Acid-Base Balance

and Imbalance
James Barnett, RN, MSN
Clinical Educator – Neuroscience PCC
Vanderbilt University Medical Center
May 2007
 Definitions
 pH
 Measurement of how alkaline or acid a substance is
 Chemistry
 Neutral ph = 7
 pH < 7 is acid

 pH > 7 is alkaline

 Normal human blood pH is slightly alkaline at

7.35 – 7.45
 Definitions
 An Acid is…
 A molecule that can donate a H+ ion
 Examples:
 H2O  H+ + OH-
 H2CO3  H+ + HCO3-

 An acid can be weak, moderate, or strong depending

on its pH
 Weaker acids are closer to 7
 Stronger acids are closer to 1
 Definitions
 A Base or alkali is…
 A molecule that can accept a H+ ion
 Examples:
 H+ + OH-  H2O
 H+ + HCO3-  H2CO3

 A base can be weak, moderate, or strong depending

on its pH
 Weaker bases are closer to pH 7
 Stronger bases are closer to pH 14
An Important Equilibrium Equation

H2O + CO2  H2CO3  H+ + HCO3-

Water plus carbon dioxide equals carbonic acid which is broken down by
carbonic anhydrase into a hydrogen ion and bicarbonate.
 Types of Acids
 Volatile acids
 Easily move from liquid to gas state
 Within the body
 Lung can remove
 H2CO3 + renal enzyme  H2O + CO2 (both of which
are exhaled)
 Carbon dioxide is therefore considered an acid

KEY CONCEPT: As CO2 rises, there is more acid  respiratory acidosis

KEY CONCEPT: As CO2 drops, there is less acid  respiratory alkalosis

 Types of Acids
 Nonvolatile acids
 Cannot be changed to gas state
 Within the body
 Must be removed by the kidneys (metabolic)
 Examples
 Keto acids
 Lactic acids
Acid-Base Imbalance
 Acid Imbalance
 Too much CO2 leads to decreased pH and an acid
condition

 Too little CO2 leads to increased pH and an alkaline

condition

 PaCO2
 Amount of CO2 dissolved in the blood
 Good indicator of respiratory and ventilatory function
 Base Imbalance
 Major base in body is bicarbonate (HCO3-)

 Regulated by the kidneys (metabolic)

 Too little HCO3- causes decrease in pH and acid

conditions

 Too much HCO3- causes increase in pH and

alkaline conditions
 More definitions
 Acidemia – condition where blood is more acid than
normal (pH < 7.35)

 Alkalemia – condition where blood is more alkaline

than normal (pH > 7.45)

 Acidosis – the process causing acidemia

 Alkalosis – the process causing alkalemia

 Respiratory Imbalances
 Respiratory mechanisms involve either
 Retention of excess carbon dioxide
 Retention of insufficient carbon dioxide

 Over- or Under-ventilation or respiration

abnormalities are the main causes of this
imbalance
 Metabolic Imbalances
 Metabolic mechanisms involve

 Renal function alteration

 Production of acidic metabolic products

 Loss of acid from the body

 The Normal’s
 pH  7.35 – 7.45

 PaCO2  35 – 45 mmHg

 HCO3-  22 – 26 mEq/L

 PaO2  80 – 100 mmHg

 The Abnormal’s
 Respiratory Acidosis

 Respiratory Alkalosis

 Metabolic Acidosis

 Metabolic Alkalosis
 Respiratory Acidosis
 pH < 7.35 Signs and Symptoms
 Dyspnea

 PaCO2 > 45  Restlessness

 Confusion/lethargy

Alveolar Hypoventilation  Dysrhythmias

 CNS depression or disease  Headache

 Ventilatory/respiratory
dysfunction Treatment
 Acute infections  Increase ventilation

 Treat the cause

 Respiratory Alkalosis
 pH > 7.45 Signs and Symptoms
 PaCO2 < 35  Light headedness
 Confusion
Alveolar Hyperventilation  Muscle spasm / parasthesias
 Dysrhythmias / palpitations
 Anxiety
 Sweating
 Pain
 Dry mouth
 Fever
 Blurred vision
 Thyrotoxicosis
 CNS lesions Treatment
 Improper vent management,  Slow down breathing
hypoxia  Paper bag breathing if anxiety or
 Pulmonary embolus fear is cause
 Treat the cause!
 Metabolic Acidosis
 pH < 7.35 Signs and Symptoms
 HCO3- < 22 mEq/L  Headache
 Confusion/lethargy
Causes  Stupor/coma
 Increased acids from  Weakness
 Anaerobic metabolism  Kussmaul respiration
 Abn metabolic process (DKA,  N/V
lactic acidosis)  Dysrhythmias
 Starvation  Flushing
 ASA or other acid ingestion
Treatment
 Excess HCO3- loss
 Treat the cause!!!
 Diarrhea
 Renal Failure  Give Bicarbonate
 Intestinal Fistulae  Dialysis for renal failure
 Metabolic Alkalosis
 pH > 7.45 Signs and Symptoms
 HCO3- > 28  Muscle spasms/tetany/seizure
Cause  Dizziness
 Disorientation/lethargy/coma
 Increased base
 Weakness
 Excessive use of bicarb
 N/V
 Lactate from dialysis
 Depressed respiratory drive
 Excessive antacid ingestion
 Acid loss
 Vomiting/Gastric suctioning Treatments
 Hypo- chloremia -kalemia  Treat the cause!!!!
 Diuretics  Increase respirations
 Large volume blood
transfusion
 Finished
 You have finished this in-service on Acid-Base
Balance and Imbalance.

 Continue with the next lesson titled:

 Compensated and Uncompensated Blood Gas
Analysis