ACID – BASE BALANCE 2.
decreased respirations conserve more CO2
= to increase the acid load
Acid-Base Balance Mechanisms are controlled by Carbonic acid (H2CO3) = CO2 + water
buffers, lungs, kidneys
BUFFERS
RENAL MECHANISM
prevents major changes in ECF by releasing or
Third Line of Defense (takes hours-days)
accepting H ions (pH)
1. kidneys secrete H ions & reabsorb
• Intracellular Buffers bicarbonate ions = increase blood pH
o Proteins 2. kidneys form ammonia that combines with
o Haemoglobin H ions to form ammonium ions, which are
o Phosphate excreted in the urine in exchange for sodium
• Bone buffers ions = decreased pH
• Extracellular Buffers
o Proteins
REVIEW
o Phosphate
o Bicarbonate Normal Values
pH
BUFFER SYSTEM
• 7.35-7.45
CHEMICAL BUFFER MECHANISM
pCO2 – measurement of the CO2 pressure that is
First Line of Defense (takes seconds) being exerted on the plasma
Combine with very strong acids or bases to convert • 35 - 45mmHg
them into weaker acids or bases
PaO2- amount of pressure exerted by O2 on the
[Link] Buffer System plasma
▪ most important • 80 - 100mmHg
▪ uses HCO3 & carbonic acid/H2CO3 - (20:1)
SaO2- percent of hemoglobin saturated with O2
▪ closely linked with respiratory & renal
mechanisms • 93 – 98 %
2. Phosphate Buffer System HCO3
• more important in intracellular fluids, where • 22 – 26 mEq/L
concentration is higher
• similar to bicarbonate buffer system, only
uses phosphate Acid
3. Protein Buffer System • Acid can be defined as a proton (H+ ) donor
• hemoglobin, a protein buffer, promotes • Molecules that dissociate in solution to →
movement of chloride across RBC H+
membrane in exchange for HCO3 • Physiologically important acids include:
o Carbonic acid (H2CO3)
o Phosphoric acid (H3PO4)
RESPIRATORY MECHANISM o Pyruvic acid
o Lactic acid
Second Line of Defense (takes minutes)
Base
1. increased respirations liberates more CO2 =
to reduced the acid load • Base can be defined as a proton (H+ )
acceptor
• Molecules capable of accepting a H+ ion • Chest tightness, palpitations
• Physiologically important bases include : • Dizziness, lightheadedness
o Bicarbonate (HCO3-) • Numbness, tingling
o Biphosphate (HPO4 -2 ) • Anxiety, tetany, panic
MANAGEMENT
ACID-BASE BALANCE • Rebreathe CO2 using paper bag, cupped
hands, rebreather mask
PROBLEMS • Assist patient to breath slowly
• Protect from injury
Acidosis - an excess of unwanted acid in the blood; • Anti-anxiety medications as needed
pH may be normal
Alkalosis - an excess of unwanted alkali in the
Metabolic Acidosis
blood; pH may be normal
decreased pH, decreased HCO3
Respiratory Acidosis
CAUSES
decreased pH, increased PaCO2
• Starvation, malnutrition
CAUSES • Diarrhea
• Respiratory depression • Ketoacidosis
• Airway obstruction (COPDs, etc) • Trauma, shock
• Inadequate chest expansion Pneumonia • Severe infection, fever
• Neuromuscular diseases • Salicylate intoxication Hyperkalemia
S/SX OF RESPIRATORY ACIDOSIS S/SX OF METABOLIC ACIDOSIS
• [Link],RR,BP • Deep, rapid respirations
• Mental cloudiness • Cold, clammy skin
• [Link] flow,vasodilation • Drowsiness, coma
• Hypotension
MANAGEMENT • Headaches,confusion,N/V
• Low flow O2,improve ventilation MANAGEMENT
• Clear respiratory tract of mucus
• Liquify secretions • Treat underlying cause
• If severe: mechanical ventilation Antibiotics • IV & insulin in ketoacidosis
for respiratory infections, Bronchodilators • Monitor electrolytes, esp. K
(mucomyst) • Sodium bicarbonate IV
Respiratory Alkalosis Metabolic Alkalosis
increased pH, decreased PCO2 increased pH, increased HCO3
CAUSES CAUSES
• Hyperventilation from fear, anxiety, • Excessive vomiting
hypoxemia, pain • Too much antacids
• Excessive mechanical ventilation Early • Hypokalemia
ARDS S/SX OF METABOLIC ALKALOSIS
• Salicylate intoxication
• Dizziness
S/SX OF RESPIRATORY ALKALOSIS
• Irritability, tingling of fingers
• Rapid, shallow breathing • Tremors, tetany
• Seizures o Abnormal pH
o Normal PaCO2
MANAGEMENT:
o Abnormal HCO3
• Assess for hypoK, hypoCa (due to CA
binding to albumin) Partial Compensation: with opposite directions
• Teach proper use of antacids o Abnormal pH
• K supplements if hypokalemic o Abnormal PaCO2
• Acetazolamide (Diamox) to increase renal o Abnormal HCO3
HCO3 excretion + H20
Complete or Full Compensation
o Normal pH
Analysis of Arterial Blood o Abnormal PaCO2 and HCO3
Gases Only a state of acidosis can cause the pH to
become acidotic.
Steps in Interpreting ABG Result
1. Interpret the pH
2. Identify if the primary cause is respiratory or STEP 5: Evaluate Oxygenation
metabolic
SaO2 (Pulse Oximeter)
3. Determine the presence of compensation.
Normal: 94 – 100%
Hypoxemia: Below 93%
STEP 1: Classify the pH
paO2
Normal: 7.35 – 7.45
Acidemia: < 7.35 Adequate Oxygenation: 80 – 100 mmHg
Alkalemia: > 7.45 Mild hypoxemia: 60 – 79 mmHg
Severe hypoxemia: below 39 mmHg
STEP 2: Assess PaCO2 // Evaluate Ventilation
Example Analysis
Normal: 35-45 mmHg
Respiratory acidosis: > 45 mmHg Example 1
Respiratory alkalosis: < 35 mmHg
pH = 7.25 acid
paCO2 = 55 acid
STEP 3: Assess HCO3 // Evaluate Metabolic
Process HCO3 = 25 normal
Normal: 22-26 mEq/L BE = +2 normal
Metabolic acidosis: < 22 mEq/L • Non Compensatory Respiratory Acidosis
Metabolic alkalosis: > 26 mEqL
Level of Base Excess: -5 -4 -3 -2 +2 +3 +4 +5
Example 2
pH = 7.25 acid
STEP 4: Determine Presence of Compensation
paCO2 = 55 acid
No Compensation present
o Abnormal pH HCO3 = 35 alkaline
o Abnormal PaCO2 BE = +8 alkaline
o Normal HCO3
• Respiratory acidosis with partial
-or- compensation
Example 3
pH = 7.35 acid, normal
paCO2 = 50 acid
HCO3 = 30 alkaline
BE = +5 alkaline
• Respiratory acidosis with complete
compensation