The Monster Method uses colorful monsters to help interpret arterial blood gas (ABG) results. Each monster's fur color represents the patient's pH, the shirt color represents the pCO2 level, and the pants color represents the bicarbonate level. By looking at which colors match the fur, you can determine if the acid-base imbalance is caused by respiratory or metabolic issues. The method was designed to make ABG interpretation less scary by relating the numbers to cute monsters instead of sick patients. Examples are provided to demonstrate how to identify respiratory acidosis, metabolic alkalosis, and mixed acid-base disorders using this approach.
The Monster Method uses colorful monsters to help interpret arterial blood gas (ABG) results. Each monster's fur color represents the patient's pH, the shirt color represents the pCO2 level, and the pants color represents the bicarbonate level. By looking at which colors match the fur, you can determine if the acid-base imbalance is caused by respiratory or metabolic issues. The method was designed to make ABG interpretation less scary by relating the numbers to cute monsters instead of sick patients. Examples are provided to demonstrate how to identify respiratory acidosis, metabolic alkalosis, and mixed acid-base disorders using this approach.
The Monster Method uses colorful monsters to help interpret arterial blood gas (ABG) results. Each monster's fur color represents the patient's pH, the shirt color represents the pCO2 level, and the pants color represents the bicarbonate level. By looking at which colors match the fur, you can determine if the acid-base imbalance is caused by respiratory or metabolic issues. The method was designed to make ABG interpretation less scary by relating the numbers to cute monsters instead of sick patients. Examples are provided to demonstrate how to identify respiratory acidosis, metabolic alkalosis, and mixed acid-base disorders using this approach.
The Monster Method uses colorful monsters to help interpret arterial blood gas (ABG) results. Each monster's fur color represents the patient's pH, the shirt color represents the pCO2 level, and the pants color represents the bicarbonate level. By looking at which colors match the fur, you can determine if the acid-base imbalance is caused by respiratory or metabolic issues. The method was designed to make ABG interpretation less scary by relating the numbers to cute monsters instead of sick patients. Examples are provided to demonstrate how to identify respiratory acidosis, metabolic alkalosis, and mixed acid-base disorders using this approach.
Jason Hautala The Monster Method of ABG Interpretation Arterial blood gas (ABG) interpretation can be a scary thing to learn. hat !orries people the "ost about ABGs is that the patients that ha#e the" dra!n are usually pretty sic$. This can dra"atically increase the stress le#el. %ou then ha#e to thin$ bac$ to !hat the nor"al ranges are and !hether the results sho! an acidosis or an al$alosis& !hether it is co"pensated or not& and if so& by ho! "uch. All of this can be o#er!hel"ing. I re"e"ber the first fe! ABG results I got bac$ as a nurse. I loo$ed at the" as if they !ere so"e type of "onster. hat !ere these nu"bers trying to tell "e' I still loo$ at ABG results as if they !ere "onsters& but not the scary $ind. I loo$ at the" as the nice& soft& fury& colorful "onsters you !ill find in a children(s toy store. To use this "ethod of ABG interpretation& you ha#e to #isuali)e each ABG as if it !ere a fury "onster& and based on the color of his fur and clothing& you can figure out e#erything you need to $no! about his acid*base balance. Good luc$. Hello e#erybody+ I(" an ABG "onster. Many people are afraid of ABG "onsters& but I !ill sho! you that there is no reason to be afraid. All ABG "onsters can gi#e you infor"ation about their pH& ,a-./& and bicarb le#els. I(ll sho! you ho! easy it is to understand all of this data. The first piece of infor"ation you can get fro" an ABG "onster is his pH. The pH is a "easure"ent of ho! "uch acid and base is in a fluid. The lo!er the nu"ber is& the "ore acidic the fluid. The higher the nu"ber is& the "ore basic& or al$alotic& the fluid. The nor"al range for pH in arterial blood is 0.1230.42. If you !or$ s!ing shift in a busy unit& this !ill be an easy range to re"e"ber because it represents the 15 "inutes you ta$e to eat your lunch and #isit the restroo"& 061230642. The color of fur on an ABG "onster depends on his pH. My pH is perfect at 0.45& so "y fur is !hite. ABG "onsters !ith pH le#els less than 0.12 are acidic and !ill ha#e red fur. Monsters !ith pH le#els greater than 0.42 are al$alotic and !ill ha#e blue fur. This is easy to re"e"ber if you thin$ bac$ to your che"istry class. 