Abnormalities of Acid-Base Balance

The most commonly encountered abnormalities of acid-base balance are as

follows;
1. Respiratory acidosis ---------- CO2 increased.
2. Respiratory alkalosis --------- CO2 decreased.
3. Metabolic Acidosis ----------- HCO3‫ ־‬decreased.
4. Metabolic Alkalosis ---------- HCO3‫ ־‬increased.
The normal values of different parameters relating acid-base balance in all species
in general is as follows;
pH = 7.4
HCO3‫־‬ = 24 mEq/L
PaCO2 = 40 mmHg

1. Respiratory Acidosis

Definition
 Increase in PaCO2 above normal
 Decrease in pH.
 Increase in H+
 Not serious condition.

Causes
 Increased production or decreased excretion of CO2, due to any reason.
 e.g. tetanus, botulism, diaphragmatic hernia, pneumothorax, hemothorax,
pyothorax, mechanical obstruction etc.
 Decreased O2 (Hypoxemia)
 Increased respiration rate and depth is shallow (tachypnea)
 Apnea

Compensation
 Initial compensation of increased CO2 in body (hypercapnia) is to control
increased H+ by buffering.

Diagnosis
 Clinical signs.
 Arterial blood gas analysis.
 Acidic pH value.
 Elevation in PaCO2 levels.

Treatment
 Improve ventilation.
 Remove the actual cause.
2. Respiratory Alkalosis

Definition
 When PaCO2 is below normal.
 Increase in pH.
 Decrease in H+ ion.
 Not serious condition.
 Common in animals and people.

Causes
 Decreased production or increased excretion of CO2 due to any reason.
 Hyperventilation (oxygen therapy).
 Hypoxemia which ultimately leads to hyperventilation (prolonged and deep
breathing) which then leads to hypocapnia (decrease in CO2).
 Pain, fear, anxiety and excitement are common causes.

Compensation
 HCO3‫ ־‬is lost by the kidneys as decrease in HCO3‫ ־‬level causes decrease in pH,
 To maintain negative ion electric balance in body, Cl‫ ־‬is retained by the kidneys.

Treatment
 Improve ventilation.
 Remove the actual cause.

3. Metabolic Acidosis

Definition
 When HCO3‫ ־‬level is below normal
 Decrease in pH.
 Increase in H+ ion.
 Most complex condition.
 It impairs O2 uptake by Hb.
 The patient develops cardiovascular and nervous changes.
 Disturbed ventilation due to impaired muscle strength with decreased pH.

Causes
 Diarrhea.
 Renal diseases.
 Diabetic ketoacidosis.
 Lactic acidosis.
 Compensation
 H+ loss by the kidney.
 Loss of CO2 by lungs by hyperventilation.

Treatment
 Treat underlying cause
 Administration of alkalinizing solutions as;
a. NaHCO3 (common).
b. Lactated Ringer’s sol. (common).
c. Normosol-R.
d. Plasma-Lyte.
e. Plasma.

4. Metabolic Alkalosis

Definition
 Increased level of HCO3‫־‬.
 Increase in pH.
 Decrease in H+ ion.
 Depresses thinking power.
 Neuromuscular disturbances observed.
 Coma may develop.
 Common condition.

Causes
 Iatrogenic (unknown).
 Vomiting (loss of HCl).
 Administration of alkalinizing solutions in excess as lactate, HCO3‫ ־‬etc.

Compensation
 Hypoventilation takes place to retain CO2.

Treatment
 Correct underlying cause.
 Administer acidifying solutions as;
i. Normal saline 0.9% (common).
ii. Ringer sol. (common).
iii. K salts as (KCl) dose.
iv. NaCl and KCl combination is choice.
v. Acute therapy is administration of HCl.

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