An arterial blood gas (ABG) is a blood test that measures the acidity (pH) and the levels of

oxygen and carbon dioxide in the blood. Blood for an ABG test is taken from an artery
whereas most other blood tests are done on a sample of blood taken from a vein. This test
is done to monitor several conditions that can cause serious health complications especially
to critically ill individuals.
Every day, a lot of nursing and medical students assigned in acute areas encounter ABG
results, which they may not necessarily be able to interpret with its knotty aspect. They
struggle over the interpretation of its measurements, but they are not especially complicated
nor difficult if you understand the basic physiology and have a step by step process to
analyze and interpret them.
There may be various tips and strategies to guide you, from mnemonics, to charts, to
lectures, to practice, but this article will tell you how to interpret ABGs in the easiest possible
way. And once you have finished reading this, youll be doing actual ABG analysis in the
NCLEX with fun and excitement! Here are the steps:

1. Know the normal values

Know the normal and abnormal ABG values when you review the lab reports. Theyre fairly
easy to remember: for pH, the normal value is 7.35 to 7.45; 35-45 for paCO 2; and 22-26 for
HCO3. Remember also this diagram and note that paCO 2 is intentionally inverted for the
purpose of this method.

2. Determine if pH is under acidosis or alkalosis

Next thing to do is to determine the acidity or alkalinity of the blood through the value of pH.
The pH level of a healthy human should be between 7.35 to 7.45. The human 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 acid-base is respiratory or metabolic

Next thing you need to determine is whether the acid base is Respiratory or Metabolic.
paCO2 = Respiratory
HCO3 = Metabolic

4. Remember ROME
Still, it all boils down to mnemonics. The mnemonic RO-ME.
Respiratory Opposite
When pH is up, PaCO2 is down = Alkalosis
When pH is down, PaCO2 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 can be solved work using the tic-tac-toe method. All you have to do
is make a blank chart similar to this:

6. Mark the Chart

Using the lab result values, mark them on your tic-tac-toe. Lets begin with this sample
problem:
pH: 7.26, paCO2: 32, HCO3: 18
Using the normal values reference chart in the first step, determine where the values should
be under in the tic-tac-toe. In the given example, the solution is as follows:
pH of 7.26 is LOW = ACID so place pH under Acid
paCO2 of 32 is LOW = BASE so place paCO2 under Base
HCO3 of 18 is LOW = ACID so place HCO3 under Acid
Your chart should look like this:

7. Match it up
In this step, determine at which column matches up with the pH. In the given example, HCO 3
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. Heres the trick:
If pH is NORMAL, PaCO2 and HCO3 are both ABNORMAL = Compensated
If pH is ABNORMAL, PaCO2 and HCO3 are both ABNORMAL = Partially Compensated
If pH is ABNORMAL, PaCO2 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
PaCO2 is LOW = BASE so place PaCO2 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.
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 HCO 3 is also
abnormal. When pH is NORMAL and PaCO2 and HCO3 are both ABNORMAL, it indicates
FULL COMPENSATION.

Therefore this ABG is RESPIRATORY ALKALOSIS, FULLY COMPENSATED.

Try this problem next:
pH 7.1, PaCO2 40, HCO3 18
pH is LOW = ACID so place pH under Acid
PaCO2 is NORMAL = NORMAL so place PaCO2 under Normal
HCO3 is LOW = ACID so place HCO3 under Acid
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 PaCO 2 is normal. When
pH is ABNORMAL, and when either one of PaCO2 or HCO3 is ABNORMAL, it indicates
UNCOMPENSATION.

Simple Method of Acid Base Balance Interpretation

A FOUR STEP METHOD FOR INTERPRETATION OF ABGS

Usefulness
This method is simple, easy and can be used for the majority of ABGs. It only
addresses acid-base balance and considers just 3 values.

pH,
PaCO2

HCO3-

Step 1. Use pH to determine Acidosis or Alkalosis.

ph
< 7.35

7.35-7.45

> 7.45

Acidosis

Normal or
Compensated

Alkalosis

Step 2. Use PaCO2 to determine respiratory effect.

PaCO2

< 35

35 -45

Tends
toward
alkalosis

Normal
or

Causes high Compensated

pH
Neutralizes

> 45

Tends
toward
acidosis

Causes low
pH

Neutralizes

low pH

high pH

Step 3. Assume metabolic cause when respiratory is ruled out.

You'll be right most of the time if you remember this simple table:
High pH

Low pH

Alkalosis

Acidosis

High
PaCO2

Low PaCO2 High PaCO2 Low PaCO2

Metabolic Respiratory Respiratory

Metabolic

If PaCO2 is abnormal and pH is normal, it indicates compensation.

o

pH > 7.4 would be a compensated alkalosis.

pH < 7.4 would be a compensated acidosis.

These steps will make more sense if we apply them to actual ABG values.
Click here to interpret some ABG values using these steps. You may want
to refer back to these steps (click on "linked" steps or use "BACK" button on
your browser) or print out this page for reference.

Step 4. Use HC03 to verify metabolic effect

Normal HCO3- is 22-26
Please note:

Remember, the first three steps apply to the majority of cases, but do
not take into account:
o the possibility of complete compensation, but those cases are
usually less serious, and

instances of combined respiratory and metabolic imbalance, but

those cases are pretty rare.

"Combined" disturbance means HCO3- alters the pH in the

same direction as the PaCO2.

High PaCO2 and low HCO3- (acidosis) or

Low PaCO2 and high HCO3- (alkalosis).