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Determining ABGs (Acid-Base) with Tic Tac Toe

adapted from Mays (1995)

ACID NORMAL ALKALINE

PH <7.35 7.35-7.45 >7.45
7.4

PaCO2 >45 35-45 <35
(respiratory)

HCO3 <22 22-26 >26
(metabolic)

Ask yourself 3 questions:
1. Does the pH indicate acidosis or alkalosis?
2. Is the cause of the pH imbalance respiratory or metabolic?
3. Is there compensation for the acid-base imbalance?

Using the Tic Tac Toe method:

o Place the values on the grid.
o When the PaCO2 is on the same side as the pH = respiratory disorder.
o When the HCO3 is on the same side as pH = metabolic disorder.
o If either of these two values is on the same side as the pH and the other value is opposite
= partial compensation.
o If one of these values is on the same side as the pH and the other is normal = no
compensation.
o If all three values are in different columns, could be mixed results with no compensation.
o If pH is WNL and other values are not, recalculate the pH using 7.40 as exact mid point.
o “Rename” the pH as acidic or alkalotic (pH2) = complete compensation.