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2d • General discussion
Acid-base in 3 steps (yes, ROME still works) 🧪
Greetings Gang 😈😜
pH 7.30. pCO₂ 55. HCO₃⁻ 32.
If those three numbers make your brain shut off, this post is for you. Acid-base looks scary, but it's the same 3 steps every single time.
First, anchor to the normals:
pH 7.35–7.45
pCO₂ 35–45 (the LUNGS, think ACID)
HCO₃⁻ 23–29 (the KIDNEYS, think BASE)
Step 1: Look at the pH 👀
Below 7.35 = acidosis. Above 7.45 = alkalosis.
Normal? Check which side of 7.40 it's on. 7.35–7.39 leans acid; 7.41–7.45 leans base.
Step 2: Find the culprit with ROME
Respiratory Opposite: pH and CO₂ move in OPPOSITE directions
Metabolic Equal: pH and HCO₃⁻ move in the SAME direction
Step 3: Check compensation
Only the culprit is abnormal → uncompensated
Both abnormal, pH still off → partially compensated
Both abnormal, pH back in range → fully compensated
So back to our numbers: pH 7.30 is acidosis. CO₂ is high, opposite the pH, so it's respiratory. HCO₃⁻ is also high (the kidneys are helping), but the pH isn't fixed yet.
= Partially compensated respiratory acidosis ✅
🧐 Your turn (answer in the comments):
pH 7.28 · pCO₂ 38 · HCO₃⁻ 16
I attached my upgraded Acid-Base Breakdown to this post. It covers ROME, compensation, blood gas specimen errors and 5 practice questions.
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Acid-base in 3 steps (yes, ROME still works) 🧪
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