by: MARITES A.

ROSAPAPAN, RN,MANc

Acid Base Balance

Acid

- substance that can donate or release hydrogen ions ie Carbonic acid, Hydrochloric acid
** Carbon dioxide combines with water to form carbonic acid

 Base

- substance that can accept hydrogen ions

Ie Bicarbonate

 BUFFER- substance that can

accept or donate hydrogen - prevent excessive changes in pH

TYPES OF BUFFER

1. Bicarbonate (HCO3): carbonic acid buffer (H2CO3) 2. Phosphate buffer 3. Hemoglobin buffer

Dynamics of Acid Base Balance

Acids and bases are constantly produced in the body
They must be constantly regulated

CO2 and HCO3 are crucial in the balance

A HCO3:H2CO3 ratio of 20:1 should be maintained

Respiratory and renal system are active in regulation

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Kidney
- Regulate bicarbonate level in ECF
1. RESPIRATORY/METABOLIC ACIDOSIS - kidney excrete H and reabsorbs/generates Bicarbonate 2. RESPIRATORY/METABOLIC ALKALOSIS - kidney retains H ion and excrete Bicarbonate

Lung
- Control CO2 and Carbonic acid content of ECF

1. METABOLIC ACIDOSIS - increased RR to eliminate CO2 2. METABOLIC ALKALOSIS - decreased RR to retain CO2

 pH - measures degree of acidity and

alkalinity - indicator of H ion concentration - Normal ph 7.35-7.45

 ACIDOSIS

- decreased pH; < 7.35 - increased Hydrogen

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 ALKALOSIS

- increased pH-; > 7.45 - decreased Hydrogen

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ACUTE AND CHRONIC METABOLIC ACIDOSIS

- Low pH - Increased H ion concentration - Low plasma Bicarbonate

Etiology: diarrhea, fistulas, diuretics, renal insufficiency, TPN w/o Bicarbonate, ketoacidosis, lactic acidosis S/sx: headache, confusion, drowsiness, inc RR, dec BP, cold clammy skin, dysrrythmia, shock

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 Dx: ABG low Bicarbonate, low pH, Hyperkalemia,

ECG changes
Rx: Bicarbonate for pH < 7.1 and Bicarbonate level < 10

monitor serum K dialysis

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ACUTE AND CHRONIC METABOLIC ALKALOSIS

High pH
Decreased H ion concentration High plasma Bicarbonate

Etiology: vomiting, diuretic, hyperaldosteronism, hypokalemia, excesive alkali ingestion s/sx: tingling of toes, dizziness, dec RR, inc PR, ventricular disturbances
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 Dx:ABG pH > 7.45, serum Bicarbonate > 26 mEq/L,

inc PaCO2

Rx: restore normal fluid balance

correct hypokalemia Carbonic anhydrase inhibitors

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ACUTE AND CHRONIC RESPIRATORY ACIDOSIS Ph < 7.35 PaCO2 > 42 mmHg Etiology: pulmonary edema, aspiration, atelectasis, pneumothorax, overdose of sedatives, sleep apnea syndrome, pneumonia s/sx: sudden hypercapnia produces inc PR, RR, inc BP, mental cloudinesss, feeling of fullness in head, papil edema and dilated conjunctival blood vessels

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 Dx: ABG pH < 7.35

PaCO2 - > 42 mmHg

Rx: improve ventilation

pulmonary hygiene mechanical ventilation

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ACUTE AND CHRONIC RESPIRATORY ALKALOSIS

pH > 7.45
PaCO2 < 38 mmHg

Etiology: extreme anxiety, hypoxemia

s/sx: light headednes, inability to concentrate, numbness, tingling, loss of consciousness

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 Dx: ABG pH > 7.45

PaCO2 < 35 dec K dec Ca Rx: breathe slowly sedative

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ARTERIAL BLOOD GAS ANALYSIS

Parameter
pH

Normal Value
7.35 7.45

PaCO2
HCO3

35 45 mmHg
22-26mEq/L

O2 saturation

95 - 100%

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How to Obtain blood sample?

