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ABG Made Simple: DR Satish Deopujari Founder National Chairman (India) PICC 1998

This document provides guidance on interpreting arterial blood gas (ABG) results through a 5-step method. It begins by looking at the pH to determine if the patient is acidemic or alkalemic. The second step identifies if the disturbance is respiratory or metabolic based on changes in PaCO2 and bicarbonate. For respiratory issues, the third step judges if it is acute or chronic. The fourth step checks if metabolic compensation is appropriate. Finally, clinical correlation is considered. The document also outlines normal ABG values and limits of compensation for different acid-base disturbances.

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Bimantoko Hadi Sriyono
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129 views

ABG Made Simple: DR Satish Deopujari Founder National Chairman (India) PICC 1998

This document provides guidance on interpreting arterial blood gas (ABG) results through a 5-step method. It begins by looking at the pH to determine if the patient is acidemic or alkalemic. The second step identifies if the disturbance is respiratory or metabolic based on changes in PaCO2 and bicarbonate. For respiratory issues, the third step judges if it is acute or chronic. The fourth step checks if metabolic compensation is appropriate. Finally, clinical correlation is considered. The document also outlines normal ABG values and limits of compensation for different acid-base disturbances.

Uploaded by

Bimantoko Hadi Sriyono
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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ABG made simple

Dr Satish Deopujari
Founder National Chairman(India)
PICC 1998
[email protected] [email protected]
deopujari.com

Dr Vivek Shivhare
Paediatric Intensivist
Conventional ABG measures only 3 variables
Bicarbonate is CALCULATED from pH and PaCO2

pH PaCO2 PaO2

Acid Base Assessment Respiratory Assessment


+
Clinical Evaluation

Complete Assessment
----- XXXX Diagnostics ------

Blood
248
Gas
05:36
Report
Jul 22 2000
Blood Gas Report
Pt ID 2570 / 00
o
Measured37.0 C Measured Values : most
pH 7.463
pCO2
pO2
44.4
113.2
mm Hg
mm Hg
important
o
Corrected 38.6 C
pH 7.439
pCO2
pO2
47.6
123.5
mm Hg
mm Hg
Temperature Correction:
Calculated Data
HCO3 act 31.1 mmol / L
HCO3 std 30.5 mmol / L
BE 6.6 mmol / L
O2 CT 14.7 mL / dl Calculated Data:
O2 Sat 98.3 %
ct CO2 32.4 mmol / L
pO2 (A - a) 32.2 mm Hg
pO2 (a / A) 0.79

Entered Data
Temp 38.6 oC Entered Data:
ct Hb 10.5 g/dl
FiO2 30.0 %
The essentials

The Blood Gas Report:


Normal values
pH 7.40 + 0.05
PCO2 40 + 2 mm Hg
PO2 80 - 100 mm Hg
Calculated
HCO3 24 + 2 mmol /L

O2 Sat >95
Always mention and see FiO2
The

5 Steps for
Successful
Blood Gas Analysis
Step 1
Look at the pH

Is the patient acidemic pH less than 7.35


alkalemic pH more than 7.45
Step 2
Look who is responsible for this change ( culprit )?

Acidemia: With HCO3- < 22 mmol/L = Metabolic


With PaCO2 > 42 mm Hg = Respiratory

Alkalemia: With HCO3- > 26 mmol/L = Metabolic


With PaCO2 < 38 mm Hg = Respiratory
Step 3 Respiratory acidosis
If there is a Compensation in respiratory
primary respiratory abnormality can be judged by
acidosis , is it
correlating change in HCO3- with
acute or chronic ?
change in PaCO2.

With every 10mmHg increase in


PaCO2 above 40, increase in Bicarb
by 1 : Acute respiratory acidosis
by 4 to 5 : Chronic respiratory
acidosis
Respiratory alkalosis
Compensation in respiratory

Step 3 abnormality can be judged by


correlating change in HCO3- with
If there is a
change in PaCO2.
primary
respiratory
alkalosis , is it With every 10mmHg decrease in
acute or chronic? PaCO2 below 40, decrease in Bicarb
by 2 : Acute respiratory alkalosis
by 4 to 5 : Chronic respiratory
alkalosis
Step 4
If disturbance is metabolic, is the respiratory
compensation appropriate ?

For metabolic acidosis:


Expected PaCO2 = (1.5 x [HCO3-]) + 8 + 2 )

For metabolic alkalosis:


Expected PaCO2 = 0.7 x HCO*
) − 24 + 40 ± 2

Actual PaCO 2 more than expected : additional respiratory


acidosis
Actual PaCO 2 less than expected : additional respiratory
alkalosis
160

Resp Meta
Acidosis Alkalosis

CO2 40

Meta Resp
Acidosis Alkalosis

6.8 pH 7.85
7.4
5
th step

Clinical correlation
Same direction
HCO3 pH META.
Same direction

PaCO2 pH RESP.

Opposite direction
HCO3-
Metabolic Acidosis
Normal Range

Primary disorder

pH
Bicarb. Change the pH
Normal Range
in same direction

PaCO2
Normal Range
Hyperventilation
Compensation
Metabolic Alkalosis
Primary disorder
HCO3-
Normal Range

Bicarb. Change the pH


in same direction
pH

Normal Range

PaCO2
Compensation Hypoventilation
Normal Range
PaCO2 Primary disorder Respiratory Acidosis
Normal Range

pH
Normal Range
PaCO2 Change the pH
in opposite direction

HCO3- Compensation
Renal Compensation
Normal Range
PaCO2
Respiratory Alkalosis
Normal Range

Primary disorder

PaCO2 Change the pH


in opposite direction
pH

Normal Range

HCO3-
Normal Range
Compensation Renal Compensation
INTERPRETATION OF A.B.G.
FOUR STEP METHOD OF DEOSAT (Deopujari Satish)

1) LOOK FOR pH

2) WHO IS THE CULPRIT ?


(PaCO2 MOVES pH in opposite direction, Bicarb in same direction)

3) IF RESPIRATORY : ACUTE / CHRONIC ?

4) IF METABOLIC : Compensation ?/ Anion gap ?

CLINICAL CORRELATION
Limits of compensation
METABOLIC ACIDOSIS
PaCO2 = Not less than 10

METABOLIC ALKALOSIS
PaCO2 = Maximum 60

RESPIRATORY ACIDOSIS
BICARB = Maximum 35

RESPIRATORY ALKALOSIS
BICARB = Not less than 13

( Limits of compensation may vary + 2 )


Its all about concepts, understanding
& mathematics of ABG
Plus
The creativity of BLOSSOM

THANKS

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