ROME Electrolytes

[skitches1]

Hi, can someone please explain "ROME" to me when it comes to electrolytes?? I know it means Respiratory Opposite and Metabolic Equal but what is opposite? and what is equal? Can you give an example that explains this "Barney Style" (very basic)? Sorry, I'm sure it's probably obvious and I'm being a dunce...Thanks for your help in advance!

[203bravo, MSN, APRN]

ROME has to do with acid-base balance --- When evaluating an ABG you look at the pH, PCo2, and HCO3.... since PCo2 indicates respiratory then as pH drops and the body become more acidotic it is respiratory in nature if the body is retaining too much Co2, thus pH goes down and PCo2 goes up... if a person retains too little Co2 then they become alkalotic, pH goes up and PCo2 goes down (Respiratory opposite)

on the other hand if the body is retaining too much bicarb then the ABG represents metabolic alkalosis since pH goes up and HCO3 goes up -- if someone is getting rid to too much bicarb then it's metabolic acidosis, pH goes down and HCO3 goes down (Metabolic equal)

[missmollie, ADN, BSN, RN]

Here's the simplest way to figure out if it's acidosis, alkalosis, metabolic or respiratory. Write out your values, and circle (it's underlined here) the ones that are acidic.

pH: 7.35 - 7.45

CO2: 35- 45

HCO3: 22 - 26

Now take some lab values:

pH: 7.33

CO2: 48

HCO3: 26

pH is below the underlined = acidosis.

CO2: Above the underlined = acidosis

HCO3: Normal.

Answer: Respiratory Acidosis

pH: 7.46

CO2: 48

HCO3: 28

pH: Alkalotic

CO2: 48, above the underlined value. It's acidotic

HCO3: Alkalotic.

The pH and HCO3 match...so you know you've got Metabolic alkalosis. Why is the CO2 acidotic? The lungs are trying to compensate for the alkalotic state in pH, so it's hanging on to the H+ ions in order to increase the acidity, in a way to counteract the alkalosis. It's compensating.

Answer: Metabolic alkalosis with partial compensation.

It's only partially compensated because it hasn't brought things back to a normal value.

Try this method and use this website to practice: Practice ABGs Or you can do your own google search for alkalosis/acidosis practice questions.

Hope that's helpful! Best of luck!

[SopranoKris, MSN, RN, NP]

Use the search feature and find GrnTea's post about ABGs. It got me through acid-base in Med Surg. So easy to understand if you follow her directions