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 paCO2; and 22-26 for HCO3. Remember also this
diagram and note that paCO2 is really 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, HCO3goes 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 HCO3 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 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.