Fluid, Electrolyte and Acid-base Balance Block

ACID-BASE BALANCE By Harliansyah, PhD 2012

HYDROGEN IONS, ACIDS, AND BASES

HYDROGEN IONS (H+)

ACIDS BASES PH Normal arterial pH is 7.35 7.45

ACID-BASE BALANCES

Acidosis pH < 7.35 Alkalosis pH > 7.45 Buffers

PRIMARY BUFFER SYSTEMS IN EXTRACELLULAR FLUID

REGULATION OF ACIDS AND BASES

THE BIG THREE ACID-BASE REGULATORS

Chemical regulation Biological regulation Physiological regulation

PHYSIOLOGICAL REGULATION

Alkalosis

Acidosis

ACID BASE IMBALANCES

RESPIRATORY ACIDOSIS RESPIRATORY ALKALOSIS METABOLIC ACIDOSIS METABOLIC ALKALOSIS

ARTERIAL BLOOD GASES

NORMAL BLOOD GAS VALUES pH 7.35-7.45 PCO2 35-45 mmHg HCO3 22-27 mEq/L PO2 80-100 mmHg

ARTERIAL BLOOD GASES

RESPIRATORY IMBALANCES Respiratory function indicator is PCO2 Opposite response between the pH and PCO2 pH is down in an acidotic condition and is elevated in an alkalotic condition pH and PCO determines if the condition is a respiratory problem

ARTERIAL BLOOD GASES

METABOLIC IMBALANCES HCO3 is indicator for metabolic function A corresponding response between the pH and the HCO3 pH is down in an acidotic condition and is elevated in an alkalotic condition The pH and the HCO3 determines if the condition is a metabolic problem

ANALYZING ARTERIAL BLOOD GAS RESULTS

PYRAMID STEPS

Look at the blood gas report Look at the pH. Is it up or down? If it is up, it reflects alkalosis. If it is down, it reflects acidosis. Look at the PCO2. Is it up or down? If it reflects an opposite response as the pH then you know that the condition is a respiratory imbalance. If it does not reflect an opposite response as the pH, then move on to Pyramid Step 3.

PYRAMID STEP 1

PYRAMID STEP 2

ANALYZING ARTERIAL BLOOD GAS RESULTS

PYRAMID STEP 3

Look at the HCO3. Does the HCO3 reflect a corresponding response with the pH? If it does, then the condition is a metabolic imbalance. Remember, compensation has occurred if the pH is in a normal range of 7.35-7.45. If the pH is not within normal range, look at the respiratory or metabolic function indicators.

PYRAMID STEP 4

FLUID, ELECTROLYTE & ACID -BASE

REMEMBER~~~~

NORMAL CHEMISTRY LABORATORY VALUES

Serum electrolyte levels CBC (changes in Hct related to FVD & FVE) BUN & Blood Creatinine Levels (kidney functions) Urine Specific gravity (normal 1.003 1.023) ABGs

LUID, ELECTROLYTE & ACID BASE

OVERALL GOALS/EVALUATION

NORMAL FLUID, ELECTROLYTE AND ACID BASE BALANCE CAUSES OF IMBALANCES IDENTIFIED OR CORRECTED

NO COMPLICATIONS FROM THERAPIES NEEDED TO RESTORE BALANCE

INCLUDE FAMILY IN PROCESS