CONCEPT 9

Acid–Base Balance
1

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GOALS FOR THIS CONCEPT
PRESENTATION
1. Define and describe the concept.
2. Notice risk factors for disorders that cause acid–base imbalances.
3. Recognize when an individual has an acid–base imbalance.
4. Provide appropriate nursing and collaborative interventions to
optimize acid–base balance.

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3 DEFINE AND DESCRIBE THE
CONCEPT OF ACID–BASE
BALANCE

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DEFINITION
Acid–base balance is the process of regulating the
pH, bicarbonate concentration, and partial pressure
of carbon dioxide of body fluids.

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OTHER KEY TERMS
 Acid production
 Generation of acid through cellular metabolism

 Acid buffering
 Process to control changes in pH by neutralizing acids with buffers

 Acid excretion
 Removal of acid from the body

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SCOPE OF CONCEPT

Acid–base balance can be viewed as on a continuum; optimal balance is

seen in the middle and extremes of imbalance are on each end of the
spectrum.

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COMPARING ACID–BASE
BALANCE AND IMBALANCE
Acid–Base Balance Acid–Base Imbalance
 Expected in all well  Develops as a
individuals complication of another
 Requires normal underlying condition
physiological functioning  Never considered
 Indication of homeostasis “normal,” but may be
“expected” if a chronic
condition (e.g.,
compensation) is present

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ACID PRODUCTION AND
EXCRETION

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REVIEW OF RESPIRATORY AND RENAL
SYSTEMS ANATOMY AND PHYSIOLOGY

 Lungs
 Kidneys

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OPTIMAL ACID–BASE
BALANCE
 Acid excretion keeps pace with acid production
 Buffers are not overwhelmed
 The blood pH is maintained in the normal range of 7.35 to
7.45

Acid Base

Buffers
Renal System
Respiratory System
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 ACIDOSIS
Caused by retention of too much
acid or loss of too much base.
Base

Acid

Respiratory acidosis:
CO2 retention

Metabolic acidosis:
HCO3 loss or H+ retention
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ALKALOSIS
Acid Caused by loss of too much
acid or retention of too much
base.

Base

Respiratory
alkalosis: CO2 loss
Metabolic alkalosis
HCO3 excess or H+ loss
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CONSEQUENCES:
IMPAIRED CELLULAR AND
ORGAN FUNCTION
 When compensatory mechanisms fail, the following physiological
consequences occur:
 Altered cell function, especially in the brain when CO 2 crosses the blood–
brain barrier
 Change in intracellular enzyme activity resulting in cell dysfunction
 Acidosis: decreases the level of consciousness (LOC)
 Alkalosis: decreases the LOC and has other neurological manifestations; may
cause dysrhythmias

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NOTICE RISK FACTORS
14 FOR ACID–BASE
IMBALANCE

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RISK FACTORS
 All individuals are at risk, regardless of age, race, or socioeconomic
status. Those at greatest risk have one of four risk factors:
 Excessive production or intake of metabolic acid
 Altered acid buffering due to loss or gain of bicarbonate
 Altered acid excretion
 Abnormal shift of H+ into cells

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16
RECOGNIZE WHEN AN
INDIVIDUAL HAS AN ACID–BASE
IMBALANCE

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DIAGNOSTIC TEST:
ARTERIAL BLOOD GAS
INTERPRETATION
 Consider the condition and clinical findings
 Consider the pH, whether acidosis or alkalosis is present

 Consider the PaCO2 (35 to 45 mm Hg)

 Consider the HCO3 (22 to 26 mmol/L)

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18
PROVIDE APPROPRIATE NURSING AND
COLLABORATIVE INTERVENTIONS TO
OPTIMIZE ACID–BASE BALANCE

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CLINICAL MANAGEMENT:
PRIMARY PREVENTION
 Prevent risk factors of health conditions and situations that can cause
acid–base imbalances. A few examples include:
 Healthy eating habits
 Safe weight loss
 Smoking prevention or cessation
 Poison control measures
 Safe food handling

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CLINICAL MANAGEMENT:
COLLABORATIVE
INTERVENTIONS
 Treatment strategies always start by treating the underlying condition
causing the acid–base disturbance
 Problems caused by an underlying respiratory condition require respiratory
support
 Problems caused by an underlying metabolic condition require fluid and
electrolyte support
 Interventions often include managing a fluid and electrolyte disturbance
as well

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INDEPENDENT NURSING
INTERVENTIONS
 Safety
 Comfort
 Patient education

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INTERRELATED CONCEPTS

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