7it"us paper turns red in an acid solution and blue in a basic& or al$alotic& solution. 7et us practice. If an ABG "onster has a pH of 0./& !hat is the color of his fur' A pH of 0./ is "ore acidic than the nor"al range of 0.1230.42& so his fur is red. If an ABG "onster has a pH of 0.2& !hat is the color of his fur' A pH of 0.2 is "ore al$alotic than nor"al& so his fur is blue. The ne8t piece of infor"ation you should loo$ at on your ABG is the ,a-./ le#el. The ,a-./ le#el is the partial pressure of -arbon 9io8ide& -./& in the arterial blood. -./ can be considered an acid !hen loo$ing at your ABG results. The "ore -./ in the blood& the "ore acidic the blood !ill be& and accordingly& the lo!er the pH. The lo!er the -./ le#el is& the higher the pH. -./ is a !aste product of cellular "etabolis" and is carried fro" the cells to the lungs by the blood. The a"ount of -./ in the blood is regulated by the respiratory syste". The capillaries and al#eoli in the lungs e8change -./ and .8ygen& ./. As you breathe& you increase the a"ount of ./ in your blood and decrease the a"ount of -./. This process is co""only called :blo!ing off; -./& since the -./ lea#es your body as you e8hale. The nor"al #alue for ,a-./ in arterial blood is 12342. This is an easy range to re"e"ber because it is the sa"e nu"bers found in the nor"al pH& 0.1230.42& !ithout the 0. To re"ind you that ,a-./ is regulated by the respiratory syste"& all ABG "onsters !ill !ear color coordinated shirts& depending on their ,a-./ le#el. Monsters !ith a nor"al ,a-./& 12342& !ill !ear !hite shirts& since their ,a-./ le#els are not "a$ing the blood "ore acidic nor al$alotic. Monsters !ith ,a-./ le#els abo#e 42 !ill !ear red shirts to sho! that their -./ le#els are "a$ing the blood "ore acidic& and "onsters !ith ,a-./ le#els belo! 12 !ill !ear blue shirts to sho! that their lac$ of -./ is "a$ing the blood "ore al$alotic. 7et(s practice this once. hat color shirt is an ABG "onster !earing if his ,a-./ le#el is 4<' =ince his ,a-./ le#el is abo#e nor"al& he has "ore -./& an acid& in his blood. Therefore& he is !earing a red shirt to indicate that his respiratory syste" is "a$ing his blood "ore acidic. The third piece of infor"ation to loo$ at on your ABG is the H-.1& (bicarbonate) (bicarb) le#el. Bicarb is a base that "a$es the blood "ore al$alotic. The higher the bicarb le#el is& the higher the pH. The nor"al range for the bicarb le#el "ay #ary slightly fro" one lab to another& but !e !ill use the #alues of //3/> for the standard range. This range for bicarb is also easy to re"e"ber because it is the ages you !ish you !ere& !hen you are no longer that age. The $idneys regulate the a"ount of bicarb in the blood. ?or ABG interpretation& this is called the "etabolic syste". To help you re"e"ber that the $idneys& or "etabolic syste"& regulate the a"ount of bicarb& ABG "onsters !ill !ear color coordinated pants based on their bicarb le#els. Monsters !ith bicarb le#els of //3/> !ill !ear !hite pants& since their bicarb le#els are not "a$ing the blood "ore acidic or al$alotic. Monsters !ith bicarb le#els of less than // !ill !ear red pants& since their lac$ of bicarb !ill allo! the blood to be "ore acidic. Monsters !ith bicarb le#els of "ore than /> !ill !ear blue pants since their e8tra bicarb !ill tend to "a$e the blood "ore al$alotic. 7et(s practice this once. hat color of pants !ould an ABG "onster !ear if his bicarb le#el !ere /5' This bicarb le#el !ould sho! that the $idneys& or "etabolic syste"& !ere e8creting too "uch bicarb into the urine. The loss of this e8tra base !ould "a$e the blood "ore acidic& so this ABG "onster !ould !ear red pants& to indicate the decrease in pH. This is all of the data you need to interpret ABG #alues. 7oo$ at the fur color& the shirt color& and the pants color& and the rest !ill fall into place. Ta$e a loo$ at "y friend here. His pH is 0.15& !hich is "ore acidic than the nor"al range of 0.1230.42. That is !hy his fur is red. @o! loo$ at his ,a-./& !hich is 21. He has "ore -./& !hich is an acid& than the nor"al range of 12342& so his respiratory syste" is "a$ing hi" "ore acidic. That is !hy he !ears a red shirt. 