ACID-BASE BALANCE The normal pH lies within the range of 7.36-7.44.

. The terms acidosis and alkalosis indicate a change or tendency to change in pH of the blood in either direction.

 In acidosis there is accumulation of acid or a loss of base causing a fall in pH. In alkalosis the converse occurs. The most important of various buffering system that regulate and control the pH of the blood is weak acids and bases, the most important is the bicarbonate- carbonic acid ratio. HCO3:H2C03. It is regulated by removal of carbon dioxide by the lungs and excretions of both acids and bases by the kidneys

 The ratio of bicarbonate to carbonic acid is normally 20:1. Decrease in the ratio leads to increase acidity and vice versa. The bicarbonate level altered by metabolic factors. The carbonic acid level is control by respiratory factors. Acid base measurments made by arterial blood.

 PCO2 is the partial pressure of CO2 in the blood. (3142) PO2 is the tension or partial pressure of oxygen in the blood. (80-110mmHg) Standard bicarbonate is the concentration of serum bicarbonate after fully oxygenated blood equiliberated with carbondioxide at 40mmHg. Normal values 2225mmol. Base excess or deficit--- the total buffer anion (expressed in mmol) present in the blood in excess of deficit of normal. Normal base exces or deficit +2.5

 Respiratory Alkalosis Arterial PCO2 below the normal range of 3142mmHg Caused in surgical practice by excessive pulmonary ventilation carried out on anaesthetised patient. Other causes hyperventilation at high altitude, hyperpyrexia, hysteria and hypothalamic lesion.

 Compensation by increased excretion of bicarbonate usually inadequate. Treatment . Respiratory suppression due to alkalosis is by insufflation of carbondioxide.

 Acidosis Metabolic Acidosis Deficit of base or excess of any acid other than carbonic acid (H2C03). A) Increased in fixed acids due to

Formation of ketone bodies : starvation and diabetes mellitus Lactic and pyruvic acids by anaerobic tissue metabolism- cardiac arrest and release of clamped Aorta following abdominal aneurysm repair Renal insufficiency ( retention of metabolites) loss of bases
Sustained Diarrhoea Ulcerative colitis Gastro-colic fistulae

 Clinical Features Severe acidosis-- Low pH in the blood stimulates respiratory centre- results in rapid deep breathing to eliminate C02 derived from H2CO3. The standard bicarbonate level is lowered and there is base deficit.

 Clinical Features Severe acidosis-- Low pH in the blood stimulates respiratory centre- results in rapid deep breathing to eliminate C02 derived from H2CO3. The standard bicarbonate level is lowered and there is base deficit.

 Treatment Restoration of adequate tissue perfusion Decreased Tissue perfusion leading to hypoxia is the commonest cause acute peroperative metabolic acidosis.

 Treatment with bicarbonate solutions will only correct the measured metabolic acidosis but not treat the problem Administration of Bicarbonate solutions is given only where bases has been lost or where the acidosis is so severe to endanger myocardial function. Following cardiac arrest resulting in acute acidosis requires infusion of 50mmol of 8.4% sodium Bicarbonate solution.

 Respiratory Acidosis Impaired alveolar ventilation, leading to increased PCO2 above the normal range in the blood Commonly seen in patients in anaesthetised patient with inadequate ventilation. Respiratory acidosis may be seen in patients undergoing surgery with pre-existing pulmonary disease such as chronic bronchitis and emphysema.

 Anion Gap Difference between concentration of cations other than Na and concentration of anions other than Cl and HCO3 in the plama. It consists of the most part of proteinsin the anionic form,HPO4-2,SO4 -2 and organic acid. Normal value is 12meq/litre.

 It is increased when plasma concentration of K+, Mg+, or Ca++ is decreased, when the concentration of plasma proteins is increased or When organic anions such as lactate or foreign anions accumulate in the blood It is decreased when cations are increased or plasma albumin is decreased.