ACID-BASE BALANCE

Fluids & Electrolytes

Normal ABG Results

pH 7.35 – 7.45

PO2 80 – 100 mmHg

PCO2 35 – 45 mmHg

HCO3 22 – 26 mEq/ L

O2 saturation 95-99%
RESPIRATORY ALKALOSIS
Respiratory alkalosis

• Carbonic Acid Deficit

• Characterized by ↓CO2 due to Hyperventilation
• pH : >7.45
• CO2 : <35mmHg
Causes of Respiratory Alkalosis

• Anxiety (hyperventilation)
• Salicylate intoxication (Aspirin overdose) -
stimulate the respiratory center potentially leading
to Hyperventilation.
• Mechanical Ventilation---Rate of tidal Volume of
vent is excessive
• Hypoxia
• ↑Temperature
RESPIRATORY ALKALOSIS

pH PACO2 HCO3
Uncompensate
d
N
Partially
Compensated

Fully
Compensated
N
Nursing Diagnoses: Respi Alka

• Anxiety related to cause of respiratory alkalosis.

• Impaired gas exchange related to alveolar
hyperventilation.
• Ineffective breathing pattern related to deep, rapid
breathing.
Medical Management / Nursing
Interventions
• Institute safety measures for the patient with vertigo or the
unconscious patient.
• Encourage the anxious patient to verbalize fears
• Administer sedation as ordered to relax the patient
• Keep the patient warm and dry
• Encourage the patient to take deep, slow breaths or breathe into a
brown paper bag (inspire CO2).
• Monitor vital signs
• Monitor ABGs, primarily PaCO2; a value less than 35 mmHg indicates
too little CO2 (carbonic acid)
RESPIRATORY ACIDOSIS
• Carbonic Acid Excess
• pH : <7.35
• CO2 : >45 mmHg
Causes of Respiratory Acidosis

• Depression of Respiratory center

• Lung disease
• Airway obstruction
• Disorders of the chest wall and respiratory
muscles
• Breathing air with high CO2 content
• Chronic Metabolic Alkalosis
• Neuromuscular diseases
RESPIRATORY ACIDOSIS

pH PACO2 HCO3
Uncompensate
d
N
Partially
Compensated

Fully
Compensated
N
Nursing Diagnoses:

• Fear related to threat of death.

• Impaired gas exchange related to alveolar
hypoventilation.
• Ineffective breathing pattern related to rapid
shallow respirations.
Medical Management / Nursing
Interventions:

• Institute safety measures

• Assist with positioning
• Monitor I&O and administer fluids as ordered
• Administer oxygen and medications for order;
monitor hourly vital signs and respiratory status
(may require mechanical ventilation)
• Monitor arterial blood gases (ABGs); pH, PaCO2,
HCO3
METABOLIC ALKALOSIS
Metabolic Alkalosis

• Base Carbonate Excess

• pH : >7.35
• HCO3 : >26 mEq/L
Causes: Metabolic Alkalosis

• Vomiting
• Gastric Suctioning
• Hypokalemia
• Drug Induce [ingesting antacids that contain HCO3
or administration of HCO3 to treat metabolic
acidosis.
METABOLIC ALKALOSIS

pH PACO2 HCO3
Uncompensate
d N
Partially
Compensated

Fully
Compensated
N
Nursing Diagnoses: Meta Alka

• Disturbed thought processes related to neurologic

dysfunction.
• Decreased cardiac output related to AV
arrhythmias.
• Risk for injury related to tetany.
Medical/ Nursing Mgt: Meta Alka

• Mild Metabolic Alkalosis may require NO

treatment.
• Severe Metabolic Alkalosis includes administration
of IV Ammonium Chloride
• Potassium chloride and normal saline solutions
(replace gastric losses)
• Oral or IV Acetazolamide (enhances renal
bicarbonate/ potassium excretion)
Medical/ Nursing Mgt: Meta Alka

• When administering IV solutions containing

potassium salts, dilute potassium with the
prescribed IV solution and use an IV infusion
pump.
• Infuse ammonium chloride 0.9% IV no faster than
1L over 4 hours; Faster administration may cause
RBC hemolysis. Don’t give ammonium chloride to
patients with hepatic/ renal disease.
Medical/ Nursing Mgt: Meta Alka

• Observe seizure precautions, and provide a safe

environment for the patient with altered thought
process. Orient the patient as needed.
• Irrigate the patient’s NG tube with normal saline
solution instead of plain water to prevent loss of
gastric electrolytes.
METABOLIC ACIDOSIS
Metabolic Acidosis

• Base Carbonate Deficit

• pH : <7.35
• HCO3 : <22 mEq/L
 
Causes of Metabolic Acidosis

• Diabetes (Diabetic Ketoacidosis-incomplete

oxidation of fatty acids)
• Renal Insufficiency
• Diarrhea, vomiting [loss K+, Na+] of, fistulas – loss
of base
METABOLIC acidosis

pH PACO2 HCO3
Uncompensate
d N
Partially
Compensated

Fully
Compensated
N
Nursing Diagnoses: Meta Acid

• Disturbed thought processes related to neurologic

dysfunction.
• Decreased cardiac output related to arrhythmias.
• Ineffective breathing pattern related to pulmonary
dysfunction.
Medical/Nursing Mgt

• Acute Metabolic Acidosis, treatment may include

IV administration of Sodium Bicarbonate.
• Chronic Metabolic Acidosis, treatment may
include oral bicarbonate.
• Others:
Treat the underlying cause
Mechanical ventilation
Medical/Nursing Mgt

• Provide care to eliminate the underlying cause of

metabolic acidosis.
• Administer sodium bicarbonate.
• Position the patient to promote chest expansion
and turn him every 2 hours.
• Orient the patient frequently.
END