7astly& let(s loo$ at his bicarb le#el. His bicarb is />. The nor"al range of bicarb is //./>& so he !ears !hite pants& since his bicarb le#el is nor"al. Ha#e you figured out !hat type of ABG "onster he is yet' His fur is red& so you $no! he is so"e type of acidosis. @o! !e need to figure out if he is a respiratory or "etabolic acidosis. To do this& find the piece of clothing that "atches his fur color and this !ill tell you !hich syste" is causing the proble". In this case& it is his red shirt that "atches his red fur. The shirt co#ers the respiratory syste"& so he is a respiratory acidosis. 7et(s try another ABG "onster. This "onster(s #alues are6 pH 0.2& ,a-./ 1<& and bicarb 12. The pH is higher than the 0.1230.42 nor"al range& so he has the blue fur of al$alosis. His ,a-./ is in the nor"al range of 12342& so he has on a !hite shirt to indicate that his respiratory syste" is not "a$ing hi" acidic or al$alotic. His bicarb le#el is higher than the nor"al range of //3/>& so he has on blue pants to sho! his "etabolic syste" is raising his pH& "a$ing hi" "ore al$alotic. @o! !e find !hich clothes "atch his fur color& !hich is blue. e see that it is his blue pants& !hich co#er the "etabolic syste"& !hich "atches his blue& al$alotic fur. This is ho! !e $no! that he is a "etabolic al$alosis. 7et(s try one "ore& but be careful not to Au"p to conclusions because this one is a little bit different. This ABG "onster has a pH of 0./<& a ,a-./ of 2/& and a bicarb le#el of /1. hat type of "onster is he' e can see by his pH that he is acidic& so !e $no! !e !ill call hi" so"e type of acidosis& but !hich type' 7et(s see if either his pants or shirt "atch his red& acidic fur. His ,a-./ le#el is high at 2/& so !e $no! his respiratory syste" is not blo!ing off enough acid& so he !ill !ear a red shirt& indicating that it is his respiratory syste" that is "a$ing his blood "ore acidic. 9on(t stop here though+ %ou ha#e to loo$ at his bicarb le#el too. His bicarb le#el is only /1& !hich "eans that his $idneys are du"ping out too "uch base. ?or this reason he !ill also ha#e on red pants& to sho! that his "etabolic syste" is also "a$ing his blood "ore acidic. 7astly& !e loo$ to see !hich articles of clothing "atch his fur& and !e see that both his pants and shirt "atch his red fur color. In this case !e !ill ha#e a respiratory and "etabolic acidosis. Both syste"s are "a$ing his blood "ore acidic. In the last case& both the "etabolic syste" and the respiratory syste" !ere each !or$ing& or not !or$ing& as the case "ay be& to "a$e the blood too acidic. @or"ally though& if one syste" is "a$ing the pH too high or too lo!& the other syste" !ill try to counteract it& so that the pH !ill stay !ithin the nor"al range. ?or this reason& you can ha#e ABG "onsters that ha#e all of their #alues out of the nor"al range& but only one syste" is causing the proble". The other syste" is out of the nor"al range to co"pensate for the proble". As a rule& the respiratory syste" can change the pH #ery Buic$ly by holding onto or blo!ing off -./. It ta$es the "etabolic syste" a longer ti"e to affect the pH by holding onto or e8creting bicarb. Ho! do you $no! !hat to call these ABG "onsters that ha#e one syste" raising the pH and the other syste" lo!ering the pH' 7et(s ta$e a loo$ at another ABG "onster. His pH is 0.4<& his ,a-./ is 4/& and his bicarb le#el is 1/. hat should !e call hi"' His pH is high& so he has the characteristic blue fur of al$alosis. His ,a-./ is also high& but this !ould tend to "a$e hi" "ore acidic& so he has on a red shirt. His bicarb le#el is high also& !hich gi#es hi" blue pants to indicate his "etabolic syste" is "a$ing hi" al$alotic. His fur tells us he is al$alotic and it is his pants that "atch his fur& so !e $no! that he is so"e type of "etabolic al$alosis. hat about his red shirt' In this case& his lungs are trying to hang onto "ore -./ in an effort to "a$e his pH co"e bac$ do!n into the nor"al range. His pH !ould be e#en higher than 0.4< if it !eren(t for the increase in the ,a-./ le#el. ?or this reason !e !ill call this ABG a partially co"pensated "etabolic al$alosis. If his ,a-./ le#el !ere nor"al& and he !as !earing a !hite shirt li$e in our other e8a"ples& he !ould be called a non3co"pensated "etabolic al$alosis& since the respiratory