![]() So, what do you think? You have a tic-tac-toe with the Bicarb matching up with the pH…so you have a METABOLIC ALKALOSIS. Is it acidotic, normal, or alkalotic? It’s alkalotic, so let’s write it in: He’s suspected of taking an overdose of antacids, thinking they were candy. You’ve got a patient who’s on a vent, sedated, and breathing at a set rate of 16. This patient most likely needs to be intubated RIGHT AWAY, or at the very least needs some aggressive oxygen support. Now we’re going to take note of his O2 and his clinical presentation. So, we have UNCOMPENSATED RESPIRATORY ACIDOSIS. But in this case, it’s within the normal range, which means the renal system has not yet had a chance to balance out the acidic pH. The Bicarb is normal, so what does this mean? This means the kidneys have not yet had a chance to kick in and start buffering that acid. Next we look at the Bicarb…the only number we have left (except for O2, which we’ll get to in a minute). Is it abnormal? Yes…so this are definitely not compensated. The next question you’re going to ask yourself is, “Is this compensated, partially compensated or uncompensated respiratory acidosis?” To determine compensation, we look at the pH first. So which one is in your column? The CO2, right? That means, this is a RESPIRATORY ACIDOSIS. Respiratory acid/base is determined by the CO2, while metabolic acid/base is determined by the Bicarb. Now, is it respiratory or is it metabolic? This one is easy. To determine exactly what’s going on with your patient, the first thing you’re going to do is draw a tic-tac-toe grid, like this:īecause your three-in-a-row is in the acidic column, you know you’re dealing with an ACIDOSIS. Right from the start, you can probably surmise this is a pretty bad ABG. You are definitely worried about this patient, so you get an ABG. He’s needing more oxygen, has lower O2 saturation levels, and is complaining of more shortness of breath. In this scenario, you have a patient with pneumonia who is looking worse. The next thing you need to understand is that CO2 has to do with the lungs, and Bicarb has to do with the kidneys…so CO2 is respiratory related and Bicarb is metabolic related. PH: 7.35 – 7.45 (lower than 7.35 is acidic, higher than 7.45 is basic)ĬO2: 35-45 (lower than 35 is basic, higher than 45 is acidic)īicarb: 22-26 (lower than 22 is acidic, higher than 26 is basic) Metabolic or Respiratory? In this article, I’m going to talk you through ABG interpretation using the tic-tac-toe method, which was originally shared in the article “Turn ABGs into child’s play” by Doreen Mays and Eileen O’Connor The first thing to solidify are the normal values: ![]() ABG interpretation is one of the most challenging things you’ll learn in nursing school, but the good news is…it DOES get much easier with practice. ![]()
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