Acid-Base Imbalance

By
Aminullah
Lecturer :MCON
 Acid Base
 The body normally maintains a steady balance
between acid produced during metabolism and
bases that neutralize and promote the excretion
of the acid , many health problems lead to acid
base imbalance in addition to fluid and
electrolyte imbalance
 Patient with diabetes mellitus, chronic
obstructive pulmonary disease and kidney
disease frequently develop acid-base imbalance
 Hydrogen Ion concentration
 Acidity or alkalinity of a solution is
determined by its concentration of hydrogen
ions (H+)
 The unit used to describe acid base is PH
 The PH scale ranges from 1-14.
 A neutral solution measures 7
 Normal blood plasma is slightly alkaline and
has a normal PH range of 7.35-7.45
 Acidosis & Alkalosis
ACIDOSIS:
 It is the condition characterized by an excess
of H ions or loss of base ions/bicarbonate in
 ECF in which the PH falls bellow 7.35
ALKALOSIS:
 It occurs when there is a lack of H ions or
again of based and the PH exceeds 7.45
 Acid Base Regulation
• The body’s metabolic processes constantly
produce acids.
• These acids must be neutralized and excreted
to maintain acid base balance
• Normally the body has three mechanisms by
which it regulates acid-base balance to
maintain the arterial PH 7.35 to 7.45
 Acid Base Balance Mechanism
 BUFFER SYSTEM
 THE RESPIRATORY SYSTEM
 THE RENAL SYSTEM
 Buffers
 A buffer is a substance, that has the ability to bind or
release H+ in solution, thus keeping the pH of the
solution relatevily constant despite of considerable
quantities of acid or base
 The important buffer systems in blood include
proteins, carbonic acid-bicarbonate buffers and
phosphates.
 Chemical Buffers

Bicarb buffer:
 Immediate acting
 mainly responsible for
 Combine with buffering blood and
interstitial fluid
offending acid or
Phosphate buffer:
base to neutralize  effective in renal tubules
harmful effects until Protein buffers:
most plentiful - hemoglobin
another system takes
over
 Respiratory System
 Lungs regulate blood levels of CO2
 CO2 + H2O = Carbonic acid
 High CO2 = slower breathing (hold on to
carbonic acid and lower pH)
 Low CO2 = faster breathing (blow off
carbonic acid and raise pH)
 Twice as effective as chemical buffers, but
effects are temporary
 Kidneys/ Renal System

 Reabsorb or excrete  Adjustments by the

excess acids or kidneys take hours
bases into urine to days to
 Produce accomplish
bicarbonate  Bicarbonate levels
and pH levels
increase or
decrease together
 Acid Base Balance Mechanism
BUFFER:
 Reacts immediately
RESPIRATORY SYSTEM:
 Responds in minutes and reaches maximum
effectiveness in hours
RENAL RESPONSE:
 Takes 2-3 days to responds maximally
 Alteration of Acid Base balance
 The acid-base imbalance is produced when the
ratio of 1:20 between acid and base content is
altered
 A primary disease or process may alter one side
of the ratio
 The compensatory process attempts to maintain
the other side of the ratio
 When compensatory mechanism fails, an acid–
base imbalance occurs
 Types of Acid-base imbalances
Types of Acidosis:
 Respiratory Acidosis
 Metabolic Acidosis
Types of Alkalosis:
 Respiratory Alkalosis
 Metabolic Alkalosis
 Arterial Blood Gases
Normal ranges
 PH 7.35 - 7.45

 PaCO2 35 - 45 mmHg

 HCO3 22-26 mEq/L

 Respiratory Acidosis
 Also called respiratory failure or ventilatory
failure
 PH < 7.35 and
 PaCo2 > 45mmHg.
 It may either acute and chronic
 Clients At Risk
 Post op abdominal surgery
 Mechanical ventilation
 Analgesics or sedation
 CAUSES
 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
 Sign & symptoms
 Apprehension, restlessness
 Confusion, tremors
 Decreased DTRs
 Diaphoresis
 Dyspnea, tachycardia
 N/V, warm flushed skin
 Management

 Correct underlying cause

 Bronchodilators
 Supplemental oxygen
 Treat hyperkalemia
 Antibiotics for infection
 Chest PT to remove secretions
 Remove foreign body obstruction
 Treating respiratory acidosis
Acute form:
 Treating acute acidosis usually means addressing the underlying cause. For
example, your airway may need to be cleared. This must be done as soon as
possible. Artificial ventilation may also be needed.
Chronic form:
 Treatment will focus on managing any underlying conditions.
 The goal is to improve airway function.
 Some strategies include:
 Antibiotics (to treat infection)
 Diuretics (to reduce excess fluid affecting the heart and lungs)
 Bronchodilators (to expand the airways)
 Corticosteroids (to reduce inflammation)
 Mechanical ventilation (in severe cases)
 Respiratory Alkalosis
 PH > 7.45
 PaCo2 < 35mmHg
 Most commonly results from hyperventilation
caused by pain, salicylate poisoning, use of
nicotine or aminophylline, hypermetabolic
states or acute hypoxia (overstimulates the
respiratory center)
 Sign & symptom
 Anxiety, restlessness
 Diaphoresis
 Dyspnea ( rate and depth)
 EKG changes
 Hyper reflexia, paresthesia
 Tachycardia
 Tetany
 Management
 Correct underlying disorder
 Oxygen therapy for hypoxemia
 Sedatives or antianxiety agents
 Paper bag breathing for hyperventilation
 Metabolic Acidosis
 PH<7.35
 HCO3 <22mEq/L
 characterized by gain of acid or loss of bicarb
 Associated with ketone bodies
 Diabetes mellitus, alcoholism, starvation,
hyperthyroidism
 Other causes
 Lactic acidosis secondary to shock, heart failure,
pulmonary disease, hepatic disease, seizures,
strenuous exercise
 Sign & symptom

 Confusion, dull headache

 Decreased DTRs
 S/S of hyperkalemia (abdominal cramps,
diarrhea, muscle weakness, EKG changes)
 Hypotension, Kussmaul’s respirations (
is an abnormal breathing pattern
characterized by a deep repaid breathing)
 Lethargy, warm & dry skin
 Management
 Regular insulin to reverse DKA
 IV bicarb to correct acidosis
 Fluid replacement
 Dialysis for drug toxicity
 Antidiarrheals
 Metabolic Alkalosis
 PH > 7.45
 HCO3 > 26mEq/L
 Commonly associated with hypokalemia from
diuretic use, hypochloremia and hypocalcemia
 Also caused by excessive vomiting, NG
suction, Cushing’s disease, kidney disease or
drugs containing baking soda
 Sign & symptom

 Anorexia  Muscle twitching

 Apathy  Nausea
 Confusion  Paresthesia
 Cyanosis  Polyuria
 Hypotension  Vomiting
 Loss of reflexes  Weakness
 Management
 IV ammonium chloride
 D/C thiazide diuretics and NG suctioning
 Antiemetics
 Interpreting ABGs
 Step 1: Check the pH
 Step 2: What is the CO2?
 Step 3:Watch the bicarb
 Step 4: Look for compensation
 Step 5 : What is the PaO2 and SaO2?