ACID BASE BALANCE By: Rizatina G. Paret fon “Anatom or molecule thet has gained or lost one or more electrons and acquired a positive charge fa cation} o negative charge {an anion) FLECTRQLYTE A substance that in solution conducts an electric cunent and ionizes into an electrically charged particles; dixcciales into ions, tused in solution, thus becoming capable of conducling clecticity, MAJOR ELECTROLYTES 1 Nat * wer 3. HCOS 4. Kr & Gap & Mgr 7, Phosphorus fpnesonaze} FUNCTIONS OF ELECTROLYES 1. Promote neuromuscular iritability Maintain body tid volume and osmolality 3. Distrloute body H: between tivid compartments 4 REGULATE ACID BASE BALANCEACID PH BUFFERS ; A compound that yields hydrogen ions when placed I an aqueous solution Such substance consists of hydrogen aloms, covalenily bonded fo a negative valence nen metal or + radical or contains hydrogen iens that can be relented. Ex -Hydrechtorie acid (HOH, stboric aciel {HeCOs} \ A compound that yields hydroxyl ions (OH when placed info aqueous solution. A substance thal can accept hyeragen # Gi Bicarbonate (HCO, 3 The negative logarithm of the (H*} used os. a postive number. Its derived by converting inc vale or Wy ie negative exponent of IG. and calculating its egamhim. - Alkalinity anc is oppeste, acidity, re a terms of hycrogen ions concentration expressed on © scale Called PH. pH is controlled by buffer systems in al body nulde ‘gad by sespiratory and kidney reguiatary systems. > dfe a mixture ct acia and base componer is. Ine acid component is Ine Ht cation, formed whon a Weak aod Gissociaies in sclufion, the base companent s the remaining anion portion of the acid molecule, known as conjugare Base, An important biood buffer system is-2 solution cf carbonic acid and its conjugate bese, bicarbonate ions IMCOg ,THREE MAIN BUFFER SYSTEMS IN THE BODY bs Bicarbonate - Carbonic acid buffer > Bicarbonate pufter system Phosphaie bulfer | —» Non-bicarbonale butter system Protein butter n + The blood buffer bose is the sum of bicarbonate and nen bicarbonate basas in | Lof blood, ACID BASE BALANCE - a physiclogical mechanism that keep the hydrogen COMPENSATION concentration of body fluids ina range compatible with life. Hydrogen ions react really with protein molecules,the builaing blocks of vital cellular catalytic enzymes, Such reactions change the protein molecules shape anc may render the enzyme inactive. Therefore, to sustain tife, the body normally maintains the pH fluids within o norow range from 7.35 ~ 7.45, ~ Meintenance of a normat BH in the body. % PH is proportionate to the ratio of bicaroonate ion concentration (controlled by the kidneys) to dissolved carbon dioxide {controled by the tungs), @ primary failure of one. Ofgan system can be compensated for by the other.PARTIAL COMPENSATION -cases In which the expected compensatory response begun but has had an insutficlent time to retum the pH to normal range. COMPLETE COMPENSATION-Compensctory response returns Ihe pti to normal range. ABG PARAMETERS : Detinition and normal values pH HCOs BE hydrogen ion concentration PH = 735-746 lextracellylar tug! bicarbonate ions (kidney — requiatecs) HCOs = 22 ~ 26 mEq/L like @ serum bicarbonate, reilecis ine metaborc kKigney ieguaredy component of oad base balance, put it adiusis for tne client's Remogionin level, which aifects tne puifering ality of plod BES 2 2merq/t Partiot pressure of carson dioxge in arrenct pilosa PaCOe = 38 - 45 mtg (1ORK) Parfic! pressure of oxygen dissolved in ine prasma. PaO: = 80-100 mmtig —» normal or adequare oxygenation 80-79 mmHg — mid hypoxemia 40-5¥mmHg —+ moderate hypoxemia £39 mmHg = — severe hypoxerniaSaCz0r OzSat a meas ' of the degrea fo which hemogiotin is saivrated with, oxygen. It provides some indication of the efficiency of the client's jung ventilation. SaQz = 95-98% of 93~ 100% S¥Oz = 60 - 85% Hemoglebin = oxygen carying pigment of the erythrocytes, which is Important In maintaining acid-base batance in ne blood. A tow hemeglobin reduces the blood''s ability to buffer H* ions. Hgb = Male —> 14-18 g/dl Female —* 12-16 o/dtCAUSES OF ACID BASE Dt. : S/S & Interventions RESPIRATORY ACIDOSIS {ccrbonic acid excess) COPD fike asthma, emphyseme and CRID CNS depression by drugs ex. Morphine, anesthesia Neuromiscviar disease Chést trauma Severe pulmonary edema eek en Severe pain ACUTE: cardiac aurest, pulmonary