syste" !ouldn(t ha#e been !or$ing to bring the pH bac$ into the nor"al range. hat if one syste" !as able to co"pensate the other syste" enough to bring the pH bac$ into the nor"al range of 0.1230.42' This is often the case& so let(s ta$e a loo$ at another e8a"ple. An ABG "onster has a pH of 0.1>& ,a-./ of 4C& and bicarb of /<. His ,a-./ is higher than nor"al& "a$ing his blood "ore acidic& so he !ill be !earing a red shirt. His bicarb is also high& "a$ing his blood "ore al$alotic& so he !ill be !earing blue pants. His pH& ho!e#er& is nor"al at 0.1>& so !hat is going on' Is it a fully co"pensated respiratory acidosis or a fully co"pensated "etabolic al$alosis' To decide& !e need to loo$ "ore closely at the pH. @or"al pH is 0.1230.42. A pH that is in this range& but closer to 0.12& can be considered to be on the acidic side of nor"al. A pH that is closer to the 0.42 can be considered to be on the al$alotic side of nor"al. The pH in our e8a"ple& 0.1>& is in the nor"al range& but on the acidic side. Therefore& !e are dealing !ith a fully co"pensated acidosis. @o! !e need to loo$ at the syste" that !ould be causing the acidosis. In this case& it !ould be the respiratory syste" that is causing the acidosis& so !e ha#e a fully co"pensate respiratory acidosis. D#en though the "etabolic syste" !as able to bring the pH bac$ up into the nor"al range& it !ill ne#er be able to o#er co"pensate and bring the pH o#er 0.45. In fact& !hen co"pensating for an acidic syste"& it !ould be difficult& if not i"possible& for the other syste" to bring the pH abo#e 1.1C. It !ould be eBually hard for a syste" to co"pensate an al$alotic syste" enough to bring the pH do!n belo! 0.4/. hat color fur do you thin$ this ABG "onster ought to ha#e' To "a$e things si"ple& and to gi#e a little "ore color to our red& !hite& and blue !orld. e !ill say that the fur of an ABG "onster that has a pH bet!een 0.12 and 0.1< !ill be light red& or pin$. This !ill indicate that it is in the nor"al range& but tending to be "ore acidic. e !ill also say that a pH bet!een 0.41 and 0.42 !ill be a light blue& to indicate that it is in the nor"al range& but tending to be "ore al$alotic. 7et(s practice this ne! bit of infor"ation a fe! ti"es. hat color !ould the ABG "onster be if he had a pH of 0./' The correct ans!er !ould be red& since 0./ is lo!er than the nor"al range& "a$ing hi" acidic. hat color !ould an ABG "onster be if he had a pH of 0.4/' In this case& the fur color !ould be a light blue. @ot dar$ blue fur li$e in an al$alotic ABG "onster& but a light blue& indicating that he !as on the basic side of nor"al. hat color !ould a "onster be if he had a pH of 0.10' =ince the nor"al range is 0.123 0.42& this "onster !ould be pin$& or light red& to indicate that he !as on the acidic side of nor"al. In order to $eep all of this straight& Aust re"e"ber that if one syste" is causing the change in the pH and the other syste" is nor"al& then it is an unco"pensated change& based on the color of fur and !hich article of clothing "atches it. If both syste"s are outside the nor"al range& one being red& the other being blue& and the pH is outside the nor"al range& then it is a partially co"pensated proble"& based on the "onster(s pH and !hich syste" is causing that change. If both syste"s are outside nor"al& one acidic and the other al$alotic& and the pH is !ithin the nor"al range& then !e ha#e a fully co"pensated state& and !ill base the na"e on the fact that the pH !ill either be on the acidic or basic side of nor"al& and on !hich syste" is causing that de#iation. Just re"e"ber& if both syste"s are "a$ing the blood "ore acidic or basic& then it is not co"pensated& e#en though both are outside the nor"al range. In these cases it !ould be a respiratory and "etabolic acidosis or a respiratory and "etabolic al$alosis. 