1

Acid/Base Balance
CO2 = Acid

HcO3 = Base

H2 = Acid

-First to help is lungs but at the end is kidney who compensate

PH 7.35 -7.45 PH < 7.35 = Acidosis

PH > 7.45 = Alkalosis
CO2 35 – 45

HCo3 22- 26

Patient Hypoventilation = Impaired gas exchange = High CO2 Respiratory Acidosis

Patient Hyperventilation = Loss CO2 = loss of CO2 = Respiratory Alkalosis

PH PH
Respiratory Metabolic
Co2 HCO3

Alkalosis
Alkalosis

Acidosis
Acidosis

7.4 7.45
7.35

Acidosis Compensate Alkalosis

d

6.80 = death 7.80 = death

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Acid/Base Balance
Hypoventilation = Impaired Gas Exchange

Respiratory Acidosis = CO2 +. PH +

Cause:

-CNS Depression

-Drugs Producing Respiratory Depression

*MgSO4 (Magnesium Sulfate)
*Opioids
*Barbituric
*Alcohol
*Benzodiazepines

-Neurologic Disorders producing respiratory muscle weakness:

*Crisis Myasthenia Gravis
*Crisis Gilliam Barre
*Crisis Lou Gehrig
*Multiple Sclerosis

-Spinal Cord Injuries at the level C1 and C4 this patient has respiratory drive compromised and
as consequence gets into Mechanical Ventilation
*this patient is not yet in respiratory acidosis Spinal cord injury at the level of C5 and C7 this
patient breath spontaneously but is at high risk of respiratory failure and keep at bedside
intubation equipment

-Chest Trauma:
*Flail Chest or Paradoxus Respiratory
*Pneumothorax
*Rib Fracture

-Lung Disease:
*COPD (Chronic Bronchitis, Asthma, Emphysema, Bronchiectasis, Cystic Fibrosis, Pneumonia,
ARDS)

-Excessive Obesity: (compress diaphragm)

-Surgery Close to Diaphragm

*This type of surgeries produce pain and as a consequence Shallow respiration =
Hypoventilation and impaired gas exchange and Increase CO2 = Respiratory Acidosis
*Cholecystectomy
*Fundoplication
*Nephrectomy
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Acid/Base Balance
~N/I: Pain Management, analgesia, splinter and Deep Breathing and Coughing, Spirometer

-----Low Suction to all this patient -----------Respiratory Acidosis / Deep Breathing and Coughing

Respiratory Alkalosis

Hyperventilation =. CO2 + PH

-Stress

-Anxiety

-Panic Attack

-Acute Pain

-Over Ventilation on Mech Ventilation

-Fever

~N/I: tell patient to Calm or Offer a paper bag/copping hand

~If patient is in ICU = Mask (partial Rebreathing Mas 1/3 Co2)

~Give patient Anxiolytics

------High Suction to all patient ---------Stress/Anxiety/Panic Attack = High Risk Alkalosis ---------
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Acid/Base Balance

Stomach = Acid

Vomit = Acid

Pancreas = Base

Diarrhea = Base

Metabolic Acidosis = HCo3 + PH

-Overdose of ASA

-Diabetes Ketoacidosis

-Impaired Metabolic Carbs

-High intake of Fats

-Diarrhea / Ileostomy / Colostomy

-Renal Failure (because waste products are acid)

-Starvation

-Alcohol Abuse (malnourished)

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Acid/Base Balance
-The most concern in a Hyperemesis Gravidarum patient don’t eat enters in starvation and
organism start using ketones and enters in Metabolic Acidosis (but if patient only vomits is
Metabolic alkalosis)

Metabolic Alkalosis = HCo3 +. PH

-Bicarbonate Overdose

-Vomits / Ng Suction

-Hyperemesis Gravidarum but can be evolve in a Metabolic Acidosis by starvation

-Hyperaldosteronism = Conn’s Syndrome

-Massive Blood Transfusion because increase PH

-Loop Diuretics (because you lose water, electrolytes and H2 = Acid)

Allen’s Test = to verify or check patency in the ulnar artery before to do the ABG

1- Explain the procedure

2- Apply pressure over radial/ ulnar artery simultaneously
3- Ask the patient to open and close hands
4- Release pressure over ulnar artery while apply pressure over radial artery
5- Look color on distal in pressure site
6- Document