embalism, severe acute pulmonary edema, severe pheumonia, pneumothorax, myasthenia gravis, CNS depression, asptation of toreign body. crownirig incroase PR & RR, shallow respi eysenea, diginess, visual dstursanc: ventric Laie: Urowsiness, Convuision. chronic lung diseases like asthma, sb roGis, ct weakness, necINTERVENTIONS: 1, improve respiratory ventilations > aserdered: odminister tronchodilalors, antibiotics, oxygen > postural drainage = chest clapping Maintain adequate hydration {2-3 Lot fuid/day) Sodium bicerbonate for ventricular fibrillation cr potassium excess Monitor fivid intake and outeul, vital signs, A8G and pH PR wR Carefully regulate mechanical ventilator it used. “RESPIRATORY ALKALOSIS (carbonic acid deficit} |. Extreme anxiety Fover Ovarventitation with mechantcal ventiiater Hypoxa CNS stimutation by crug ex. ASA overciase Meningitis Pneumonia PNORREN Inttial stage of pulmonary embetism 9. Pregnancy 10. High otitude li, Acute asthma Clinical $)Sx: - Hyperveniilation (deep and repici} lightheadedness Numbness or tingling of fingers or toos + Trousseau's sign+ Difficulty concentrating or confusion - Potassiurn detictt late: tetany convulsions INTERVENTIONS: Manitgr vital signs and ABG’s Assist cliant to breath more siowly de 2 3. Administer CO» inhotations of help client breathe in a paper bag 4, Trea! the underlying conditions METABOLIC ACIDOSIS (HCO; deficit] 1. Renal fatlure 2 DM [Ketoacid production) starvation ketoacidosis Prolonged or chronic diarrhea 4 Excessive infusion of chioride fluids 3. Strenucus exercise, circulatory shack & Ingestion of base depleting drugs oF acids like: = ASA > alcono} - ethylene glycot = paraldehyce Clinical S/5< ~~ Headache - Fruity breath - Kussmaul's respirations - Mental duilness {Gisorlentation)Neowewp - Lethargy - Weakness - Potassium excess INTERVENTIONS: Treatment of underlying cause and restoration of electrolyte balance. Administer IV sodium bicarbonate corefully if ordered. Monitor ABG values Maintain good respiratory functions Fluid replacernent, measure | & O Protect from injury Corfect underlying problem as ordered. METABOUC ALKALOSIS (HCOz excess} Excessive losses of acids in the body due to: + prolonged vomiting + gastric suction + excessive use of potassium - losing diuretics {hypokalemia, hyponatremia, hypochieremia) Conallions of requlalary organs such as: ~ Cushing'ssyndrome + HYypereldosteronism Excessive Bicarbonaje Intake from: antacas parentetal NaHCOs or excessive ingestion of baking toda Intestinal fistulas Small powel drainageClinical $/Sx: Decrease kR end depth - Mentat confusion - Divziness = hypotension > muscle hypertonicity potassium datict - nausea, vomiting - diathea ~ numbness and tingling of fingers or toes - restlessness > aithylhmias Late: tetany, convulsions INTERVENTIONS: Monitor clients fiuid tosses closely, Monitor vital signs, especially respirations. Administer ordered Iv ftuids coretully. + Nactoremmonium chloride oral or iV Carbonic anhydrase inhibiter (Digmox] ~ to increase excretion ot bicarbonate by the kidneys. Maintain good respiratory functions. Protect from injury. Revérse underiying prodiom.INTERPRETATION OF BLOOD GAS 1, Interpretation of Acid Bose Status a. jegorize the pH b, determing respiratory involvement ©. determine the metabolic involvement d. assess for compensation 2. Assessment of level of hypoxemia 3. Assessment ot tissue hypoxia SAMPLE QUESTIONS: 1 The client has A8G results of SH 7.30, HCO; 19, PCO: 30. The nurse interprets this as: G. resoirclory acidosis, partial compensation b. respiratory akcioss, partial compensetion C. ° metanalic acicesis, partial compenscation ‘d. : metabolic alkaiosis, partial comperisation 2. the cients experiencing melabolic acidosis which of the following serum Potossium levels may result? ‘c. serum K level is 4.0 mEg/L b. serum K fovel is 3,0 mEo/L ©. . serum K level is 6.0 m&a/t di. serum & level is 4.5 mEg/L 3. Apatisnt's arterial gases resuils reveal the ff, data: PH 7.5, PaO 65 mmiHg, PaCO, 30 PmMHg Gnd HOO. 24 meqYL, hls. indicates. a. respiraiory acidosts bb. respraiory aikatosis & melabolc ackdosis dd. méfaboite cikaiosis 4. A bed tidden client develops slew, shallow respiration. He is tkely to develop which of the ff. acid-base Imoclances? G. respiratory acidosis b. respiratory aikalosis ©. | metabolic acidosis d. metabolic alkalosis