Acid-Base Balance

N4935

pH
pH is a calculation based on the percentage of hydrogen ions in a solution. This calculation is based on the number of acids and bases in the solution. Acids are substances that give up H ions to other molecules when dissolved in water. Bases are substances that have molecules that accept H ions when dissolved in water.

pH norms
Most often measured in arterial blood. Normal: 7.35 to 7.45 Low pH: Free H or HCO3 High pH: Free H or HCO3 Acidosis: Alkalosis:

..so what?
Electrolyte imbalance Enzyme activity Muscle contraction Cellular function

Regulators
Chemical Buffers The Respiratory System The Kidneys

Chemical Buffers
Bicarb Buffer: Pairs of weak acids and bases combine with stronger acids and bases, thereby weakening them

Phosphate Buffer: interact with acids or bases to form compounds that slightly alter pH Protein Buffer: Hemoglobin and proteins bind with acids and bases to neutralize them.

Respiratory System
Lungs regulate CO2. CO2 combines with water to form carbonic acid. The pH does what?_______ Chemoreceptors : vary the rate and depth of breathing to compensate for pH changes. Increasing rate or depth: pH Decreasing rate or depth: pH

Respiratory System Cont...

PaCO2: norm is 35-45 mm Hg It reflects the concentration of CO2 in the blood. As the concentration of CO2 increases, the partial pressure increases. What happens to the pH?___________

Kidneys
Reabsorb and excrete acids and bases into the urine. They also produce and regulate bicarbonate. Normal Bicarb level (HCO3): 22-26 mEq/L

Too much acid in the blood:

What happens to the pH? With this change, what typically has happened to H or Bicarb level?

Too much base in the blood

What happens to the pH? With this change, what typically has happened to H or Bicarb level?

Compensation
Partial compensation: the pH will still be out of the normal range Complete or Full compensation: The pH will go back to normal

Causes determine compensation

Metabolic disturbance: Lungs compensate (respiratory compensation) Respiratory disturbance: Kidneys compensate (Metabolic compensation)

Arterial Blood Gases

This is a diagnostic test used to assess the effectiveness of ventilation and overall acidbase-imbalance. Norms: pH: 7.35-7.45 PaCO2 35-45 mm Hg HCO3 22-26 mEq/L Other things that are measured: Pao2 and Sao2

Interpreting an ABG
Step: 1 Determine if the pH, PaCO2 & HCO3 are within normal limits. Norms: pH: 7.35-7.45 Paco2 35-45 mm Hg HCO3 22-26 mEq/L

Interpreting an ABG
Step: 2 Determine if acidity or alkalinity is the problem: If the pH > 7.45 then it is alkalosis If the pH < 7.35 then it is acidosis

Interpreting an ABG
Step: 3 Check the PaCO2 & HCO3 levels to see which has the same acid-base status as the pH.
PaCO2 Respiratory acidosis > 45 Respiratory alkalosis < 35 HCO3 Metabolic acidosis < 22 Metabolic alkalosis > 26

Interpreting an ABG
Step: 4 Determine the extent of the compensation. Look at the value that does not match the acid-base status (PaCO2 or HCO3)

Absent: value within normal range

Partial: the value is abnormal and the pH is abnormal Complete: the value is abnormal and the pH is normal

Give it a try!
A patient is in the intensive care unit because he suffered a severe myocardial infarction 3 days ago. The lab reports the following values from an arterial blood sample: pH = 7.30 (normal 7.35-7.45) HCO3- = 20 mEq/liter ( normal 22-26) PaCO2 = 32 mm Hg ( normal 35-45)

A colleague hands you these blood gas results:

pH PaCO2 HCO3

7.52 47mm Hg 36 mEq/L

You receive these ABG results on your patient. What is going on?
pH 7.30 PaCO2 58 mm Hg HCO3 26 mEq/L Pao2 50 Sao2 80

One more
pH 7.55 PaCO2 28 mm Hg HCO3 24 mEq/L