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Acid Base Balance

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Terms in this set (55) Original

pH

~The negative log (base power) of the H+

concentration or the FREE H+ in a solution
~inversely proportional (↓ H+ → ↑ pH)
~Normal body function is dependent on
NARROW range

Hydrogen Ion and pH

~H+ is imperative for CELL MEMBRANE

integrity
~Concentration very small in the body
~0.0000001 mEq/L or pH 7.0

Acids

"DONATE" or release H+ in aqueous

solution; "Acidic"

i.e. Hydrochloric acid

Bases

"ACCEPT" H+ in aqueous solution; "Alkaline"

i.e. Bicarbonate

Acidosis

Blood pH of <7.35

Alkalosis

Blood pH of > 7.45

Buffer

Substance which MINIMIZES/PREVENTS

large changes in pH when either an acid or
base is added to a solution containing the
________; Helps us to get body back to midline
range

Compensation

What one system does to make up for

another system that is not functioning; The
primary disorder is not corrected!!!

~Physiologic RESPONSE of the body

~Body NEVER over-________

Correction

When the "sick system" moves toward

regaining normal function

~Made by interventions to TREAT THE

CAUSES
~Healthcare Professional CAN over-________

Strong Acids

GREATER potential to change the pH of a

solution; DISSOCIATE easily

Weak Acids

LESS ability to change the pH of a solution;

DO NOT dissociate easily

Volatile Acids

Can move from LIQUID → GAS and then

be exhaled via the LUNGS

i.e. carbonic acid

Non-Volatile Acids

CANNOT change into gas form, therefore

are excreted via the KIDNEY

i.e. lactic, ketoacids, sulfuric, phosphoric

acids

pH Balance

Depends on ratio of HCO³ to H₂CO₃ (20:1)

- Very Important!!!

Normal Acid-Base Balance Importance

~Nearly all chemical and enzyme reactions

function OPTIMALLY in a narrow pH range
~H+ and HCO₃ and other ions affect the
EXCITABILITY/RESPONSIVITY of neural,
muscle, and other cells
i.e. acidosis causes arrhythmias

pH in Body

Blood - 7.35 - 7.45

Urine - 6.0
Gastric Acid - 4

Relationship btw pH and H+

pH is INVERSELY related to H+ ion

concentration

↑H+ = pH↓
↓H+ = pH↑

Relationship btw pH and Acid-Base

Balance

Acids are formed as END PRODUCTS of

protein, carbohydrates, and fat metabolism
~H+ must be neutralized or excreted
~BONES, LUNGS, KIDNEYS are the major
organs involved in the regulation of acid
and base balance

Three Part System of Compensation

Buffer System
Excretion
Cellular Ion Exchange

Buffer Systems

Can ABSORB or DONATE H+ ions ->

minimize/prevent LARGE pH changes

Excretion Sites

LUNGS (CO₂)
KIDNEYS (HCO₃ and H+)
GI TRACT (HCO₃ and H+)

Cellular Ion Exchange

Exchange of H+ or HCO₃ ion for another

LIKE-CHARGE ion across the cell
membrane

Buffers

Consists of a WEAK acid and its

CONJUGATE base

~The MOST important plasma buffering

system are the carbonic acid - bicarbonate
and hemoglobin systems

Carbonic acid-bicarbonate System

WEAK acid (H₂CO₃) + Conjugate base

(HCO₃)

Location - plasma (primarily) and interstitial

fluid; KIDNEY TUBULES

Protein

Have NEGATIVE charges, so they can serve

as buffers for H+ (Mainly in the cells)

How Buffer Systems Work

GAIN acid or LOSE base = excess H+ ions

bind with conjugate base becoming a weak
acid → little H+ remains free and pH
change is minimized

(Weak acid does not readily give up the H+)

How Buffer Systems Work

GAIN base or LOSE acid = excess base

combines with the weak acids to form H₂O
and a SALT → ↓s the effect of the stronger
base on pH

NaOH→Na + OH-
OH- + H₂CO₃→ H₂O + HCO₃

Respiratory Effects on pH

EXCRETE acids

Lungs exhale CO₂ as a waste product→ ↓

blood levels of H₂CO₃ (carbonic acid)

Hyperventilation → CO₂ LOSS

Hypoventilation → CO₂ EXCESS

Renal Effects on pH

EXCRETE non-volatile acid and regulate

HCO₃

~Reabsorbs HCO₃ from renal tubules; but

can compensate for alkalosis too
~ "Titratable acids" - NH3 and PO₄ combine
with H+ ions to be excreted in the urine

Potassium

Maintains acid-base equilibrium, and it has

a significant and inverse relationship to pH:
↓ in pH of 0.1 = ↑ K+ level by 0.6

~It moves INSIDE the RBCs into the

extracellular fluid, while H+ moves into the
RBC (in Acidotic states)

Calcium

Alkalosis: ↑ blood pH causing intracellular

uptake of Ca+ ↔ for intracellular H+
(become hypocalcemic)

