PREPARED BY:

Sarah A. Ligaya, PTRP

Arisa Takagi, PTRP, PT
Arterial Blood Gases (ABGs)
• are measured in a laboratory test where blood is taken
from artery to determine the extent of compensation
by the buffer system and to monitor several conditions
that can cause serious health complications, especially
to critically ill individuals.
Respiratory acidosis
• occurs when breathing is inadequate and PaCO2
or respiratory acid builds up. The extra CO2
combines with water to form carbonic acid,
causing a state of acidosis — a common
occurrence in emphysema.
Respiratory alkalosis
• can occur as a result of hyperventilation.
Metabolic acidosis
• is when there is a decrease in bicarbonates and a
buildup of lactic acid occurs. This happens in
diarrhea, ketosis, and kidney disorders.
Metabolic alkalosis
• occurs when bicarbonate ion concentration
increases, causing an elevation in blood pH.
• This can occur in excessive vomiting, dehydration,
or endocrine disorders.
 Arterial Blood Gases (ABGs)

• It measures the acidity (pH) and the levels of bicarbonate and

carbon dioxide in arterial blood.
• The normal range for ABGs is used as a guide, and
determination of disorders is often based on the blood pH.
• For pH, the normal range is 7.35 to 7.45
• If the blood is basic, the HCO3 level is considered because the
kidneys regulated bicarbonate ion levels.
• N HCO3 level: 22 to 26
• o If the blood is acidic, the PaCO2 or partial pressure of carbon
dioxide in arterial blood is assessed because the lungs regulate
the majority of acid.
• N PaCO2: 35 to 45
 GOALS FOR ABG ANALYSIS:

• we have set three (3) goals that we need to accomplish

when interpreting arterial blood gases. The goals are as
follows:
#1. Determine if values interpret ACIDOSIS or
ALKALOSIS.
#2. Determine if values define METABOLIC or
RESPIRATORY.
#3. Determine the compensation if it is: FULLY
COMPENSATED, PARTIALLY COMPENSATED, or
UNCOMPENSATED.
STEPS IN ABG ANALYSIS
USING THE TIC-TAC-TOE
METHOD
1. Memorize the normal values

• Familiarize yourself with the normal and abnormal

ABG values when you review the lab results. They
are easy to remember:
2. Create your tic-tac-toe grid.
3. Determine if pH is under NORMAL,
ACIDOSIS, or ALKALOSIS.

• Determine the acidity or alkalinity of the blood with the

given value of the pH as our determining factor.
Remember in step #1 that the normal pH range is from
7.35 to 7.45.
Where to place the values:

• If the pH value is within the range and is normal: place pH

under NORMAL column

7.35-7.39 7.40 7.41 – 7.45

Slightly Neutra Slightly
Acidosis l Alkalosis
If the pH value is below 7.35: place pH under
ACIDOSIS column

BELOW
7.35
If the pH value is above 7.45: place pH under
ALKALOSIS column

ABOVE
7.45
4. Determine if PaCO2 is under
NORMAL, ACIDOSIS, or ALKALOSIS.
•If PaCO2 is below 35 à ALKALOSIS
•If PaCO2 is above 45 à ACIDOSIS
•If PaCO2 is within its normal range (35-45) à
NORMAL
5. Determine if HCO3 is under
NORMAL, ACIDOSIS, or ALKALOSIS.
• If HCO3 is below 22 à ACIDOSIS
• If HCO3 is above 26 à ALKALOSIS
• If HCO3 is within its normal range (22-
26) à NORMAL
6. Solve for goal #1: ACIDOSIS or
ALKALOSIS.

The ABG Interpretation as to ACIDOSIS or

ALKALOSIS is based on what is the value of the
pH,
1. IF THE PH IS ACIDOSIS COLUMN,
THEN IT IS ACIDIC.
2. if the pH is in ALKALOSIS column,
then it is ALKALINIC
3. IF THE PH IS NORMAL, THEN THE INTERPRETATION IS
NORMAL, DETERMINE WHETHER THE VALUE IS LEANING
TOWARDS ACIDOSIS OR ALKALOSIS AND INTERPRET
ACCORDINGLY.
7.35-7.39 à ACIDOSIS
7.41-7.45 à ALKALOSIS
7.35-7.39 7.40 7.41 – 7.45
Slightly Neutral Slightly
Acidosis Alkalosis
7. Solve for goal #2: METABOLIC or
RESPIRATORY.

•The ABG Interpretation as to

METABOLIC or RESPIRATORY is
based on what is the component is in
the same column as the pH
What lines up with pH?
• If pH is under the same column as
PaCO2, it is RESPIRATORY.
• If pH is under the same column as
HCO3, it is METABOLIC.
• If pH is under the NORMAL column,
determine whether the value is leaning
towards ACIDOSIS or ALKALOSIS and
interpret accordingly.
If pH is under the same column as
PaCO2, it is RESPIRATORY.
If pH is under the same column
as HCO3, it is METABOLIC.
• IF PH IS UNDER THE NORMAL COLUMN,
DETERMINE WHETHER THE VALUE IS LEANING
TOWARDS ACIDOSIS OR ALKALOSIS AND
INTERPRET ACCORDINGLY.
8. Solve for goal #3:
COMPENSATION.

• It is FULLY COMPENSATED if pH is normal.

• It is PARTIALLY COMPENSATED if all three (3)
values are abnormal.
• It is UNCOMPENSATED if PaCO2 or HCO3 is
normal and the other is abnormal.
IT IS FULLY COMPENSATED IF PH IS
NORMAL.
It is PARTIALLY COMPENSATED if all
three (3) values are abnormal.
It is UNCOMPENSATED if PaCO2 or HCO3 is
normal and the other is abnormal.
EXAMPLES
Practice Problem #1:
pH=7.26 | PaCO2=32 | HCO3=18

ACIDIC BASIC
7.26 pH 7.35 – 7.45
PaCO2 45 – 35 32
18 HCO3 22 – 26
ANSWER: METABOLIC ACIDOSIS,
PARTIALLY COMPENSATED ABG
Practice Problem #2:
pH=7.44 | PaCO2=30 | HCO3=21

ACIDIC BASIC
pH 7.35 – 7.45 N
PaCO2 45 – 35 30
21 HCO3 22 – 26
ANSWER: Respiratory Alkalosis, Fully
Compensated
Practice Problem #3:
pH=7.1 | PaCO2=40 | HCO3=18

ACIDIC BASIC
7.1 pH 7.35 – 7.45
PaCO2 45 – 35 40 (N)
18 HCO3 22 – 26
ANSWER: Metabolic Acidosis,
Uncompensated
REFERENCE:
Wayne, G. (2019, January 16). ABG
Analysis Made Easy! 8-Step Guide
Using the Tic-Tac-Toe Method. Retrieved
from https://nurseslabs.com/8-step-
guide-abg-analysis-tic-tac-toe-method/