Acid and Bases

• Circulating acids are classified as carbonic or respiratory acids, or noncarbonic or

metabolic acids
• Carbonic acid(H2CO3) - results from carbohydrate metabolism
• In the presence of carbonic anhydrase in the red blood cells, it is catalyzed to H+
and HCO3−, and CO2 and H2O are released at the alveolar level
• These reactions are summarized by CO2 + H2O ↔ H2CO3 ↔ H+ + HCO3−
• Noncarbonic acids including lactate and ketones, often result from the
metabolism of proteins and fats or the intake of foods containing sulfates or
phosphates.
• The amount of acid produced or ingested each day must equal the amount
removed, otherwise, an imbalance occurs
Buffering
• Chemical buffering and the secondary (compensatory) responses,
which includes the respiratory response and the metabolic response
• Buffering occurs with the production of HCO3−, as shown in the
carbonic acid equation above, and is the fastest and most common
way the body regulates pH
• The lungs regulate CO2 by way of the medulla and chemoreceptors
located throughout the body.
• The lungs are able to rapidly alter the pH by changing the minute
ventilation (minute ventilation = respiratory rate x tidal volume) and
amounts of exhaled CO2
Read
Metabolic Acidosis
• The primary reduction in the serum concentration of bicarbonate
(HCO3–), a secondary decrease in the arterial partial pressure of carbon
dioxide (PaCO2), and a reduction in blood pH.
• Acute (lasting minutes to several days) vs chronic (lasting weeks to years)
• Metabolic acidosis frequently occurs as a part of mixed acid–base
disorders, especially among the critically ill.
• Anion Gap
• The serum anion gap, defined as [Na+] – ([Cl–] + [HCO3–]),
• is a valuable diagnostic tool as the various disorders that produce metabolic
acidosis can affect the serum anion gap differently.
Causes of metabolic acidosis
• High anion gap metabolic acidosis
• Acute kidney injury, Chronic kidney disease, Diabetic ketoacidosis, Alcoholic ketoacidosis,
Lactic acidosis, Salicylate intoxication, Toxic alcohol intoxication (methanol, ethylene glycol)
Pyroglutamic acidosis, Fasting ketoacidosis
• Normal (hyperchloremic) anion gap metabolic acidosis- high serum K+
administration of HCl or precursors
• Administration of cationic amino acids, Chronic kidney disease, Adrenal insufficiency
(primary or secondary), Hyporeninemic hypoaldosteronism, Hyperkalemic distal rTA,
Pseudoaldosteronism, (Gordon’s syndrome), Drugs (spironolactone, prostaglandin inhibitors,
triamterene, amiloride, trimethoprim, pentamidine, ciclosporin)
• Normal (hyperchloremic) anion gap metabolic acidosis (low serum K+ Diarrhea)
• intestinal, pancreatic, or biliary fistulae, Proximal rTA, Distal rTA, Ureterosigmoidostomy,
Ureteroileostomy, Diabetic ketoacidosis, Lactic acidosis
Symptoms
• Rapid and shallow breathing- Kussmal respirations
• Confusion
• Fatigue
• Headache
• Sleepiness
• Lack of appetite
• Shock
• Nausea and vomiting
Complications
Complications
Metabolic alkalosis
• Associated with an increase in serum bicarbonate as a result of
depletion of chloride and sometimes potassium
• Causes
• Excessive volume loss GI suctioning
• vomiting
• diarrhea
• Diuresis
• Mineralocorticoid excess.
Symptoms
• May not show any symptoms. • Tremors in hands
• Vomiting & Nausea • Lightheadedness
• Diarrhea • Irritability
• Prolonged spasms in the muscles (Tetany)
• swelling in the lower legs (peripheral edema)
• Twitching of the muscles
• Fatigue • Tingling sensations in the face
• Facial numbness

• Severe cases of metabolic alkalosis can cause:

• agitation
• disorientation
• seizures
• coma
• Often associated with chronic liver disease.
Complications
• Heart failure
• Convulsions
• Coma
Respiratory Acidosis
• Respiratory acidosis is a condition that occurs when the lungs can’t
remove enough of the carbon dioxide (CO2) produced by the body
• Acute – emergency- occurs quickly. Left untreated, symptoms will get
progressively worse. It can become life-threatening.
• Chronic – develops over time, It doesn’t cause symptoms. Instead, the
body adapts to the increased acidity.
Causes
• Chronic
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Acute pulmonary edema
• Severe obesity (which can interfere with expansion of the lungs)
• Neuromuscular disorders (such as multiple sclerosis or muscular dystrophy)
• Scoliosis

• Acute:
• lung disorders (COPD, emphysema, asthma, pneumonia)
• conditions that affect the rate of breathing
• muscle weakness that affects breathing or taking a deep breath
• obstructed airways (due to choking or other causes)
• sedative overdose
• cardiac arrest
Symptoms -Acute
• Initial signs
• headache
• anxiety
• blurred vision
• restlessness
• confusion
• Without treatment, other symptoms may occur such as;
• sleepiness or fatigue
• lethargy
• delirium or confusion
• shortness of breath
• coma
Symptoms- Chronic
• No symptoms but can present with;
• memory loss
• sleep disturbances
• personality changes
Complications
• Poor organ function
• Respiratory failure
• Shock
Respiratory alkalosis
• Occurs when you breathe too fast or too deep and carbon dioxide levels drop too low.
• Causes
• Hyperventilation
• Causes of hyperventilation
• heart attack
• pain
• drug use
• asthma
• fever
• chronic obstructive pulmonary disease
• infection
• pulmonary embolism
• pregnancy
Symptoms
• Dizziness
• Bloating
• Feeling lightheaded
• Numbness or muscle spasms in the hands and feet
• Discomfort in the chest area
• Confusion
• Dry mouth
• Tingling in the arms
• Heart palpitations
• Feeling short of breath
Thank you