Acid Base Balance

Chapter 7
Acid-Base Balance and Regulation
Des Jardins, Cardiopulmonary Anatomy & Physiology: Essentials of Respiratory Care, 7th Edition. © 2020 Cengage. All Rights
Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Acid-Base Balance and Regulation
Nearly all biochemical reactions in Normal arterial pH range:

body influenced by acid-base o 7.34 to 7.45
balance of their fluid environment
Alkalosis
o pH > 7.45
Acidosis
o pH < 7.35
pH: Acid-Base Concentration (1 of 2)
Pure water has neutral pH of 7

o (0.0000001 mol/liter) of hydrogen ions
Solution with pH below 7 is acidic
o More hydrogen ions than hydroxide ions
For example, solution with pH of 6 has 10 times more hydrogen ions than
solution with pH of 7
pH: Acid-Base Concentration (2 of 2)
Solution with pH greater than 7 is alkaline

o Hydroxide ions outnumber hydrogen ions
For example, solution with pH of 8 has 10 times more hydroxide ions than
solution with pH of 7
Thus, as hydrogen ion concentration increases, hydroxide ion concentration
falls
o And vice-versa
Respiratory System and Acid-Base Balance (1 of 3)
Due to protein buffer system, H generated by CO2 transport system is not

permitted to increase
o Therefore, has little to no effect on blood pH
Under abnormal conditions, respiratory system quickly responds by either
increasing or decreasing rate and depth of breathing to compensate for acidosis
or alkalosis, respectively
For example, when pH declines (e.g., metabolic acidosis caused by lactic

acids), respiratory system responds by increasing breathing depth and rate
Causes more CO2 to be eliminated from lungs

o Therefore, pushes preceding reaction to left and reduces concentration
Process works to return acidic pH back to normal
Conversely, when pH rises (e.g., metabolic alkalosis caused by hypokalemia),

respiratory system responds by decreasing breathing depth and rate
Causes less CO2 to be eliminated from lungs

o Therefore, moves preceding reaction to right and increases concentration
Process works to pull alkalotic pH back to normal
Acid-Base Balance Disturbances (1 of 2)
Normal bicarbonate to carbonic acid (H2CO3) ratio in blood plasma:

o 20:1
• For every H2CO3 ion produced in blood plasma, 20
must be formed to maintain 20:1 ratio (normal pH)
• For every H2CO3 ion loss in blood plasma, 20
must be eliminated to maintain normal pH
o H2CO3 ion is 20 times more powerful than in changing blood pH
Acid-Base Balance Disturbances (2 of 2)
Under normal conditions, 20:1 acid-base However, these normal acid-base

balance in body is automatically regulated regulating systems have limits
by:
o Chemical buffer systems
o Respiratory system
o Renal system
Acid Base Disturbance
Respiratory Acidosis : Various causes results in alveolar hypoventilation
which accumulates CO2. This increases the H+ ion concentration and
decreases pH.
CO2 pH
Respiratory Alkalosis: The reverse of respiratory acidosis.

CO2 pH
Acid Base Disturbance
Metabolic acidosis: Because of various causes, the HCO3 can be lost or
more H+ ions can accumulate resulting in metabolic acidosis.
HCO3 pH
Metabolic alkalosis: HCO3 accumulates or increases or more acid is lost from

the body resulting in metabolic alkalosis.
HCO3 pH
Acid base disorders
Primary Disorder Secondary Response
Respiratory Acidosis Metabolic Alkalosis
Respiratory Alkalosis Metabolic Acidosis
Metabolic Acidosis Respiratory Alkalosis
Metabolic Alkalosis Respiratory Acidosis
Steps to ABG Interpretation - Basics
Example 1
A 60 year old man with h/o smoking is admitted to ICU with respiratory failure.
ABG shows:
pH : 7.30
PaCO2 : 55mmHg
HCO3 : 26 mmol/l
BE : -3
PaO2 : 65mmHg
SaO2 : 85%
Interpretation
PaO2 – low – hypoxemic (it is an ABG sample)
pH – Acidosis
PaCO2 – high (moves in the opposite direction of pH) so it’s the primary
disorder
HCO3 – normal
Interpretation : Respiratory Acidosis with hypoxemia
Example 2
A 20 year old female is admitted with case of hyperemesis. She cannot tolerate
oral intake of food. ABG shows:
pH : 7.51
PaCO2 : 45 mmHg
HCO3 : 36 mmol/l
PaO2 : 80mmHg
SaO2 : 94%
Interpretation
PaO2 – normal (sample tells its an ABG)
pH – Alkalosis
PaCO2 – normal (not the primary)
HCO3 – HIGH (moves in the same direction of the pH) –primary problem
Interpretation – metabolic alkalosis with normal oxygenation.
Acid base disturbance and compensation
(The dark arrow – primary disturbance
The light arrow – compensation)

Acid Base Balance

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Chapter 7

Acid-Base Balance and Regulation

Nearly all biochemical reactions in Normal arterial pH range:

Pure water has neutral pH of 7

Solution with pH greater than 7 is alkaline

Due to protein buffer system, H generated by CO2 transport system is not

For example, when pH declines (e.g., metabolic acidosis caused by lactic

Causes more CO2 to be eliminated from lungs

Conversely, when pH rises (e.g., metabolic alkalosis caused by hypokalemia),

Causes less CO2 to be eliminated from lungs

Normal bicarbonate to carbonic acid (H2CO3) ratio in blood plasma:

Under normal conditions, 20:1 acid-base However, these normal acid-base

Respiratory Alkalosis: The reverse of respiratory acidosis.

Metabolic alkalosis: HCO3 accumulates or increases or more acid is lost from

Respiratory Acidosis Metabolic Alkalosis

Respiratory Alkalosis Metabolic Acidosis

Metabolic Acidosis Respiratory Alkalosis

Metabolic Alkalosis Respiratory Acidosis

PaO2 – low – hypoxemic (it is an ABG sample)

Interpretation : Respiratory Acidosis with hypoxemia

PaO2 – normal (sample tells its an ABG)

PaCO2 – normal (not the primary)

Interpretation – metabolic alkalosis with normal oxygenation.

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