Allens test - evaluate patency of

radial and ulnar artery Heparinized syringe and container Pressure dressing, no activity at the site and check 5 ps distal to the site of punctured artery Note if patient is under O2 therapy Label the sample and send immediately to the laboratory

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ABG Responsibilities

Arterial blood Radial or ulnar artery Allens test Prepare Heparinized (Syringe, specimen container) Note: 02 therapy, FIO2, temp (bmr, o2) Bring specimen to the LAB (ice)

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 After injection
Maintain extension position, no activity 8H Apply pressure 5-15 min

Observe the site

Distal, 5 ps

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 Vascular assess
Pulselessness Pain

Paresthesia
Poikilothermia Pallor

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Handling of Specimen

Expel all air bubbles immediately Do not agitate the syringe Discard frothy specimen 1:1000 U/ml HEPARIN Place sample in ice Cool sample to 5 C if it can not be analyzed quickly

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Evaluating ABGs
1.

Note the pH pH = 7.35 7.45 (normal) pH = < 7.35 (acidosis) pH = > 7.45 (alkalosis)

Partially compensated if the Co2 and Hco3 are the same, with abnormal pH Fully Compensated if the pH is normal Uncompensated if the Co2 and HCo3 are opposite, with or if one of them is normal, abnormal pH

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2. Determine primary cause of disturbance 2.1 pH > 7.45 a. PaCo2 < 40 mmHg respiratory alkalosis b. HCO3 > 26 mEq/L metabolic alkalosis 2.2 pH < 7.35 a. PaCo2 > 40 mmHg respiratory acidosis b. HCO3 < 26 mEq/L metabolic acidosis

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3. Determine compensation by looking at the value other than the primary disturbance

pH 7.20

PaCO2 HCO3 60 mmHg 60 mmHg 24 mEq/L 37 mEq/l

Uncompensated Respiratory acidosis Partially Compensated Respiratory acidosis
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7.30

4. Mixed acid-base disorders

Metabolic and Respiratory Acidosis

pH

7.21

Dec acid

PaCO2

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Inc acid

HCO3

13

Dec acid

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DRILL

pH = 7.40 HCO3 = 20 PaCO2 = 40 Simple Metabolic Acidosis pH = 7.40 HCO3 = 28 PaCO2 = 40 Simple Metabolic Alkalosis

pH = 7.40 HCO3 = 24 PaCO2 = 48 Simple Respiratory Acidosis pH = 7.40 HCO3 = 24 PaCO2 = 32 Simple Respiratory Alkalosis

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 pH = 7.33 HCO3 = 20 PaCO2 = 40

pH = 7.33 HCO3 = 24 PaCO2 = 48

pH = 7.47 HCO3 = 28 PaCO2 = 40

pH = 7.47 HCO3 = 24 PaCO2 = 32

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 DRILL pH = 7.33 HCO3 = 20 PaCO2 = 32 pH = 7.33 HCO3 = 28 PaCO2 = 48

pH = 7.47 HCO3 = 28 PaCO2 = 48

pH = 7.47 HCO3 = 20 PaCO2 = 32

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 ANSWER:

pH = 7.33 HCO3 = 20 PaCO2 = 32 Uncompensated Metabolic Acidosis

pH = 7.47 HCO3 = 28 PaCO2 = 48 Uncompensated Metabolic Alkalosis

pH = 7.33 HCO3 = 28 PaCO2 = 48 Uncompensated Respiratory Acidosis pH = 7.47 HCO3 = 20 PaCO2 = 32 Uncompensated Respiratory Alkalosis

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 DRILL pH = 7.40 HCO3 = 18 PaCO2 = 32 pH = 7.40 HCO3 = 28 PaCO2 = 48

pH = 7.35 HCO3 = 30 PaCO2 = 48

pH = 7.44 HCO3 = 20 PaCO2 = 32

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 ANSWER

pH = 7.40 HCO3 = 18 PaCO2 = 32 Fully Compensated Metabolic Acidosis pH = 7.35 HCO3 = 30 PaCO2 = 48 Partially Compensated Respiratory Acidosis

pH = 7.40 HCO3 = 28 PaCO2 = 48 Fully Compensated Respiratory Acidosis pH = 7.44 HCO3 = 20 PaCO2 = 32 Partially Compensated Respiratory Alkalosis

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Thank You!

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