Acidosis: Long-standing acidosis can result

in osteoporosis and release of Ca+ into
circulation as H+ moves into the cells
(smokers at risk for osteoporosis)

Chloride Shift

Shift of Cl- ions from the plasma → the

RBCs upon the + of HCO₃ from the tissues,
and the reverse movement when CO₂ is
released in the lungs

Acid-Base Disorders

Respiratory Alkalosis
Respiratory Acidosis
Metabolic Alkalosis
Metabolic Acidosis

Respiratory Alkalosis

HIGH pH
Low PaCO₂

Respiratory Acidosis

LOW pH
HIGH PaCO₂

Metabolic Alkalosis

HIGH pH
HIGH HCO₃
HIGH Base Excess

Metabolic Acidosis

LOW pH
LOW HCO³
LOW Base Excess

Arterial Blood Gases (ABGs)

ARTERIAL blood, not venous; Able to

measure O₂, CO₂, HCO₃, pH and O₂
Saturation

Respiratory Alkalosis

↓PaCO₂ < 38 mmHg

↑ in pH
Cause: HYPERVENTILATION "blowing off
CO₂"

Compensation: KIDNEYS
~Active secretion of HCO₃
~↓ secretion/excretion of H+
~Requires 2-4 days

Clinical Manifestations: Respiratory

Alkalosis

Hypocalcemia: intracellular uptake of Ca+

↔ intracellular H+
~Rapid respirations (Hyperventilation)
~CNS: dizziness, muscle contractions
~Changes in LOC

Treatment: Respiratory Alkalosis

Rebreathing CO₂ (paper bag)

Treat underlying cause

Respiratory Acidosis

↑ PaCO₂ > 45 mmHg

↓ pH

Causes:
Obstructive lung dz
Restrictive lung dz
Nueral damage or disruption
Hypoventilation

Compensation: Kidneys
~Little or no secretion of HCO₃ (hold on to
it)
~Secrete H+ into renal tubule to be
excreted in the urine
~Requires 2 - 4 days

Clinical Manifestations: Respiratory Acidosis

Hypoventilation (Respiratory depression)

Headache
Behavior changes
Changes in LOC

Treatment: Respiratory Acidosis

~Treat underlying cause

~Mechanical ventilation
~Bronchodilators, bronchial hygiene
~Judicious use of narcotics, sedatives,
tranquilizers (can depress the treatment)

Metabolic Alkalosis

↑ HCO3 or loss of acids

↑pH

Causes:
~Loss of acid: vomiting
~↑ HCO₃ levels (digestion of antacids)
~↓ Fluid Volume (hypovolemia - DIURESIS)
~Electrolyte levels
(Hypokalemia/Hypochloremia)

Compensation: Metabolic Alkalosis

(Respiratory) Lungs: Hypoventilating to ↑

PaCO₂; Occurs immediately

Clinical Manifestations: Metabolic Alkalosis

~HypoVentilation (compensatory
mechanism)
~HypoVolemia s/s
~HypoKalemia s/s
~Possible neurological irritability

Treatment: Metabolic Alkalosis

~Fluid, K+, Cl- replacements as needed

~Carbonic anhydrase inhibitor

Metabolic Acidosis

Gain of NON-VOLATILE acids (↓pH)

and/or loss of base (HCO₃)

High Anion Gap

~Starvation/protein malnutrition
~Diabetic ketoacidosis
~Lactic acid
~Alcoholic ketoacidosis
~Uremic acidosis
~Toxic ingestion

Normal Anion Gap

~Acid gain
~HCO³ loss

Anion Gap

~Gap represents the anions NOT

ROUTINELY measures: PO₄, proteins, SO₄,
etc.
~Normal 10 - 14
~Used to distinguish btw different types of
METABOLIC ACIDOSIS

Abnormal Anion Gap

Occurs as a result of an ↑ level of an

abnormal unmeasured anion

As abnormal anions accumulate, the

measured anions have to ↓ to maintain
electroneutrality

Causes: Anion Gap

Metabolic acidosis w/ HIGH Anion Gap

↑ organic aids:
Lactate
Alcohol
Uremia
Toxins/Poisons
Ketones

Metabolic acidosis w/ NORMAL Anion Gap

↑ Cl-
↓ HCO₃

Compensation: Metabolic Acidosis

(Respiratory) Lungs: Hyperventilation;

Expiring more CO₂
~Requires minutes to hours
~Protein and cellular buffering systems in
action

Clinical Manifestations: Metabolic Acidosis

~Hyperventilation (compensatory
mechanisms)
~Nueromuscular depression (poor muscle
function and mental status changes)
~N/V (↓ GI motility)
~Cardiac dysrhythmias
~Hypotension
~↓ Cardiac contractility, and
responsiveness to drugs

Treatment: Metabolic Acidosis

Treat the cause, HCO₃ replacement,

dialysis

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