 We're going to talk about Rome. So not this Rome, just a beautiful picture. This is the Roman Colosseum in Rome, Italy. We're going to talk about Rome, which stands for respiratory opposite metabolic equal. So if you have lab, lab values and you know someone's pH, their PCO2, their partial pressure of carbon dioxide and their bicarbonate levels, you can identify if they have an acidosis or alkalosis condition and you can identify if it's respiratory and metabolic in nature. Let's go ahead and take a look. Here we see this, the normal values of the pH is normally 7.35 to 7.45. Anything below 7.35 is an acidosis, anything above 7.45 is an alkalosis. PCO2 or partial pressure of carbon dioxide, think respiratory, which you should. Normal values, 35 to 45 millimeters of mercury, then HCO3, your bicarbonate, think metabolic and normal is 22 to 26, but I've seen 21 to 28, 22 to 29, you're going to see different numbers. Let's actually take a look at this. So we have all four conditions here, metabolic acidosis will start there. So metabolic equal, what that means is that the pH drops, your bicarbonate levels also drop. So metabolic equal, respiratory opposite means that as you're with respiratory acidosis, as the pH drops, your carbon dioxide levels go up. So that's what respiratory opposite metabolic equal means. So metabolic acidosis often caused by lactic acidosis from sepsis or diabetic keto acidosis or a loss of bicarbonate from diarrhea. Metabolic acidosis, you'll see the pH, it's low, which is why it's an acidosis. And the bicarbonate also low metabolic equal metabolic alkalosis, which can be caused by too much an accumulation of bicarbonate, or I'm most commonly, what I see it with, it would be vomiting. So if you're losing a whole bunch of acid that has to be replaced, that would cause the pH to climb. So metabolic alkalosis, pH up, and since metabolic is equal, your bicarbonate levels also up. Respiratory acidosis, most common caused by lung diseases or congestive heart failure are things that cause hypoventilation and inability to move enough option and most importantly, carbon dioxide. So respiratory acidosis can be caused by CNS disorders, drugs, lung diseases, COPD, et cetera, congestive heart failure. What's happening there is you have too much carbon dioxide. So it's an acidosis, so the pH is down, carbon dioxide is up. Remember carbon dioxide, synonymous think carbonic acid. So if you can't breathe off carbon dioxide well enough, you have too much carbon dioxide, which means you have too much carbonic acid, and that's why having too much of it. So as CO2 goes up, pH goes down. So the treatment, of course, would be to fix the hypoventilation if you can. Respiratory alkalosis is caused by hyperventilation. So if you're breathing too fast, you're breathing out too much CO2s. Your CO2 levels go down. Respiratory opposite, pH climbs. So solution here, if someone's hyperventilating, calm them down, have them breathe in a bag. That way they breathe that CO2 back into their lungs, gets back in their blood and their pH should climb. So respiratory opposite, as pH goes up, CO2 goes down, as pH goes down, CO2 goes up. Respiratory opposite, metabolic equal as pH goes down, bicarbonate goes down. As pH goes up, bicarbonate goes up. So respiratory opposite, metabolic equal. If you want examples of these, you just use these arrows and replace them with numbers. So like for example, a metabolic acidosis, pH is 7.3, so we know it's an acidosis, bicarbonate levels of 20, so we know it's metabolic in nature. Now notice the normals here. So in metabolic problems, CO2 should be normal. And with respiratory problems, bicarbonate should be normal. But there is compensation. Your lungs will try to pitch in to help with metabolic problems, just like your kidneys and will try to pitch in to help with respiratory problems. So you might see compensations there. So for example, metabolic acidosis, the CO2 would look normal for a while, but then trying to bring the pH down, you'd probably see the PCO2 come down. So the compensation is a whole other layer we covered in a separate video. So that is Rome, respiratory opposite, metabolic equal. And that's how with these three lab values, you should be able to determine if someone has an acidosis or alkalosis and why, with that second layer of compensation on top of it. Okay, I hope this helps. Have a wonderful day. Be blessed.