ACID Base Imbalance

KRISTINE MAJELENE F. ERCILLO, RN, MSN

Overview of Acid Base Balance
• It is an important property of blood is it’s degree of acidity or alkalinity.
• pH scale ranges from 0 (strongly acidic) to 14 (strongly basic or alkaline)
• pH of 7.0 in the middle of this scale (neutral)
Acidity or Alkalinity?
• Acidity increases when:
• Level of acidic compounds in the body rises (through increased intake or production,
or decreased elimination)
• Level of basic (alkaline) compounds in the body falls (through decreased intake or
production) or increased elimination

• Alkalinity increases when:

• When the level of acid decreases or base increases.
Control of Acid Base Balance
Lungs
• Release of CO2 from the lungs
***CO2 is slightly acidic compound
***waste product produced by cells in
the body as they used O2. Cells release
it into your blood and it’s taken to
your lungs.
Kidneys
>Their cells reabsorb bicarbonate
(HCO3) – from urine back to blood
>they secrete H+ ions into the urine.
> By adjusting the amounts reabsorbed
and secreted, they balance the
bloodstream’s pH.
Buffer System
• Works chemically to minimize
changes in the pH of a solution by
adjusting the proportion of acid and
base.
• Most important pH buffer system
includes carbonic acid (a weak acid
formed from the CO2 dissolved in
blood) and bicarbonate ions (the
corresponding weak base)
Laboratory Test to Check for ABG:
• Allen’s Test
• Rest 30 minutes before
• Tight pressure at least 5-7 minutes
• Evaluate ABG.
• Room Air/O2/Mech Vent @ Bedside.
• ICE – to prevent hemolysis
• Avoid suctioning
• Lab within 15 minutes.
STEPS:
• 1. Occlude Radial and Ulnar Arteries.
• 2. Open close the fist for 3x.
• 3. Release the Ulnar Artery.
• 4. Assess Perfusion.
• 5. Obtain sample and send to the laboratory stat.
Normal Values
pH 7.35-7.45

PaCO2 35-45 mmhg

HCO3 22-26 mEq/L

PaO2 80-100 mmHg

SaO2 95-100 %

PCO2 – concentration of gaseous oxygen in the blood.

HCO3 – measures concentration of HCO3-ion only.
Respiratory Acidosis
• low Ph high PaCO2
• COPD
• Secretions
• Asthma (late phase)
• Hypoventilation
Respiratory Alkalosis
• high Ph low PaCO2
• Asthma (early phase)
• Hyperventilation
• Anxiety
Metabolic Acidosis
• low Ph low HCO3
• Diarrhea
• Diabetic Ketoacidosis
• Renal Failure
• Hypoxia
Metabolic Alkalosis
• high Ph high HCO3
• Vomiting
• Nasogastric Lavage or Drain
Rule of the B’s
• If the Ph and Bicarb (HCO3) are both in the same direction ---then it is
Metabolic
• As the Ph goes, so goes the patient except for K+ (because it will try to
compensate)
Signs and Symptoms of Acid Base Imbalance

PH (UP), K (DOWN) ALKALOSIS PH (DOWN), K (UP) ACIDOSIS

• Tachycardia • Bradycardia
• Bradypnea
• Tachypnea
• Hypotension
• Diarrhea
• Decreased lucidity
• Tremors • Anorexia
• Seizure • Coma

• Hyperreflexia • Lethargy

• Agitated
Partially Compensated Metabolic
Acidosis
low pH, low HCO3, high PaCO2

Uncompensated Respiratory Acidosis

normal pH, high HCO3, high PACO2

Uncompensated Respiratory Alkalosis

high pH, normal HCO3, low PACO2

Partial Respiratory Acidosis

low pH, high HCO3, high PACO2

R - respiratory
O - opposite
M - metabolic
S - same
Thank you 