Acid Base

Imbalances
Fluid balance
Infants – body water accounts
for 75% - 80% of total weight
Children – body water
accounts for 65%-70% of total
weight
Fluid distribution
1. Intracellular 35%-40% of body
weight
2. Interstitial (surrounding cells and
bloodstream) - 20% of body
weight
3. Intravascular (blood plasma) –
5% of body weight
Interstitialand intravascular fluid referred
to as extracellular fluid (ECF) - totaling
25% of body weight
ECF
◦ Infants – 45% of total body weight
◦ Young children – 30% of total body weight
◦ Adolescents – 25% of total body weight
Infants do not concentrate
urine – immature kidneys
They have greater loss of water
in their urine
A 7-kg infant have an ECF volume of 1750
ml
They ingest approximately 700 ml per day
and excrete approximately 700 ml daily
Exchange rate is approximately 40% of
their volume daily
The increased exchange rate may be more
critically affected when they are ill
Infants who do not eat for a day
(providing kidney function remains
constant) will be 40% short of ECF by
the end of the day
pH – determined by the proportion of
hydrogen ions in relation to hydroxide
ions
A solution is acid (pH below 7.0) if it
contains more H+ ions than OH+ ions
A solution is alkaline (pH above 7.0) –
OH + ions exceeds H + ions
Sample – arterial blood for blood gases
pH of blood – slightly alkaline – 7.35 –
7.45
The amount of dissolved carbon dioxide
in arterial blood (Pco2) – 35-45 mmHg
Bicarbonate (HCO3) in arterial blood is
normally 22-26 mEq/L
Metabolic Acidosis
May result from diarrhea
Great deal of Na is lost
Body conserves H+ ions – to keep the
total number of positive ions and negative
ions in serum balanced
Child becomes acidotic as the number of
H+ ions in the blood increases
proportionately over the number of OH +
ions
Metabolic Acidosis
ABG analysis reveal a decreased pH
under 7.35 and a low HCO3 near or below
22mEq/L
The lower the HCO3 is, the larger the
number of Na+ that have been lost or the
more extensive diarrhea has been
A blood serum over 7.45 is incompatible
with life
Metabolic Acidosis
To correct acidosis, the body uses both
kidney and respiratory buffering
system
• Respiratory buffering system attempts
to correct the imbalance - H+ ions
combines with HCO3 ion to form carbonic
acid
This in turn is broken down into CO2 and
water which is then eliminated by the
lungs during expiration
Metabolic Acidosis
The process works immediately and
continues for a time
The carbonate level in the serum falls lower
and lower as the body uses up its bicarbonate
store
In the kidneys, H+ ions are excreted directly
or combine with other substances, such as
phosphate and ammonia to form a weak acid
which is excreted. The process is slow taking
up to 24 hrs to complete
Metabolic alkalosis
With vomiting, a great deal of
hydrochloric acid is lost
when Cl- ions are lost, the body has to
decrease the number of H+ ions
the number of positive and negative
charges remains balanced
causes the child to become alkalotic as
the number of H+ ions becomes
proportionately lower than the number of
OH+ ions present
Metabolic alkalosis
to reduce the number of H+ ions, the
lungs conserve CO2 and water by slowing
respirations
the excessive CO2 retained by this
maneuver dissolves in the blood as
carbonic acid and then is converted into
excessive H+ and HCO3
with metabolic alkalosis, the serum
invariably will be high HCO3
Metabolic alkalosis
The higher the value is presumably the
larger the number of Cl- ions that have
been lost or the more extensive vomiting
has been
the child will breath slowly and
shallowly
pH will be elevated – near or above 7.45
 HCO3 level will be near or above 28
mEq/L
Metabolic alkalosis
When alkalosis occurs from vomiting, a
secondary electrolyte problem occurs
As the kidneys begin to help conserve H +
ions, K+ ions are exchanged for H+ ions
(K+ ions are excreted in order to retain H +
ions)
with K+ loss in the urine, hypokalemia
accompany metabolic acidosis