II. ACID-BASE BALANCE
C02
A. Major chemicals you have to
remember:
1. Bicarb - BASE, Hydrogen -
ACID, CO2- ACID
2. Lung chemicals CO2 ACID
3. Kidney chemicals BICARB
and HYDROGEN
4. These chemicals can either
make you sick or compensate. It
depends on which
imbalance you have.
B. pH:
1. What does pH tell you about
the blood?
If the blood is ACIDIC,
alkaline, or neutral.
2. Normal pH range 7.35-7.45.
3. pH below 7.35 ACIDOSIS
4. pH above 7.45 ALKALOSIS
If pH is messed up it can be
dangerous
5. The BALANCE does not like it
when the pH is messed up.
6. Heres how the body keeps
the pH within normal range:
Compensating Organs
Kidneys
Lungs
Remove acid through URINE.
One way to get rid of
CO2
Bicarb? HOLD ON
What is it? EXHALE
OR
Hypoventilation retain
CO2
Hyperventilation
eliminate CO2
Kidney takes hours to days to
do
their job
C. Respiratory Acidosis:
1. Pathophysiology:
a. Is this a lung problem or a
kidney problem? LUNG PROBLEM
b. What chemical is causing the
problem? CO2
c. Do we have too much or too
little of this chemical in the
body? TOO MUCH
d. Hypoventilating or
hyperventilating?
HYPOVENTILATING
e. Whos going to compensate?
KIDNEYS
f. How, with what chemicals?
BICARB and hydrogen
g. The body must EXCRETE the
acid.
h. The body will secrete bicarb.
i. Is the pH high or low? LOW
2. Causes:
Retain CO2.
Mid abdominal incision,
narcotics, sleeping pills,
pneumothorax, collapsed lung,
pneumonia
3. S/S:
a. Headache,CONFUSED,sleepy
b. If not corrected, could lead
to a COMA.
c. Hypoxic
Give them OXYGEN.
Early sign and symptoms of kick in.
hypoxia? RESTLESSNES &
TACHYCARDIA
4. Tx:
a. Fix the BREATHING problem.
b. Treat pneumonia, get rid of
secretions by postural
drainage, percussion (vibration
therapy), deep breathing
exercises, suctioning, fluids,
elevate HOB, incentive
spirometry.
c. Pneumothorax client will have
CHEST tubes
d. Encourage post op to turn,
cough and DEEP BREATHE.
Normal Lab Values
pH: 7.35-7.45
PaO2: 80-100 mmHg
PaCO2: 35-45 mmHg
HCO3: Bicarbonate:
22-26 mEq/L
*TESTING STRATEGY*
Restlessness think Hypoxia
FIRST
*TESTING STRATEGY*
CO2 = LOC
CO2 = O2
CO2 and O2 have inverse
relationship.
D. Respiratory Alkalosis:
1. Pathophysiology:
a. Whos sick? Whos going to
compensate? KIDNEYS
b. Kidneys excrete BICARB.
Retain HYDROGEN.
c. Problem chemical?
d. Gaining or losing CO2. LOSING
e. Hypoventilating or
hyperventilating?
HYPERVENTILATING
f. pH? HIGH
2. Causes:
a. Problem? C02
b. Hysterical
The client is breathing too
FAST and GETTING RID OF CO2,
c. Acute aspirin overdose
therefore, removing C02.
d. Situation: Hysterical client
3. S/S:
Lightheaded, faint, peri-oral
numbness, numbness and tingling
in fingers and toes.
4. Tx:
a. Do not wait for kidneys to
b. Breathe into a PAPERBAG.
c. May SEDATE client to decrease
respiratory rate.
d. Treat the cause
e. Monitor ABGs
E. Metabolic Acidosis:
1. Pathophysiology:
a. Whos sick? KIDNEYS Whos
going to compensate? LUNGS
b. With what chemical? C02
c. Problem chemical? BICARB &
HYDROGEN
This client is retaining
HYDROGEN or do not have enough
bicarb.
d. pH? LOW
e. Respiratory rate will
INCREASE
2. Causes:
a. DKA
Cells are starving for GLUCOSE,
so the body will
b. Starvation break down protein
and FATS, produce KETONES,
ketones are ACIDS.
c. Renal failure
d. Severe DIARRHEA .
3. S/S:
a. Depend on the CAUSE.
b. Hyperkalemia
Muscle twitching, muscle
weakness, flaccid paralysis,
ARRYTMIAS.
c. Increased respiratory rate
4. Tx: Interpretation: RESPIRATORY
a. Treat the PROBLEM. ACIDOSIS WITH PARTIAL
b. Drug to help acidosis? IV COMPENSATION
PUSH SODIUM bicarb 4. Problem:
Hurst Review Services 19 pH: 7.45 NORMAL
F. Metabolic Alkalosis: PCO2: 52 ACID
1. Pathophysiology: HCO3: 35 BASIC
a. Whos sick? KIDNEYS Whos Interpretation: METABOLIC
going to compensate? LUNGS ALKALOSIS FULLY COMPENSATED
b. With what chemical? BICARB Normal:
AND HYDROGEN pH: acidosis 7.35 7.45
c. Problem chemical? BICARB & alkalosis
hydrogen PCO2: basic 35 45
d. The client is in alkalosis, acidic
so they are retaining too much HCO3: acidic 22 - 26 basic
BICARB and Normal:
excreting hydrogen. pH: acidosis 7.35 7.45
e. pH? HIGH alkalosis
2. Causes: PCO2: basic 35 45
a. Loss of upper GI content acidic
b. Too many antacids. Too much HCO3: acidic 22 26
BASE. basic
c. Too much IV bicarb, YES. Normal:
3. S/S: pH: acidosis 7.35 7.45
a. Depend on cause alkalosis
b. Observe LOC PCO2: basic 35 -45 acidic
c. Serum K+ will go UP in HCO3: acidic 22 26
metabolic acidosis and go DOWN basic
in Normal:
metabolic alkalosis. pH: acidosis 7.35 7.45
d. Monitor for MUSCLE CRAMPS. alkalosis
4. Tx: PCO2: basic 35- 45 acidic
a. Fix the problem. HCO3: acidic 22 26
b. Replace POTASSIUM. basic
*TESTING STRATEGY*
Metabolic Acidosis = Hyperkalemia
Metabolic Alkalosis = Hypokalemia
G. ABG Interpretation Practice
Problems:
1. Problem:
pH: 7.32 ACIDOSIS
PCO2: 41 NORMAL
HCO3: 20 ACIDOSIS
Interpretation: METABOLIC
ACIDOSIS
2. Problem:
pH: 7.56 ALKALOSIS
PCO2: 31 ACID
HCO3: 25 NORMAL
Interpretation: RESPIRATORY
ALKALOSIS
3. Problem:
pH: 7.26 ACIDOSIS
PCO2: 51 ACID
HCO3: 29 BASIC