COLEGIO DE DAGUPAN

Arellano St., Dagupan City

COLLEGE OF NURSING

Acid-Base Balances

Acid – is any substance that ionizes in water and forms hydrogen

ions and anions. An acid is a hydrogen donor.

Base – is any substance that can bind to hydrogen ions. A base is

a hydrogen acceptor.

pH (power of Hydrogen) – ie hydrogen ion concentration in the

blood, is a measure os acid-base balance. The more
hydrogen ions, the more acidic, the medium and lower its
pH; conversely, the fewer the hydrogen ions, the more base
and the higher its pH.

Normal pH for humans is approximately 7.4

Homeostatic mechanisms
1. Renal system
a. The kidneys reabsorb bicarbonate, secrete
hydrogen ions in proximan and distal tubules, and
produce ammonia
b. The kidneys compensate more slowly than the
lungs. They may take up to several days to
achieve balance.
2. Cardiovascular system
a. The cardiovascular system maintains adequate
renal perfusion
b. Normal arterial blood gas values reflecting
homeostasis include:
i. pH 7.35 – 7.45
ii. partial pressure of oxygen (PO2) : 80 – 100
mmHg
iii. partial pressure of carbon dioxide (PCO 2) :
35 – 45 mmHg
iv. bicarbonates (HCO3) : 22 – 26 mEq/L

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3. Pulmonary system
a. The lungs work to maintaine acid-base balance by
controlling carbon dioxide and carbonic acid
excretion
b. PCO2 is the most powerful respiratory stimulant,
followed by pH, then PO2
4. Buffer system
a. Buffers are chemical systems that maintain body
pH (acid-base balance) by inactivating or releasing
Hydrogen ions
b. The primary buffer system involves HCO3 and
H2CO3
c. The HCO3 (base) buffer system is regulated by the
kidneys; they can regenerate HCO 3 ions and
reabsorb them from the renal tubular cells
d. The H2CO3 buffer system is regulated by the
lungs; they do so by adjusting ventilation in
response to the amount of CO2 in the blood
e. An HCO3 to H2CO3 ratio of 20:1 is necessary to
maintain body pH; disruption of the ratio alters pH
(normal 7.35 – 7.45)
f. Less important buffer system are the phosphate
buffer system (intracellular) and the protein buffer
system

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Metabolic Acidosis
- This is an acid-base imbalance resulting from excessive
absorption or retention of acid or excessive excretion of
bicarbonate (HCO3)

Etiology:
- Ketoacidosis
- Lactic acidosis
- Prolonged fasting
- Salicylic poisoning
- Oliguric renal disease
- Abnormal HCO3 losses which can occur in loss of fluid
from the lower GI tract from surgery, drains, or severe
diarrhea

Assessment findings
- Clinical manifestations
o Headache
o Drowsiness and confusion
o Weakness
o Increased respiratory rate and depth
o Nausea and vomiting

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 o Diminished cardiac output with pH below 7, which
results in hypotension, cold and clammy skin, and
cardiac arrhythmias
- Laboratory and diagnostic findings
o Arterial blood gas (ABG) studies reveal abnormal
values: pH below 7.35 and HCO3 below 22 mEq/L
o Serum potassium levels reveal hypokalemia

Nursing management
- Prepare for and assist with therapy, as prescribed
o Monitoring ABG values
o When appropriate, administer sodium bicarbonate
o Monitor the serum potassium level closely as
acidosis is reversed
o Treat chronic metabolic acidosis (seen with
chronic renal failure) by administering calcium to
avoid tetany, use of alkalizing agents, and
hemodialysis or peritoneal dialysis
- Prevent injury
o Monitor cardiovascular status closely, noting blood
pressure, pulse rate, and rhythm, capillary refill
time, temperature and color of extremities
o Institute safety precautions. Keep bed side rails
up, keep bed brakes locked, and secure all
invasive lines properly

Metabolic alkalosis
- Is an acid-base imbalance characterized by excessive
loss of acid or excessive gain of bicarbonate (HCO3)

Etiology
- Loss of hydrogen and chloride ions because of prolonged
vomiting or gastric suctioning (most common cause)
- Excessive intake of alkali (ie antacids, baking soda)

Assessment findings
- Clinical manifestations
o Tingling of the fingers and toes
o Dizziness, belligerence, or confusion
o Tetany

