PART 1 : Let’s Play….

ABG Tic-Tac-Toe

Values:
pH (acid): < 7.35 PaCO2 (acid): > 45 HCO3 (acid): < 22
pH (normal): 7.35 – 7.45 PaCO2 (normal): 35 – 45 HCO3 (normal): 22 – 26
pH (base): > 7.45 PaCO2 (base): < 35 HCO3 (base): > 26

ABG values: pH______________ PaCO2__________________ HCO3_____________________

Acid/Normal/Base: pH_________ PaCO2__________________ HCO3_____________________

Now plug in your values:

Acid Normal Base (Alkaline)

pH

PaCO2

HCO3

RESPIRATORY ACIDOSIS:
Respiratory acidosis uncompensated: pH acid () PaCO2 acid () HCO3 normal
Respiratory acidosis partially compensated: pH acid () PaCO2 acid () HCO3 base ()
Respiratory acidosis totally compensated: pH normal PaCO2 acid () HCO3 base ()

RESPIRATORY ALKALOSIS:
Respiratory alkalosis uncompensated: pH base () PaCO2 base () HCO3 normal
Respiratory alkalosis partially compensated: pH base () PaCO2 base () HCO3 acid ()
Respiratory alkalosis totally compensated: pH normal PaCO2 base () HCO3 acid ()

METABOLIC ACIDOSIS:
Metabolic acidosis uncompensated: pH acid () PaCO2 normal HCO3 acid ()
Metabolic acidosis partially compensated: pH acid () PaCO2 base () HCO3 acid ()
Metabolic acidosis totally compensated: pH normal PaCO2 base () HCO3 acid ()

METABOLIC ALKALOSIS:
Metabolic alkalosis uncompensated: pH base () PaCO2 normal HCO3 base ()
Metabolic alkalosis partially compensated: pH base () PaCO2 acid () HCO3 base ()
Metabolic alkalosis totally compensated: pH normal PaCO2 acid () HCO3 base ()

Interpretation:
Uncompensated: pH and one other value (either PaCO2 or HCO3) are abnormal. Abnormal pH determines whether acidosis or
alkalosis. Abnormal PaCO2 or HCO3 determines whether respiratory or metabolic.
PaCO2 abnormal = respiratory; HCO3 abnormal = metabolic.
Partial compensation: all values are abnormal. Two values “agree” (pH and either PaCO2 or HCO3 are BOTH acid or BOTH base),
and the remaining value (either PaCO2 or HCO3) is the OPPOSITE of the pH. The value (PaCO2 or HCO3) that “agrees” with the pH
is correct (determines whether respiratory or metabolic).
Compensation: pH is normal, both PaCO2 and HCO3 are abnormal. One will be acidotic, the other base. The value that most closely
matches the pH identifies the true (underlying) state. If the fully compensated pH is between 7.35-7.40, then the normal pH is closer to

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the acid end and the acidotic value (either PaCO2 or HCO3) is correct. If the pH is between 7.40-7.45, then the normal pH is closer to
the alkalotic end and the base value (either PaCO2 or HCO3) is correct.

Acid-Base Interpretation Table Values

Respiratory acidosis uncompensated Acid Normal Base

pH X
PaCO2 X
HCO3 X
Respiratory acidosis partially compensated Acid Normal Base

pH X
PaCO2 X
HCO3 X
Respiratory acidosis totally compensated Acid Normal Base

pH X
PaCO2 X
HCO3 X
Acid Normal Base
Respiratory alkalosis uncompensated
pH X
PaCO2 X
HCO3 X
Respiratory alkalosis partially compensated Acid Normal Base

pH X
PaCO2 X
HCO3 X
Respiratory alkalosis totally compensated Acid Normal Base

pH X
PaCO2 X
HCO3 X
Metabolic acidosis uncompensated Acid Normal Base

pH X
PaCO2 X
HCO3 X
Acid Normal Base
Metabolic acidosis partially compensated
pH X
PaCO2 X
HCO3 X
Metabolic acidosis totally compensated Acid Normal Base

pH X
PaCO2 X
HCO3 X
Metabolic alkalosis uncompensated Acid Normal Base

pH X
PaCO2 X
HCO3 X
Acid Normal Base
Metabolic alkalosis partially compensated
pH X
PaCO2 X
HCO3 X

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Metabolic alkalosis totally compensated Acid Normal Base

pH X
PaCO2 X
HCO3 X

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PART 2 : Well, now you have your key. So take your ABG reports and look at them. Remember:

Values:
pH (acid): < 7.35 PaCO2 (acid): > 45 HCO3 (acid): < 22
pH (normal): 7.35 – 7.45 PaCO2 (normal): 35 – 45 HCO3 (normal): 22 – 26
pH (base): > 7.45 PaCO2 (base): < 35 HCO3 (base): > 26

1) pH = 7.20, PaCO2 = 60, HCO3 = 40.

