8-Step Guide to ABG Analysis: Tic-Tac-Toe Method

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January 21, 2015

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, you’ll be doing actual ABG analysis
in the NCLEX with fun and excitement! Here are the steps:

1. Know the normal values

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Know the normal and abnormal ABG values when you review the lab reports. They’re 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 paCO2 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, PaCO 2 is up = Acidosis
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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. Let’s 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:

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7. Match it up
In this step, determine at which column matches up with the pH. In the given example,
HCO3 goes with pH. HCO3 is considered Metabolic (shown in step 3), and both are under
Acid, so this example implies Metabolic Acidosis.

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8. Determine compensation
The last step is to determine if the ABG is Compensated, Partially Compensated, or
Uncompensated. Here’s 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 HCO3 is also
abnormal. When pH is NORMAL and PaCO 2 and HCO3 are both ABNORMAL, it indicates
FULL COMPENSATION.

Therefore this ABG is RESPIRATORY ALKALOSIS, FULLY COMPENSATED.

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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 PaCO2 is normal. When
pH is ABNORMAL, and when either one of PaCO2 or HCO3 is ABNORMAL, it indicates
UNCOMPENSATION.

Therefore this ABG is METABOLIC ACIDOSIS, UNCOMPENSATED.

Try it out with these quizzes

Want to try out the Tic-Tac-Toe method? Here are some sample ABG Analysis quizzes:

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