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 o Slow, shallow respirations; possibly apnea
- Laboratory and diagnostic findings
o Arterial blood gas (ABG) studies reveal abnormal
values: pH above 7.45 and HCO3 above 26 mEq/L
o Urine chloride concentrations help to differentiate
between vomiting or diuretic ingestion or one of
the causes of mineralocorticoid excess

Nursing management
- Prepare for and assist with therapy, as prescribed
o Monitor ABG values
o Monitor intake and output carefully
o Provide treatment to correct the underlying cause
as ordered
o Administer sodium chloride to restore normal fluid
volume (continuing volume depletion serves to
maintain the alkalosis)
o Correct electrolyte deficits, particularly of
potassium and sodium
o Treatment of chronic metabolic alkalosis (seen in
long-term diuretic therapy, chronic ingestion of
milk and calcium carbonate, and external drainage
of gastric fluids) is aimed at treating the underlying
acid-base disorder
- Prevent injury
o Monitor respiratory rate and pattern and auscultate
lung sounds
o Institute safety precautions. Keep bed side rails
up, keep bed brakes locked, and secure all
invasive lines.

Respiratory acidosis
- Is an acid-base imbalance characterized by increased
partial pressure of carbon dioxide (PCO 2) decreased
blood pH.

Etiology:

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 - Chronic obstructive respiratory disorders such as
bronchial asthma and emphysema
- Acute disorders, such as chest-wall trauma, pulmonary
edema, atelectasis, pneumothorax, drug overdose,
pneumonia, and Guillain-Barré syndrome
- Any condition that’s results to hypoventilation

Assessment findings
- Clinical manifestations
o Acute respiratory acidosis
 Increased pulse rate and respiratory rate
 Increased blood pressure
 Mental cloudiness and feeling of fullness in
head
o Chronic respiratory acidosis
 Weakness
 Dull headache
- Laboratory and diagnostic findings
o Arterial blood gas (ABG) studies reveal abnormal
values: pH below 7.35 and partial pressure of
carbon dioxide above 45 mmHg

Nursing management
- Prepare for and assist with therapy, as prescribed
o Monitor ABG values
o Improve ventilation with bronchodilators, postural
drainage, antibiotic therapy to treat infections,
regular coughing, turning, and deep breathing, and
mechanical ventilation may be needed
o Treat underlying cause
o Treat chronic respiratory acidosis (ie the client
who has chronic obstructive pulmonary disease
and hypoxic stimulus for breathing) by
administering low-flow oxygen therapy to prevent
respiratory arrest
- Prevent injury
o Position the client in semi-Fowler’s position (or
another comfortable position) to ease work of
breathing

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 o Maintain a quiet, relaxing environment, cluster
activities to allow for periods of uninterrupted rest
o Keep needed items within client’s reach
o Monitor cardiovascular status, noting blood
pressure, pulse rate and rhythm, capillary refill
time, and temperature and color of extremities
o Monitor respiratory status, noting respiratory rate,
rhythm, difficulty, level of consciousness, and
peripheral and buccal cyanosis
o Maintain fluid and electrolyte balance

Respiratory alkalosis
- Is an acid-base imbalance characterized by decreased
pressure of arterial carbon dioxide and increased blood
pH

Etiology
- Most common, hyperventilation due to anxiety, hypoxia,
or improper mechanical ventilation
- Fever
- Salicylate poisoning

Assessment findings
- Clinical manifestations
o Lightheadedness
o Inability to concentrate
o Convulsions
o Positive Chvostek’s sign
o Muscle twitching
- Laboratory and diagnostic findings
o Arterial blood gas (ABG) studies reveal abnormal
values: pH above 7.45 and partial pressure of
carbon dioxide below 35 mmHg

Nursing management
- Prepare for and assist with therapy, as prescribed
o Monitor ABG values
o Aim treatment at the underlying cause, such as
decreasing pain, fever, and anxiety

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 o Encourage the client to take slow, deep breaths
using a brown paper bag
o Treat chronic respiratory alkalosis (from chronic
hypocapnia resulting in decreased serum
bicarbonate) the same as acute respiratory
alkalosis. Clients with chronic alkalosis are usually
asymptomatic
- Prevent injury
o Assess the respiratory rate and pattern
o Institute and maintain seizure precautions as
necessary
o Assess source of anxiety and intervene to help
reduce anxiety
o Assist the client with activities as necessary

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