First thing to look at is the pH: is acidosis, with a low pH.
PaCO2 at 60 is what (acid/normal/base)? That’s right: PaCO2 is acid.
HCO3 at 40 is what (acid/normal/base)? That’s right: HCO3 is base.
Find the acidosis where the PaCO2 is acid and the Bicarb is base, and you find your answer:
Respiratory acidosis with partial metabolic compensation.

This is what you see in chronic COPD’ers who have had high CO2's for so long their kidneys have adapted things by
retaining bicarb.

2) pH = 7.54, PaCO2 = 60, HCO3 = 40

pH here?: is alkalosis, with a high pH.
PaCO2 at 60 is what (acid/normal/base)? That’s right: PaCO2 is acid.
HCO3 at 40 is what (acid/normal/base)? That’s right: HCO3 is base.
The only box where pH is base, PaCO2 is acid, and Bicarb is base is:
Metabolic alkalosis with partial respiratory compensation.
Sometimes you'll see this in people who have a bigtime antacid habit.

3) pH = 7.19, PaCO2 = 24, HCO3 = 12.

pH here? _______________
PaCO2? ________________
HCO3? _________________
Bingo, you found it: an acidosis where the PaCO2 is base and the Bicarb is acid.
Only fits in the metabolic acidosis box, so you have:
Metabolic acidosis with partial respiratory compensation.

Incidentally, this is what you see in diabetic ketoACIDOSIS, when they come in huffing and puffing to blow out that CO2
because their ketosis is so high. Also you see this picture in ASA OD's, because this is acetylsalicylic ACID they ate.

4) pH = 7.50, PaCO2 = 35, HCO3 = 32

A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis

Is this Uncompensated or Compensated?

A. Uncompensated
B. Partially Compensated
C. Totally Compensated

5) pH = 7.41, PaCO2 = 30, HCO3 = 20

(HINT: is the normal pH closer to the alkalotic or to the acidic end?)
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis

Is this Uncompensated or Compensated?

A. Uncompensated
B. Partially Compensated

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C. Totally Compensated

Acid Normal Base Acid Normal Base Acid Normal Base

pH pH pH
PaCO2 PaCO2 PaCO2
HCO3 HCO3 HCO3

Acid Normal Base Acid Normal Base Acid Normal Base

pH pH pH
PaCO2 PaCO2 PaCO2
HCO3 HCO3 HCO3

Acid Normal Base Acid Normal Base Acid Normal Base

pH pH pH
PaCO2 PaCO2 PaCO2
HCO3 HCO3 HCO3

Acid Normal Base Acid Normal Base Acid Normal Base

pH pH pH
PaCO2 PaCO2 PaCO2
HCO3 HCO3 HCO3

Acid Normal Base Acid Normal Base Acid Normal Base

pH pH pH
PaCO2 PaCO2 PaCO2
HCO3 HCO3 HCO3

Acid Normal Base Acid Normal Base Acid Normal Base

pH pH pH
PaCO2 PaCO2 PaCO2
HCO3 HCO3 HCO3

Acid Normal Base Acid Normal Base Acid Normal Base

pH pH pH
PaCO2 PaCO2 PaCO2
HCO3 HCO3 HCO3

Acid Normal Base Acid Normal Base Acid Normal Base

pH pH pH
PaCO2 PaCO2 PaCO2
HCO3 HCO3 HCO3

Acid Normal Base Acid Normal Base Acid Normal Base

pH pH pH
PaCO2 PaCO2 PaCO2
HCO3 HCO3 HCO3

Acid Normal Base Acid Normal Base Acid Normal Base

pH pH pH

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PaCO2 PaCO2 PaCO2
HCO3 HCO3 HCO3

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