7et(s try a fe! "ore& no! that !e ha#e all of the facts. A "onster has a pH of 0.1>& a ,a-./ of 25& and a bicarb le#el of 15. To use a syste"atic "ethod& let(s first loo$ at the pH. In this case& the pH is on the acidic side of nor"al& so his fur color !ill be pin$& or light red. @e8t& his ,a-./ is too high& "a$ing the blood "ore acidic& so his shirt !ill be red& "atching the reddish tint of his fur. 7astly& his bicarb le#el is also too high& but this is a base& so his pants !ill be blue& since his "etabolic syste" is "a$ing his blood "ore al$alotic. =ince it is his shirt that "atches his acidic fur& !e can call this a respiratory acidosis. =ince his "etabolic syste" is going in the opposite direction& trying to fi8 the proble"& and in fact& has brought the pH bac$ into the nor"al range& !e can call this a fully co"pensated respiratory acidosis. If the bicarb and the ,a-./ le#els stayed the sa"e and the pH !as lo!er than 0.12& such as 0.1/& then he !ould ha#e red fur& instead of pin$& and !e !ould call hi" a partially co"pensated respiratory acidosis. hat !ould you call an ABG "onster !ith a pH of 0.4C& a ,a-./ of 4C& and a bicarb le#el of 11' The pH is higher than nor"al& so his fur !ill be a dar$ blue& indicating so"e type of al$alosis. The ,a-./ is high& "a$ing the blood "ore acidic& so his shirt !ill be red. The bicarb le#el is high& "a$ing the blood "ore al$alotic& so his pants !ill be blue. His fur is blue& his shirt is red& and his pants are blue. It is the pants that "atch the blue fur& so !e ha#e a "etabolic al$alosis. His shirt clashes !ith his pants& so there is so"e type of co"pensation going on& but not enough to bring the pH bac$ into the nor"al range& so !e ha#e a partially co"pensated "etabolic al$alosis. If the pH had co"e bac$ into the high end of nor"al and the other #alues re"ained the sa"e& then !e !ould ha#e had a fully co"pensated "etabolic al$alosis and light blue fur. 7et(s try one "ore e8a"ple& pH of 0./<& ,a-./ of 25& and a bicarb le#el of 11. The fur !ill be red& since the pH is belo! nor"al. The shirt !ill be red& since the ,a-./ is abo#e nor"al& and the pants !ill be blue& since the bicarb is abo#e nor"al. Eed fur and red shirt "a$es this a respiratory acidosis. =ince the pants clash !ith the shirt& !e !ill call it a partially co"pensated respiratory acidosis. Had the $idneys been able to bring the pH bac$ into the nor"al range& !e !ould ha#e had a fully co"pensated respiratory acidosis and pin$ fur. %ou should be able to !or$ so"e of these on your o!n no!. Here are a fe! ABG "onsters for you to na"e yourself. The correct ans!ers !ill follo! if you get stuc$. 1. pH F 0.25& ,a-./ F /5& bicarb F />. /. pH F 0./1& ,a-./ F 15& bicarb F 1<. 1. pH F 0.1>& ,a-./ F 21& bicarb F 11. 4. pH F 0.4<& ,a-./ F 11& bicarb F 15. Ans!ers6 1. Blue fur& blue shirt& !hite pants. This gi#es us a respiratory al$alosis !ith no co"pensation. A non3co"pensated respiratory al$alosis. /. Eed fur& blue shirt& red pants. This gi#es us a "etabolic acidosis& !ith so"e respiratory co"pensation. A partially co"pensated "etabolic acidosis. 1. ,in$ fur& red shirt& and blue pants. This gi#es us a respiratory acidosis that is fully co"pensated by the "etabolic syste". A fully co"pensated respiratory acidosis. 4. Blue fur& blue shirt& and blue pants. This gi#es us an al$alosis that is caused by both the respiratory and "etabolic syste"s. A co"bination respiratory*"etabolic al$alosis. Ho! did you do' If you still need !or$& you can "a$e up your o!n ABG #alues and use this syste" to figure out !hat to call your "onsters. Just re"e"ber to loo$ at the fur color first& and then the shirt color& and lastly the pants color& to find !hich ones "atch. %ou can use the attached color coded reference sheet to chec$ your results. But !ait a "inute+ I told you that "y color !as !hite because "y pH !as 0.45. hat should you do if you co"e across an ABG "onster !ith a pH of 0.45' %ou should be happy& because your ABG !ould be nor"al. There is #ery little chance that you !ill e#er see an ABG !ith a perfect pH li$e "ine& and e#en less of a chance if one or "ore of the other le#els are not nor"al. There is one last piece of infor"ation gi#en on the ABG lab report& but don(t !orryG this one is e#en easier than the rest. This piece of datu" is the p./ or the partial pressure of .8ygen in the arterial blood. The nor"al #alue for this is C53155. If your ABG has a nor"al p.// le#el& you call it !hate#er you !ould ha#e called it based on the other ABG #alues. If the p./ is less than C5& then you call it !hate#er the fur and clothes dictate& but you add the !ords& :!ith hypo8e"ia&; to indicate that the blood does not ha#e as "uch .8ygen as it should. If the p./ is greater than 155& you add the !ords& :!ith hypero8e"ia; to your ABG na"e. %ou no! $no! e#erything you need to fully interpret any ABG "onster. They "ay loo$ scary& but they are really there to help you figure out !hat is !rong !ith the patient and !hich syste" is causing the proble". Good luc$+