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1.

Know the Normal Values


Know the normal and abnormal ABG values when you review the lab reports.
2. Check for Acidosis or Alkalosis
The first thing you need to determine when checking ABG results is the acidity of the blood which is determined by
the value of the pH. The pH level in a healthy human should be between 7.35 to 7.45. Your body is constantly
striving to keep pH in balance.
pH level below 7.35 is Acidosis
pH level above 7.45 is Alkalosis

3. Determine If
the Acid Base is
Respiratory or Metabolic
Next thing you need to determine is whether the acid base is Respiratory or Metabolic.
pCO2 = Respiratory
HCO3 = Metabolic
4. Remember ROME
Still, it all boil down to mnemonics. The mnemonic RO-ME.
Respiratory Opposite
When pH is up, pCO2 is down = Alkalosis
When pH is down, pCO2 is up = Acidosis
Metabolic Equal
When pH is up, HCO3 is up = Alkalosis
When pH is down, HCO3 is down = Acidosis
5. Tic-Tac-Toe
And yes, ABG problems work using the Tic-Tac-Toe method. All you have to do is make a blank chart a bit like a tic
tac toe chart.

6. Mark the Chart


Using the lab result values, mark them on your Tic-Tac-Toe chart. Now begin with this given example.
pH 7.26, pCO2 32, HCO3 18
pH is LOW = ACID so place pH under Acid
pCO2 is LOW = BASE so place pCO2 under Base
HCO3 is LOW = ACID so place HCO3 under Acid
Your chart should go like this:

7. Match It up
In this step, look at which column matches up with the pH. In this case HCO3 goes with pH. HCO3 is considered
Metabolic (shown in step 3), and both are under Acid, so this example implies Metabolic Acidosis.
8. Determine Compensation
The last step is to determine if the ABG is Compensated, Partially Compensated, or Uncompensated.
If pH is NORMAL, pCO2 and HCO3 are both ABNORMAL = Compensated
If pH is ABNORMAL, pCO2 and HCO3 are both ABNORMAL = Partially Compensated
If pH is ABNORMAL, pCO2 or HCO3 is ABNORMAL = Uncompensated
Therefore this ABG is METABOLIC ACIDOSIS, PARTIALLY COMPENSATED .
By applying the steps above, interpret the following ABGs.
pH 7.44, PaCO2 30, HCO3 21
pH is NORMAL = NORMAL so place pH under Normal
pCO2 is LOW = BASE so place pCO2 under Base
HCO3 is LOW = ACID so place HCO3 under Acid
*Since the acidity of the blood is determined by the value of the pH, determine whether the normal pH is
SLIGHTLY ACIDIC or SLIGHTLY BASIC. In this example, pH is NORMAL but SLIGHTLY BASIC therefore it
is ALKALOSIS.

Your chart should go like this:

In this case PACO2 goes with pH. PACO2 is considered Respiratory (shown in step 3), and both are under Basic, so
this example implies Respiratory Alkalosis. The pCO2 is also abnormal. When pH is NORMAL and pCO2 and
HCO3 are both ABNORMAL, it indicates FULL COMPENSATION.
Therefore this ABG is RESPIRATORY ALKALOSIS, FULLY COMPENSATED.
pH 7.1, PACO2 40, HCO3 18
pH is LOW = ACID so place pH under Acid
pCO2 is NORMAL = NORMAL so place pCO2 under Normal
HCO3 is LOW = ACID so place HCO3 under Acid
Your chart should go like this:

In this case HCO3 goes with pH. HCO3 is considered Metabolic (shown in step 3), and both are under Acidic, so this
example implies Metabolic Acidosis. The pCO2 is also abnormal. When pH is ABNORMAL, pCO2 or HCO3 is
ABNORMAL, it indicates UNCOMPENSATION.
Therefore this ABG is METABOLIC ACIDOSIS, UNCOMPENSATED.

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