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Acid Base Balance
Acid Base Balance
Fall 2018
Acid-Base Balance
Normal pH of blood??????
Hypocapnia?????
Acidosis and Alkalosis?????
Normal Acid-Base Balance
•Normal pH 7.35-7.45
•Narrow normal range
•Compatible with life 6.8 – 7.8
•< 6.8 or > 7.8 incompatible with life
___/______/___/______/___
6.8 <7.35 7.45˃ 7.8
Acid Acidosis Alkalosis Alkaline
Acid- Base balance
• Lungs
• Kidneys
Buffer Systems
Phosphate • (Na2PO42-/NaH2PO4- )
buffer • Active in ICF fluid
Protein
buffer
Hemoglobin
Bicarbonate-Carbonic Acid
• Body’s major buffer
• Carbonic acid - H2CO3 (Acid)
• Bicarbonate – HCO-3 (Base)
Bicarbonate-Carbonic Acid
• Body’s major buffer
• Carbonic acid - H2CO3 (Acid)
• Bicarbonate - HCO3 (Base)
pH = 7.4
How does the buffer work
CO2 +H2O H2CO3 H+ + HCO3-
hyperventilation
Increase in
H+
Reaction shift
How does the buffer work
CO2 +H2O H2CO3 H+ + HCO3-
hypoventilation
decrease in
H+
Reaction shift
Sources of endogenous acids:
• Carbonic acid formation: CO2 produced
metabolically combines with water in blood to form
H2CO3
Hyperventilation Hypoventilation
Blow off CO2 Retain CO2
pH pH
Acidosis Alkalosis
Acidemia Alkalemia
pH <7.35 pH>7.45
Acidosis • Increase in blood
(acidemia) carbonic acid (pCO2)
Hypercapnia
pH< 7.35 • Decrease in
bicarbonate
• Increase in
Alkalosis bicarbonate
(alkalemia) • Decrease in carbonic
acid (pCO2)
pH> 7.45 Hypocapnia
Acid-Base Imbalances
• change in body function that
Primary causes abnormality in pCO2 or
serum HCO-3
change
• compensatory mechanism that
Secondary act to minimize the changes in
pH caused by the primary
change change
Metabolic Respiratory
• Systemic • respiratory
alterations alterations
• Change in the • Change in the
plasma bicarbonate PCO2, reflecting an
concentration and increase or decrease
result from the in alveolar
addition or loss of ventilation.
nonvolatile acid or
alkali to or from the
extracellular fluid.
Acid Base disorders
Four Basic Types of Imbalance
• Respiratory Acidosis
• Respiratory Alkalosis
• Metabolic Acidosis
• Metabolic Alkalosis
Respiratory Acidosis
(acidosis due to respiratory change)
Exhaling of Carbonic
Hypoventilation CO2 acid builds H2CO3
inhibited up
pH <7.35
Respiratory Acidosis
(acidosis due to respiratory change)
increase in PCO2
(Hypercapnia)
decrease elimination H2CO3
of CO2
pH
Causes:
Any compromise in the essential components of breathing
Acid-Base Imbalances
• Normal
7.4
Respiratory Acidosis
1 13
7.21
Respiratory Acidosis
• Compensation: How?
• Opposite regulating mechanism
• Problem = depressed breathing,
build up of CO2 in blood
• Response - Kidney retains HCO3
(Response ….. Slow)
Causes
• Airway obstruction
• Cardiac arrest (acute) depression of medullary
respiratory center
• Central nervous system trauma
• Chronic bronchitis, extensive pneumonia
• Chronic metabolic alkalosis Why?????????
• Drugs ( opioids, general anesthetics, hypnotics,
alcohol and sedatives)
Signs and symptoms
• Restlessness caused by hypoxemia
• Change in the level of consciousness
• Headache
Diagnosis
• PaCO2 > 45mmHg
• Hyperkalemia Why???????
• Acidic urine Why??????????
