pH and Buffers

pH
quantitative measure of the acidity or basicity of aqueous or other liquid solutions (Britannica,
n.d.)

Acids
An acid is a substance or compound that releases hydrogen ions (H+) when in solution. In a strong acid, such as
hydrochloric acid (HCl), all hydrogen ions (H+), and chloride ions (Cl-) dissociate (separate) when placed in water and
these ions are no longer held together by ionic bonding (med.libretexts.org).

Examples of acids

Bases
A base is a substance that releases hydroxyl ions (OH-) when in solution. The hydroxyl ions (OH-) released will
combine with any hydrogen ions (H+) in the solution to form water molecules (OH- + H+ = H2O), so we can also define a
base as a substance that takes or accepts hydrogen ions (H+) already present in the solution (med.libretexts.org)

Buffers
A buffer is a solution that can resist pH change upon the addition of an acidic or basic components. It is able to neutralize
small amounts of added acid or base, thus maintaining the pH of the solution relatively stable (chem.libretexts.org).
ABG
“An arterial blood gas analysis (ABG) measures the balance of oxygen and carbon dioxide in your blood to
see how well your lungs are working. It also measures the acid-base balance in the blood” (URMC, n.d.)
pH 7.35-7.45

PaCO2 35-45 mmHg

HCO3 22-26 mEq/L

Acid-base balance
Acid-base balance is the maintenance of arterial blood pH between 7.35 and 7.45 through control of hydrogen ion
production and elimination.
Blood pH represents a delicate balance between hydrogen ions (acid) and bicarbonate (base) and is largely
controlled by the lungs and kidneys. Ignatavicius, Workman, & Rebar (2017)

Acidosis occurs if the arterial blood pH level falls below 7.35 and is caused by either too many hydrogen ions in
the body (respiratory acidosis) or too little bicarbonate (metabolic acidosis).
Conversely, alkalosis occurs if the pH is greater than 7.45 and is caused by either too few hydrogen ions in the
body (respiratory alkalosis) or too much bicarbonate (metabolic alkalosis). Both severe acidosis and alkalosis can lead to
death if the patient is not diagnosed accurately and treated quickly.
Compensation
If the patient is acidotic (pH lower than 7.35), the kidneys typically decrease the amount of bicarbonate ions
(base) that is excreted through the urine.
The lungs may try to rid the body of carbon dioxide (source of carbonic acid) through increased and deeper
respirations. In this case, both compensatory mechanisms aim to restore acid-base balance by increasing the blood pH to
greater than 7.35. These actions can only occur if the individual has healthy lungs and kidneys.

Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Possible causes Prolonged diarrhea Excessive acid losses Acute respiratory Hyperventilation due to
(loss of alkaline from due to vomiting conditions that impair anxiety
the GIT) alveolar gas exchange (e.g.
COPD)
Excessive infusion of
chloride containing IV
fluids Overdose of narcotics and
sedatives

Manifestations ABG: pH below 7.35 Decreased RR, dizziness Dizziness, decreased LOC Shortness of breath
HCO3 less than 22
mEq/L
ABG: pH above 7.45
Lethargy, confusion ABG: pH above 7.45 PaCO2 less than 35
HCO3 greater than 26 ABG: pH less than 7.35 mmHg
mEq/L PaCO2 above 45mmHg

Nursing Monitor ABG values. Monitor LOC, intake Assess respiratory status, Help client breath in a
interventions and output, and paper bag
vital signs
Intake and output,
LOC
Monitor airway and Advise client to breath
ventilation, I & O more slowly

Monitor vitals signs and

ABGs
 Unknown Given Formula
pH Hydronium ion concentration -log (given)
H pH –(pH)
10
pOH Hydroxide ion concentration -log (given)
Hydr xide ion pOH –(pOH)
10
concentration
pH + pOH = 14

Acidosis and alkalosis

 Under normal conditions, the intracellular potassium content is much greater than that of the extracellular fluid.
The concentration of H+ ions is low in both compartments.
In acidosis, potassium ions leave the cell, creating a relative hyperkalemia.
In alkalosis, potassium ions move from the ECF into the ICF, creating a relative hypokalemia. 
Acidosis reduces the excitability of the cardiovascular muscle, neurons, skeletal muscle, and GI smooth
muscle. Manifestations in the patient include bradycardia, hypotension, lethargy, confusion, skeletal muscle weakness,
and hyporeflexia (Ignatavicius & Workman, 2013).
Alkalosis increases the sensitivity of excitable tissues, allowing them to over-respond to normal stimuli and
respond even without stimulation. Manifestations in the patient include hyperreflexia, increased heart rate, positive
Chvostek's and Trousseau's sign, and muscle cramping and twitching (Ignatavicius & Workman, 2013).