteins.
produced

H2O + CO2 ↔ H2CO3 ↔ H+ + HCO3-


(carbonic anhydrase)

Physiologic pH.

metabolic processes  generation &


respiratory processes 
excretion of HCO3- and H+ ions in
adjust pCO2
kidneys
• Acid-base homeostasis disturbed by metabolic acidosis/alkalosis
 respiratory compensation reqd. begins immediately.
i.e. 1mEq/L of HCO3  pCO2 by1.2 mmHg
Metabolic acidosis

Anion Gap Acidosis Non-anion Gap Acidosis

• Anion Gap = (Sr.Na+) – [(Sr.Cl−) + (Sr.HCO3−)]

• Anion gap is a way of measuring “unmeasured” anions in the blood- eg. lactate, beta
hydroxybutyrate, albumin, acetoacetate etc.

• Normal values: between 8-12 mEq/L

• Common causes of Anion gap acidosis:


- Lactic acidosis
- Ketoacidosis
- Toxin ingestions
- Rhabdomyolysis
- Renal failure
• Non-anion Gap Acidosis:

 Bicarbonate loss, but without the presence of an additional, pathologic anion.

 Cl−] is increased to maintain electroneutrality and the calculated anion gap remains
normal

 D/D: GI losses v/s Renal etiology


Metabolic Alkalosis:

• Induced d/t diuretics


• Loss of gastric secretions due to vomiting or nasogastric suctioning
• Bicarbonate administration
• Massive transfusion, or fresh frozen plasma administration
• Causes:
- Gastric secretion losses
- Post hypercapnic Alkalosis
- Severe Hypokalemia etc
Respiratory Acid-base disorders:
 Altered plasma CO2 levels as measured on ABG by the
PaCO2

Respiratory Acidosis
• PaCO2, pH

Respiratory Alkalosis
• PaCO2, pH
Arterial Blood Gas:
PaO2 (Oxygen PaCO2 (Carbon
tension) dioxide tension)

Oxyhaemoglobin
pH (Acidity)
(SaO2)

HCO3 (Bicarbonate)
Other components of ABG:

Lactates Carboxyhaemoglobin Haemoglobin levels

Electrolytes- Na+, K+,


Anion gap
Cl-, Ca++
INDICATIONS:
• Acid-base status of critically ill patients.
• Warning signs include-
- Sudden/abrupt onset dyspnea/ worsening dyspnea/ sudden desaturation.
- Haemodynamic instability like hypotension, tachycardia, cool extremities i.e. s/o
impending shock.
- Sudden arrhythmias- AF, V.tach with pulse, Heart blocks etc to r/o hypo/hyperkalemia.
- To assess acid base status of patients with AKI/ CKD conditions.
• To find out partial pressures of oxygen (PaO2) / carbon dioxide (PaCO2) and monitor
the same in a patient on NIV or mechanical ventilator so as to find out the
ventilation/perfusion status.
• To measure P/F ratio in ARDS patients and alter the ventilator settings accordingly.
CONTRAINDICATIONS:

• Local infections
• Recent thrombolysis
• Severe coagulopathy
• Presence of AV fistulas
• Presence of peripheral vascular disease of the limb
• Distorted anatomy
SITES:

• Radial artery
• Femoral artery
• Other sites- brachial artery
COMPLICATIONS:
• Arteriospasm (Involuntary contraction of artery)
• Haematoma
• Fainting/ vasovagal response
Sampling errors:
Inappropriate collection or handling of ABG specimen,
including-
- Presence of air in sample.
- Collection of venous rather than arterial blood.
- Improper quantity of heparin in syringe.
- Delay in specimen transportation.
EQUIPMENT & TECHNIQUE:

• Gloves

• 2 cc syringe, pre-filled with Heparin, ~0.1ml

• Spirit swab

• Cotton swab

• Ice pack to transport the sample


NORMAL VALUES:
ABG PARAMETER NORMAL VALUE
pH 7.35 to 7.45
PaCO2 35 to 45 mm Hg
PaO2 75-100 mmHg
HCO3 22 to 26 mEq/L
Lactate 0.6 to 2.0 mmol/L
COHb < 2%
Anion gap between 8-12 mEq/L
INTERPRETATION:
CASE 1:
• Mr.Gupta, 60 yrs old retired widower, living alone visits your hospital with C/O-
Shortness of breath and tingling in fingers. His breathing is shallow and rapid. He denies
diabetes; blood sugar is normal. There are no ECG changes. He has no significant
respiratory or cardiac history. He takes several anti-anxiety medications. He says he has
had anxiety attacks before. While being worked up for chest pain an ABG is done:
• ABG results are:
• pH= 7.48
• PaCO2= 28
• HCO3= 22
• PaO2= 85

Respiratory Alkalosis
• CASE 2:

• Mr.Indulkar, 56 yrs. old gentleman/C/O DM Type II, presents with dyspnea, abdominal pain,
nausea and vomiting. He is tachypneic on presentation, though maintains an O2 saturation~
96-97% on R.A. B.P. is 126/70mmHg, P- 110/min. His BSL-R is 426 mg/dl. He also gives
H/o increased urinary frequency and feverishness since past one week and poor drug
compliance due to reduced oral intake.

• ABG shows:
• pH= 7.18
• PaCO2= 24
• HCO3= 12.6
• PaO2= 87

Metabolic acidosis
• CASE 3:

• Mrs.Gosavi, 38 yrs old lady, admitted with intestinal obstruction has a nasogastric tube
placed. For several days, large amounts of fluid were suctioned from the nasogastric
tube. Arterial blood gases and electrolytes were as follows.

• Her ABG reveals:


• pH= 7.53
• PaCO2= 49
• HCO3= 39
• PaO2= 95

Metabolic alkalosis
• CASE 4:

• A 62-year-old man with a history of chronic bronchitis is examined in the emergency


department for shortness of breath and expectoration of large amounts of yellow sputum.
P- 96/min, B.P.~ 130/70mmHg, SpO2-77% on R.A. ECG is insignificant. BSL-R IS
148mg/dl.

• ABG reveals:
• pH= 7.21
• PaCO2= 80
• HCO3= 34
• PaO2= 39

Compensated Respiratory Acidosis with hypoxia

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