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ROME Method ABG Interpretation: Uncompensated vs. Compensated

The ROME method can be used to interpret arterial blood gases (ABGs). This review is made for
nursing students and can be used during lecture exams to help you determine
respiratory/metabolic acidosis/alkalosis along with uncompensation vs. compensation.

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The ROME method is a simple and quick way to solve ABG problems found on an exam. In the
previous review, we discussed the Tic-Tac-Toe ABG method for solving arterial blood gases, which
is another great method.

In this review you will learn:

Normal vs. abnormal blood pH, CO2, HCO3 levels

Basics about the buffering system in acid-base imbalances

ROME method

Solving for respiratory/metabolic alkalosis/acidosis

Solving for uncompensation vs compensation

Lecture on the ROME Method

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 ROME Method ABGs (Arterial Blood Gases) Interpretation: …

ROME Method ABGs Review

NURSING NOTES
What’s the purpose of interpreting
arterial blood gases? It helps us
identify a potential acid-base
imbalance in the body. The following
acid-base imbalances can occur in the
body:

Respiratory acidosis or
Respiratory alkalosis

Metabolic acidosis or Metabolic

alkalosis LATEST YOUTUBE VIDEOS

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The body has a buffering system in place that helps keep the blood’s pH within a normal level,
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which is 7.35-7.45. A value lower than 7.35 is considered an acidic blood pH, and a value higher
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than 7.45 is considered an alkalotic blood pH.
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When the blood’s pH becomes abnormal, the body has two systems (the respiratory and metabolic Foley Catheter Goes POP!? #nursing
system) that will attempt to correct the abnormal state of acidosis or alkalosis. When you’re #experiment
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On exams you will be given the pH, CO2, and HCO3 level. The CO2 level (carbon dioxide) always NCLEX (NGN)
represents the RESPIRATORY system. While HCO3 level (bicarbonate) always represents the
METABOLIC system. Remember these concepts…they’re very important for when solving ABG Patient Positioning Quiz

problems.
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When solving ABG problems always ask these 3 Questions:

1. Is it a respiratory or metabolic problem?

2. Is this alkalosis or acidosis?

3. Is this uncompensated, partially compensated, or fully compensated?

ROME stands for

Respiratory

Opposite

Metabolic

Equal

*Tip: When applying the method for ABG interpretation, remember to keep the R and O together
and the M and E.

What does Respiratory Opposite mean? The CO2 (remember carbon dioxide represents the
respiratory system) and pH will be OPPOSITE of each other…one will be elevated while the other
will be decreased…this means it’s a respiratory disorder.

CO2 ⬆, pH ⬇: Respiratory acidosis

CO2 ⬇, pH ⬆: Respiratory alkalosis

What does Metabolic Equal mean? The HCO3 (remember bicarb represents the metabolic
system) and pH will be EQUAL…either both will be elevated or decreased….this means it’s a
metabolic disorder.

HCO3 ⬇, pH ⬇: Metabolic acidosis

HCO3 ⬆, pH ⬆: Metabolic alkalosis

Before solving ABG problems, you must commit to memory the following lab values:

Blood pH:

Normal: 7.35-7.45

Acidosis: <7.35

Alkalosis: >7.45

CO2 (carbon dioxide):

Normal: 35-45 mmHg

Acidosis: >45 mmHg

 Alkalosis: <35 mmHg

HCO3 (bicarbonate):

Normal: 22-26 mEq/L

Acidosis: <22 mEq/L

Alkalosis: >26 mEq/L

Now, let’s apply the ROME method and solve practice ABG problems:

Problem 1:

pH 7.28, CO2 50, HCO3 24

Setup ROME:

R: ⬆ (CO2 is 50 and acidotic)

O: ✔

M: NORMAL

E:

pH: ⬇(pH is 7.28 and is acidotic)

Answer: CO2 ⬆, pH ⬇= Respiratory acidosis, uncompensated: this is a respiratory problem and

the pH is abnormal (acidotic)…the metabolic system (HCO3) is normal and is not at this time
trying to compensate…if it was the bicarb would be abnormal (alkalotic) in an attempt to increase
the pH to normal range.

Problem 2:

pH 7.30, CO2 40, HCO3 18

Setup ROME:

R: NORMAL

O:

M: ⬇ (HCO3 is 18 and acidotic)

E: ✔

pH: ⬇(pH is 7.30 and is acidotic)

Answer: HCO3 ⬇, pH ⬇: Metabolic acidosis, uncompensated: this is a metabolic problem and

the pH is abnormal (acidotic)…the respiratory system (CO2) is normal and is not at this time
trying to compensate…if it was the carbon dioxide would be abnormal (alkalotic) in an
attempt to increase the pH to normal range.

Problem 3:

pH 7.42, CO2 26, HCO3 18

Setup ROME:

R: ⬇ (CO2 is 26 and alkalotic)

O: ✔

M: ⬇ (HCO3 is 18 and acidotic)

E:

pH: ⬆ (pH is 7.42 and is NORMAL but alkalotic*)

*You need to ask yourself what side of “normal” is the pH on? 7.40 is the absolute normal for pH…
any value greater than 7.40 is considered on the alkalotic side, while any value less than 7.40 is
considered on the acidotic side.

Answer: CO2 ⬇, pH ⬆: Respiratory alkalosis, fully compensated: this is a respiratory

problem and the pH is normal (on the alkalotic side of normal)…the metabolic system
(HCO3) is ABNORMAL and on the acidotic side, so it is compensating. Since the blood pH
level is back to normal, there is full compensation. However, if the blood pH was abnormal it
would be partial compensation.

Problem 4:

pH 7.51, CO2 47, HCO3 32

Setup ROME:

R: ⬆ (CO2 is 47 and acidotic)

O:

M: ⬆ (HCO3 is 32 and alkalotic)

E: ✔

pH: ⬆ (pH is 7.51 and is alkalotic)

Answer: HCO3 ⬆, pH ⬆: Metabolic alkalosis, partially compensated: this is a metabolic

problem and the pH is abnormal (alkalotic)…the respiratory system (CO2) is ABNORMAL
and on the acidotic side, so it is trying to compensate. However, it is only partially
compensating at this time because the blood pH level is still abnormal. If the blood pH level
was normal, there would be full compensation.

Problem 5:

pH 7.37, CO2 32, HCO3 17

Setup ROME:

R: ⬇ (CO2 is 32 and alkalotic)

O:

M: ⬇ (HCO3 is 17 and acidotic)

E: ✔

pH: ⬇ (pH is 7.37 and is NORMAL but acidotic*)

* You need to ask yourself what side of “normal” is the pH on? 7.40 is the absolute normal for pH…
any value greater than 7.40 is considered on the alkalotic side, while any value less than 7.40 is
considered on the acidotic side.

Answer: HCO3 ⬇, pH ⬇: Metabolic acidosis, fully compensated: this is a metabolic problem

and the pH is normal (on the acidotic side of normal)…the respiratory system (CO2) is
ABNORMAL and on the alkalotic side, so it is compensating. Since the blood pH level is back
to normal, there is full compensation. However, if the blood pH was abnormal it would be
partial compensation.

Test your knowledge on the ROME method with this ABG quiz.
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