Acid-Base Imbalances Common Causes Respiratory Acidosis Chronic obstructive pulmonary disease Barbiturate or sedative overdose Chest wall

all abnormality (ex. obesity) Severe pneumonia Atelectasis Respiratory muscle weakness (Guillain-Barre Syndrome) Mechanical hypoventilation Respiratory Alkalosis Hyperventilation (caused by hypoxia, pulmonary emboli, anxiety, fear, pain, exercise, fever) Stimulated respiratory centre caused by septicaemia, encephalitis, brain injury, salicylate poisoning Mechanical hyperventilation Metabolic Acidosis Diabetic ketoacidosis Lactic acidosis Starvation Severe diarrhea Renal tubular acidosis Renal failure GI fistulas Shock Metabolic Alkalosis Severe vomiting Excess gastric suctioning Diuretic therapy Potassium deficit Excess NaHCO3 intake Excessive mineralocorticoids Pathophysiology CO2 retention from hypoventilation Compensatory response to HCO3retention by kidney Laboratory Findings Decreased plasma pH Increased PCO2 HCO3- normal (uncompensated) Increased HCO3(compensated) Urine pH>6 (compensatred) Signs and Symptoms Neuro: drowsiness, disorientation, dizziness, headache, coma Cardio: low BP, ventricular fibrillation (related to hyperkalemia from compensation), warm, flushed skin (related to peripheral vasodilation) GI: no significant findings Neuromuscular: seizures Resp: hypoventilation with hypoxia (lungs are unable to compensate when resp problem) Neuro: lethargy, light-headedness, confusion Cardio: tachycardia, dysrhythmias (related to hypokalemia from compensation) GI: nausea, vomiting, epigastric pain Neuromuscular: tetany, numbness, tingling of extremities, hyperreflexia, seizures Resp: hyperventilation (lungs unable to compensate when there is resp. problem) Neuro: drowsiness, confusion, headache, coma Cardio: low BP, dysrhythmias (related to hypokalemia from compensation), warm, flushed skin (related to peripheral vasodilation GI: nausea, vomiting, diarrhea, abdominal pain Resp: deep, rapid respirations (compensatory action by lungs) Neuro: dizziness, irritability, nervousness, confusion Cardio: tachycardia, dysrhythmias (related to hypokalemia from compensation) GI: anorexia, nausea, vomiting Neuromuscular: tremors, hypertonic muscles, muscle cramps, tetany, tingling of fingers and toes Resp: hypoventilation (compensatory action by lungs)

Increased CO2 excretion from hyperventilation Compensatory response of HCO3excretion by kidney

Increased plasma pH Decreased PCO2 HCO3- normal (uncompensated) Decreased HCO3(compensated) Urine pH>6 (compensated)

Gain of fixed acid, inability to excrete acid or loss of base Compensatory response of CO2 excretion by lungs

Decreased pH PCO2 normal (uncompensated) Decreased PCO2 (compensated) Decreased HCO3Urine pH>6 (compensated)

Loss of strong acid or gain or base Compensatory response of CO2 retention by lungs

Increased plasma pH PCO2 normal (uncompensated) Increased PCO2 (compensated) Increased HCO3Urine pH>6 (compensated)