Acid Base

Imbalance
dr.Bobi Ahmad Sahid.,S.Kep

How do we know
that somebody
has the acidbase imbalance?

By measuring
his/her body pH

Why?

Because if the
body pH is out of
normal range
means that our
body becomes too
acidic or too
alkalic

What is the
normal range of
our body pH?

Between
7.35-7.45

 Metabolic reaction often

produced a huge excess of H+
Lack of any mechanism for the
disposal of H+ rise quickly to a
lethal level

What mechanisms are

responsible to
maintain our body pH
always within this
normal range?

There are 3 major

mechanisms:
1.Buffer system
(protein,carbonic acidbicarbonate,phosphate)
2.Exhalation of CO2
3.Kidney excretion

of H+

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How are those

mechanisms
work to
maintain our
body pH?

11

Mechanism

Comments

Proteins

Most consist of weak acid & its salt

function as a weak base. Prevent
drastic changes in body fluid pH.
Most abundant buffer (Hemoglobin)

Carbonic acidbicarbonate
Phosphate

Important regulator. Most abundant

buffer in ECF
Important buffer in ICF and urine

Exhalation of CO2

Exhalation increase pH increase;

exhalation decrease pH decrease.

Kidneys

Renal tubules secretes H+ into urine,

and reabsorb HCO3-

Buffer systems:

12

How can we
measure our
body pH?

13

By performing
Blood Gas Analysis

14

Blood Gas Analysis

will measures:
Normal Range

1. pH
: 7.40 + 0.05
2. pCO2
: 40
+
5 mmHg
3. pO2
: 80
- 100 mmHg
4. (HCO3-)
: 24
+
2 mmol/L
5. TCO2
: 25,2 +
2 mmol/L
6. O2 - saturation
: 95 - 98 %
7. Base, Negative (Base, deficient)
: - 2,5
8. Base, Positive (Base, Excess) : + 2,5
Value also depends on age, sex, Hb, temperature of the patient
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In the blood

pH

Too much acid

(acidemia)
Too much alkalic
(alkalemia)

Decrease

Condition
(terminology)
Acidosis

Increase

Alkalosis

16

How acidemia
and alkalemia
happend?

17

Acidemia is happended
when there is too much
acid produced or too
few alkalic produced.
While alkalemia is
happened when too
much alkalic produced
or too few acid
produced.

18

How acidosis
and alkalosis
happend?

19

If the 3 major
mechanisms
esp.lung and kidney
were failed to
work properly.

20

 pH imbalance due to kidney problem

add metabolic before the
condition:
Metabolic acidosis
Metabolic alkalosis
pH imbalance due to lung problem
add respiratory before the condition:
Respiratory acidosis
Respiratory alkalosis
21

How can we
decide that this
acidosis/alkalosis
is metabolic or
respiratory?

22

By applying
HendersonHasselbalch
equotion!
HCO3pH = 6.1 + log ------------ X 0.03
PCO2
If HCO3- is abnormal kidney problem
If PCO2 is abnormal lung problem
23

What are the

example of diseases
come with
metabolic/respiratory
acidosis/alkalosis?

24

Metabolic
Acidosis

Metabolic
alkalosis

Respiratory
Acidosis

Respiratory
Alkalosis

Diarrhea
Kidney
problems
renal acidosis
Cholestyrami
ne

Vomiting
Mineralocorti
coid excess
High dose
penicillin

Depression
of respiratory
center
(trauma,drug)
Obstruction

Overstimulati
on of RC
(anxiety,
pregnancy).
Rib fracture

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Can we use any

kind of blood to
measure its pH?

26

No, we have to use

only arterial blood.
Because.

Gas contents in our

arterial blood show what
will consume by our
tissue.
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Can we get the

arterial blood,
how?

28

Yes. In adult
usually from
femoral artery,
and in baby we
make an
arteriolization in
their heel.

29

How can we
interpret blood
gas analysis
results?

30

1.Look at the pH
decide acidosis or
alkalosis
2.Look at the HCO3-, if
abnormal metabolic
3.Look at the PCO2, if
abnormal
respiratory
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Thank you grandpa!

You are very

welcome dear!
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