Respiratory Alkalosis
(alkalosis due to respiratory change)
Exhaling of Carbonic
Hyperventilation CO2 acid H2CO3
increased decreases
pH >7.45
CO2 +H2O H2CO3 H+ + HCO3-
decrease in PCO2
(Hypocapnia)
Increase elimination
of CO2 H2CO3
pH
Causes:
Pulmonary hyperventilation
Acid-Base Imbalances
• Normal
7.4
Respiratory Alkalosis
1 40
7.70
Causes
• Pulmonary: severe hypoxemia, pneumonia,
acute asthma
• Non-pulmonary: anxiety, fever, aspirin
toxicity, metabolic acidosis, central nervous
system disease
Signs and symptoms
gain in H+
(lactic acid or ketoacidosis)
Low plasma Low pH
bicarbonate (< 7.35)
loss of HCO3
(renal failure and diarrhea)
CO2 +H2O H2CO3 H+ + HCO3-
loss of HCO3-
decrease in PCO2
(Hypocapnia) Hyperventilation to expel CO2
7.4
Metabolic Acidosis
1 10
7.10
Causes
• Excessive fat metabolism in absence of
carbohydrates: diabetic ketoacidosis, chronic
alcoholism, mal nutrition or a low – carbohydrate,
high fat diet producing more ketoacids than the
metabolic process can handle.
FAT BURN ON FLAME OF CARBOHYDRATES
• Anaerobic carbohydrate metabolism causing an
increase in lactic acid level
• Diarrhea or loss of sodium bicarbonate from the
intestine
• Salycilate intoxication (overuse of aspirin)
Signs and symptoms
Loss of H+ ion
(Vomiting and gastric
suction)
increase High pH
gain of HCO3 plasma
(antacids abuse and bicarbonate (> 7.45)
K+ wasting diuretics)
CO2 +H2O H2CO3 H+ + HCO3-
Increase in HCO3-
increase in PCO2
(Hypercapnia) Hypoventilation to retain CO2
7.4
Metabolic Alkalosis
1 30
7.58
Causes
• Chronic vomiting (causes of critical acid
loss)
• Excessive intake of absorbable alkali,
bicarbonate of soda or other antacids, IV
fluids with high concentration of
bicarbonate (causes of bicarbonate
retention)
• Alteration in extracellular electrolytes level
including low chloride (hypochloremia),
low plasma potassium (hypokalemia)
Signs and symptoms
• Slow shallow respiration
• Nausea, vomiting
Metabolic Alkalosis
• Compensation:
• Problem = too much base
• Response: Lungs compensate by
hypoventilating
• Retain CO2
• Renal: excrete less acid and more base
Interpreting arterial blood gas
values (ABGs)
• pH 7.35 - 7.45
• PaCO2 35 - 45 mmHg
• HCO3 22 - 26 mEq/L
Interpreting ABGs
1. Start with pH
– Normal?
– Acidosis?
– Alkalosis?
___/______/___/______/___
6.8 7.35 7.45 8.0
Acidosis Alkalosis
Interpreting ABGs
2. Assess PaCO2
(respiratory value)
_____/________/______
35 45
Respiratory Respiratory
Alkalosis Acidosis
Interpreting ABGs
3. Evaluate metabolic indicators
Bicarbonate (HCO3) 22-26
Interpreting ABGs
HCO3
_______/_______/________
22 26
Metabolic Metabolic
acidosis alkalosis
Practice Problem
• 80 year old female with severe
pneumonia, fever
• pH = 7.25
• PaCO2 = 55 mm Hg
• HCO3 = 24 mEq/L
Practice Problems
What is the problem?
Acidosis or alkalosis?
Respiratory or metabolic?
Compensation
1) Is it an acidosis or an alkalosis?
What is the pH? Is there an acidosis (<7.35) or alkalosis
(>7.45)?
2) Is the problem respiratory or metabolic in nature?
Look for the match. If the CO2 matches the altered pH the
problem is associated with the respiratory system. If the HCO3-
corresponds with the altered pH, then the problem is metabolic
in nature.
3) Is there any compensation occurring? Has the body tried to
fix the problem?
Has the other component (opposite to where the problem lies)
gone outside of its reference range? And to what effect? Has the
body done a good job of fixing the problem?
Compensated = the pH is close to or within normal ranges
Uncompensated = the pH is outside of normal ranges
Thank you
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