Practice Problems Acid-Base Imbalances 1. 2. 3. 4. 5.

You need to know the normal values of pH, partial pressure of carbon dioxide (PCO ), and bicarbonate (HCO ). 2 3 You need to look at the patient's ABG's - arterial blood gases - to determine what's abnormal, and whether the abnormal values are too high or too low. You need to correlate the abnormal values of PCO and HCO to the abnormality of pH. 2 3 You need to name the disorder, the cause, and the source of any compensation. You need to suggest possible causes of the disorder.

Steps: 1. 2. Normal values for ABG's: pH range 7.35 - 7.45 carbon dioxide partial pressure, 35 - 45 mm Hg bicarbonate, 24 - 28 mEq/L Evalutate the patient's ABG's: is the pH normal? Is it too high or too low? Is it acidosis or alkalosis? Is the CO normal? Is it too high or too low? Will it cause acidosis or alkalosis? Will it correct acidosis or 2 alkalosis? Is the HCO normal? Is it too high or too low? Will it cause acidosis or alkalosis? Will it correct acidosis or 3 alkalosis? Correlate the abnormal values:

3.

4. 5.

If only one of the two parameters (CO or HCO ) is abnormal, then its value should be consistent with the pH 2 3 (for example, if the CO is high, since that causes a drop in pH, the pH should be low). 2 If both of the parameter are abnormal, then usually one is CAUSING the problem, and the other is trying to CORRECT (COMPENSATE FOR) the problem. (For example, if the CO is high, and is causing the pH imbalance, 2 then the pH must be low, since CO behaves as an acid. If HCO level is also abnormal, then usually it will be 2 3 high, to compensate for the low pH, since it is a base.) Name the disorder: Respiratory acidosis (with or without renal compensation) Respiratory alkalosis (with or without renal compensation) Metabolic acidosis (with or without respiratory compensation) Metabolic alkalosis (with or without respiratory compensation) Suggest a possible cause. For example, a cause of chronic respiratory acidosis is emphysema.

Practice Problem 1 ABG's: pH 7.31 PCO 55 mm Hg HCO 28 mEq/L 2 3 ANSWER: 1. 2. Normal values for ABG's: pH range 7.35 - 7.45 carbon dioxide partial pressure, 35 - 45 mm Hg bicarbonate, 24 - 28 mEq/L

pH is too low - acidosis; PCO is too high, would cause acidosis or correct alkalosis; HCO is normal, neither 2 3 causing nor correcting imbalance high PCO is correllated with low pH, which is consistent with patient's report 2 because PCO is causing the problem, this is respiratory acidosis; because bicarbonate is normal, there is no 2 compensation possible cause: cardiac arrest

3. 4. 5.

Practice Problem 2 (Answers below) ABG's: pH 7.31 PCO 55 mm Hg HCO 35 mEq/L 2 3 Practice Problem 3 ABG's: pH 7.31 PCO 35 mm Hg HCO 20 mEq/L 2 3 Practice Problem 4 ABG's: pH 7.31 PCO 25 mm Hg HCO 20 mEq/L 2 3 Practice Problem 5 ABG's: pH 7.48 PCO 25 mm Hg HCO 28 mEq/L 2 3

ABG's: pH 7.31 PCO 55 mm Hg HCO 35 mEq/L 2 3 Practice Problem 3 ABG's: pH 7.31 PCO 35 mm Hg HCO 20 mEq/L 2 3 Practice Problem 4 ABG's: pH 7.31 PCO 25 mm Hg HCO 20 mEq/L 2 3 Practice Problem 5 ABG's: pH 7.48 PCO 25 mm Hg HCO 28 mEq/L 2 3 Practice Problem 6 ABG's: pH 7.48 PCO 25 mm Hg HCO 20 mEq/L 2 3 Practice Problem 7 ABG's: pH 7.48 PCO 45 mm Hg HCO 33 mEq/L 2 3 Practice Problem 8 ABG's: pH 7.48 PCO 55 mm Hg HCO 33 mEq/L 2 3 ANSWERS Practice Problem 2 ABG's: pH 7.31 PCO2 55 mm Hg HCO3- 35 mEq/L pH low = acidosis PCO2 high = respiratory acidosis HCO3 - high = renal compensation Practice Problem 3 ABG's: pH 7.31 PCO2 35 mm Hg HCO3- 20 mEq/L pH low = acidosis PCO2 normal; no compensation HCO3 - low = metabolic acidosis Practice Problem 4 ABG's: pH 7.31 PCO2 25 mm Hg HCO3- 20 mEq/L pH low = acidosis PCO2 low = respiratory compensation HCO3 - low = metabolic acidosis Practice Problem 5 ABG's: pH 7.48 PCO2 25 mm Hg HCO3- 28 mEq/L pH high = alkalosis PCO2 low = respiratory alkalosis HCO3 - normal; no compensation Practice Problem 6 ABG's: pH 7.48 PCO2 25 mm Hg HCO3- 20 mEq/L pH high = alkalosis PCO2 low = respiratory alkalosis HCO3 - low = renal compensation Practice Problem 7 ABG's: pH 7.48 PCO2 45 mm Hg HCO3- 33 mEq/L

 Practice Problem 6 ABG's: pH 7.48 PCO2 25 mm Hg HCO3- 20 mEq/L pH high = alkalosis PCO2 low = respiratory alkalosis HCO3 - low = renal compensation Practice Problem 7 ABG's: pH 7.48 PCO2 45 mm Hg HCO3- 33 mEq/L pH high = alkalosis PCO2 normal; no compensation HCO3 high = metabolic alkalosis Practice Problem 8 ABG's: pH 7.48 PCO2 55 mm Hg HCO3- 33 mEq/L pH high = alkalosis PCO2 high = respiratory compensation HCO3 high = metabolic alkalosis