CPR Training

Center, Madina
In Affiliation with
SAUDI HEART ASSOCIATION

ACID-BASE
BALANCE

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 Acid Base
Balance
• Introduction:
– Proper bodily function can’t be
maintained without the balance
between hydrogen donors (acids) &
hydrogen acceptors (base).
– PH is a value that is inversely related to
the logarithm of the H concentration
and it is measure of acid-base

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Introduction (Cont.):
+
Normal H ion concentration is+
_ 40 5
nEq/L +
_
+
and is corresponds to a PH of 7.4 0.05
units +
Acidosis : H < 45 nEq/L & PH=7.35
Alkalosis: H > 35 nEq/L & PH=7.45

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omponents of Acid-Base Disturbance
1. Acidosis= Respiratory & Metabolic
2. Alkalosis= Respiratory & Metabolic
A marked or of body pH is harmful,
e.g.:-
Alkalosis: the release of O2 from red cells.
Acidosis : the myocardial contractility &
vascular response to catecholamines.

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omponents of Acid-Base Disturbance ( Cont. ):

• Acid is a waste product of cellular

metabolism. During aerobic metabolism,
the body produces two forms of acid:
1. CO2 volatile agent that can be eliminated by the
lungs.
2. Metabolic acid that must be buffered by
endogenous base components or secreted by
the kidney.CO2 is eliminated from the body
within normal circulatory, renal and ventilatory
functions. When there function are abnormal, an
overload of CO2 is produced resulting in
acidosis.
• There are two ways in which basis can
accumulate:
1. Excessive ingestion of a base.
2. The loss of excessive
02/21/10
acid.hmk
Acid-Base Balance 5
 Buffer System in the Body

Two factors can influences the PH in the

body, they are:
+
1. Processes that raise or lower the H
concentration
2. Defense mechanisms (buffer systems) that
maintain the pH of body fluids at a normal
value. These buffers are, plasma protein,
hemoglobin, phosphate, ammonium and
bicarbonate.

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 Buffer System in the Body
(Cont.)

• Buffer systems reduce, but do not eliminate

the hazards of acidosis or alkalosis
+ in acute
increase or decrease in the H concentration.
• Base deficit is a term applied when these
systems are depleted.
• Proper interpretation of the etiology of an acid-
base disturbance requires arterial blood gas
analysis.
• Normal (PaCO2) is 35-45 mmHg (mean 40) and
provides an important measure of adequate
ventilation and gas exchange.

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 Blood Gas Analysis

• It measure the following parameters:

1. Carbon dioxide tension PaCO2
2. Oxygen tension PaO2
3. PH

• It can be performed on arterial or venous

blood. Samples can be taken by:
1. Intra-arterial puncture of radial artery
2. Intra-arterial catheter if continuous Monitoring of
arterial B.P is being performed

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 Blood Gas Analysis (Cont.)
• Normally PaCO2 is 40 mmHg & pH is 7.4
• When PaCO2 < 45 mmHg (hypercapnea) due to
hypoventilation or apnea, pH falls  Respiratory acidosis
• When accumulation of metabolic acid (H+) & accompanied
by normal or low PaCO2  Metabolic acidosis
• When PaCO2 > 35 mmHg due to hyperventilation,
pH rises  Respiratory alkalosis
• While alkalosis due to build-up of HCO3 accompanied by a
normal or high PaCO2  Metabolic alkalosis

02/21/10 Acid-Base Balance hmk 9

 Blood Gas Analysis (Cont.)
It has been agreed that the following formulae
apply.
• Golden Formula I.
For every 10-mmHg rise or fall in
CO2 in blood, it corresponds to a fall
or rise of 0.08 in pH
Therefore,
– if CO2 rises by 10 to 50 mmHg, pH falls to 7.32
Respiratory acidosis
– If CO2 falls to 30 mmHg, pH rises to 7.48
Respiratory Alkalosis
– Any fall or rise in pH beyond this is known as
metabolic acidosis or alkalosis
02/21/10 Acid-Base Balance hmk 10
 Blood Gas Analysis (Cont.)
• Golden Formula II.
For every 0.15 fall or rise in pH is equal
to 10 mEq/L of NaHCO3 which has to be
given to correct such metabolic acidosis.
– In fact this is known as base deficit (B-D)
– NaHCO3 cannot be given haphazardly due to
its side effect, also it has to be given
accurately according to golden formula III.

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 Blood Gas Analysis (Cont.)
• Golden Formula III.
Total Base Deficit= B.D X b.w/kg
4
 Sodium bicarbonate is found in the extra-
cellular space. This space measures one
quarter(25%) of total body weight or one
third(33.3%) of total body fluid. This is
known to be accurate dose to be given
according to body weight/kg
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 Blood Gas Analysis (Cont.)
• Example:
PaCO3 = 52 mmHg and the pH is 7.17
Then apply golden formula I, if CO2 is 40 = pH is 7.4
There is rise of 12 mmHg.
For every 10 mmHg rise or fall is equal to 0.08 fall or
rise. This 12 = 0.1 respiratory acidosis
Calculated pH = 7.4 – 0.1 = 7.3
Measured pH is 7.17
pH difference is 7.3 – 7.17 = 0.13

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 Example ( Cont.):
• According to golden formula II for every 0.15 fall or
rise in pH is 10 mEq/L of NaHCO3, which has to be
given to correct the metabolic acidosis.
But- pH difference is 0.13:
Then the base deficit is 0.13 X 10 = 9
According to Golden formula III: B.D X b.w/kg
0.15
The accurate dose of NaHCO3 that has to be given to a 60
kgs patient is: 9 X 60 = 540 = 135 mEq/L 4
The above procedure must be accompanied by adequate
oxygenation & ventilation to correct the Respiratory
acidosis 4 4

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 Example ( Cont.):

• In case of lack ABG analysis facilities &

the pt. is known to suffer a long period
of cardiac arrest e.g. 10 min., then
NaHCO3 can be given in approximately.
Dose is given as one mEq/kg body
weight as a bolus dose. This can be
followed 10-15 min. later by ½ of bolus
dose once.

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 Acid Base
Balance

• Side effects:
1. NaHCO3  Na plus CO2 H2O excessive sodium
will lead to hypernatraemia (hyper-osmolality)
2. Accumulation of CO2 in the body will result in
alkalosis
3. Administration of NaHCO3 will lead to
Hypokalaemia
4. Metabolic alkalosis will shift O2 dissociation
curve to the left. This mean that O2 will not be
released at the cell site

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 In Summary
• Therapy must be based on clinical
status of the pt. & ABG analysis.
• In case of witnessed arrest, you need
to do ventilation & oxygenation only,
but as time passes “ say over 10 min
or more, then it is better to measure
the acid/base disturbance before
giving NaHCO3.

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