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INCO 2
ACID BASE IMBALANCES
PH and H Relationship
 pH – measures H ion concentration
 pH levels are inversely proportional to H concentration
 Acidosis: increase H ions because it releases H ions
(the more acidic, more H ions)
 Basic/Alkaline: increase in pH, decrease in H ions
(kidneys
 will retain H ions and bicarbonate)
 Acids: release H ions in solution
 Bases: Retain/accept H ions in solution
Regulation of Acid-Base Balance (2 categories)
Volatile Acid
 Can be eliminated in the body as gas (has the ability to
escape)
 Carbonic Acid (H2CO3)
 only volatile acid produced in the body
 it dissociates into carbon dioxide and water
the CO2 is then eliminated from the body
throughthe lungs
 Respiratory Acidosis – mababa ang acid,
mataas ang carbon dioxide (potential acid)
Nonvolatile
 All other acids produced in the body must be
metabolized or excreted from body in fluid
 Ex: Lactic Acid, Hydrochloric Acid, Phosphoric Acid,
Sulfuric Acid
3 SYSTEMS THAT MAINTAIN pH DESPITE CONTINUOUS
ACID PRODUCTION
1. BUFFERS
 Substances that prevent major change in pH by
removing or releasing H ions
 Maintain acidity and alkalinity
 When excess acid is present in body fluid, they bind
with H ions to minimize change in pH
 If body fluids become too basic or alkaline, they
release H ions, restoring pH
 Major buffer systems
a. Carbonic Acid-Bicarbonate buffer system (CO2
+ 
b. Water = H2CO3)
c. Phosphate Buffer System – active in kidneys
d. Protein buffer system – ex. Hemoglobin
BICARBONATE-CARBONIC ACID
Bicarbonate
 A weak base
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 When an acid is added to the system, the H ion
in the acid combines with Bicarbonate and the
pH changes only slightly
Carbonic Acid
 A weak acid
 Produced when CO2 dissolves in water
 If a base is added to the system, it combines
with Carbonic Acid and pH remains within the
normal range
NORMAL RATIO
 20 Parts bicarbonate (HCO3) is to 1 part carbonic
acid (H2CO3)
 It is this ratio that maintains the pH within the
normal range
 Adding a strong acid to ECF depletes bicarbonate,
changing the 20:1 ratio and causing the pH to drop
below 7.35. this is known as ACIDOSIS
 Addition of a strong base depletes carbonic acid as it
combines with the base. The 20:1 ratio again is
disrupted and the pH rises above 7.35, a condition
known as ALKALOSIS
 Intracellular and plasma proteins (serum albumin) -
Contribute to buffering for organic acids produced
by cellular metabolism
 In RBCs, hemoglobin acts as a buffer for H ion
 Inorganic phosphates also serve as extracellular
buffers, helping to maintain a stable pH (found in
extracellular compartment)
2. RESPIRATORY SYSTEM
 Carbon dioxide is a potential acid
 Acute increases in either CO2 or H ions in the blood
stimulate the respiratory center in the brain
 COPD – increase retention of carbon dioxide in
lungs kaya wag mo taasan ang oxygen (1-2L only)
 Normal stimulus for breathing is increased in
carbon dioxide because it would stimulate your
respiratory center (medulla oblongata) as a
result both the depth and rate of respiration
increases (hypercapnia)
 As a result, both the rate and depth of respiration
increased. The increased rate and depth of lung
ventilation eliminates carbon dioxide from the body
Morphine sulfate - Depresses the respiratory center
 Both the rate and depth of respiration decrease and
is retained
 RESPIRATORY ALKALOSIS – breathe into brown
paper bag (kulang ka sa carbon dioxide)
RENAL SYSTEM
 Excess nonvolatile acids produced during
metabolism normally are eliminated by the kidneys
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 The kidneys also regulate bicarbonate levels in ECF d. Tachycardia
by regenerating bicarbonate ions as well as e. Blurring of Vision
reabsorbing them in the renal tubules f. Irritability, Decreased level of consciousness
g. Late signs: Disorientation, coma, confusion
o In acidosis, when excess H ion is present and the pH h. Electrolyte disturbance: hyperkalemia (increased
falls, the kidneys excrete H ions and retain bicarbonate neuromuscular irritability – HIGH AND FAST)
o In alkalosis, the kidneys retain H ions and excrete
bicarbonate to restore acid-base balance
MANAGEMENT
RESPIRATORY ACIDOSIS
a. Maintain patent airway
RISK FACTORS b. Give medications as prescribed
c. Administer antibiotic as ordered
a. COPD – primary
d. Administer O2 (1-2L)
 Chronic Bronchitis e. Perform tracheal suctioning, postural drainage,
 Emphysema – barrel chest (hindi maeliminate coughing
 and carbon dioxide) a. and deep breathing
 Asthma f. Oral and IV fluids

b. Pulmonary edema COMPENSATION

c. acute respiratory distress syndrome o Uncompensated

 Normal bicarbonate
PATHOPYSIOLOGY o Partially compensated
 Increased bicarbonate
o Fully compensated
 Normal pH

RESPIRATORY ALKALOSIS

a. Anxiety/ Panic attack – most common cause

MANIFESTATION

b. Anxiety, restlessness
c. Light headedness, paresthesia
d. Increased Deep Tendon Reflex (hyperreflexia),
positive Trousseaus and Chvostek’s sign
e. Tetany → laryngospasm → laryngochonstriction →
respiratory arrest
g. Decreased LOC
h. Convulsions, Seizures

COLLABORATIVE MANAGEMENT

a. Treat underlying cause, removing causative agent

b. Anxiety – anxiolytics and sedatives
c. Patients’ breath into brown paper bag with cupped
hands
d. Allay anxiety. Recommend activities that promote
relaxation (Deep breathing)
e. Provide undisturbed rest periods
f. Stay with patient during periods of extreme stress
and anxiety
CLINICAL MANIFESTATIONS g. Offer reassurance and maintain calm, quiet
environment
a. Headache – CO2 dilates cerebral blood vessels
i. Institute safety measures and seizure precautions
b. Hypercapnea – rapid rise in PaCO2 levels
(pad side rails) (seizure = side lying to promote
c. Warm flushed skin (due to peripheral
drainage of secretions)
vasoconstriction)
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 Nsg. INCO 2
 Prolonged PR interval
 Widened QRS

MANAGEMENT

a. Sodium Bicarbonate per IV (alkalinizing solution) –

to reduce the effect of the acidosis on cardiac
function. Flush it with NSS
b. Dialysis for Renal Failure
c. Institute safety precautions as necessary. Keep the
bed in the lowest position, side rails raised.
PATHOPHYSIOOGY d. Keep the clocks, calendars and familiar objects at
bedside. Reorient to time, place, and circumstances
as needed. Allow significant others to remain with
the client as much as possible

PATHOPYSIOLOGY

METABOLIC ACIDOSIS METABOLIC ALKALOSIS

Causes: Acute Renal Failure  Caused by vomiting and prolonged gastric

suction
CLINICAL MANIFESTATIONS  Increase of H production

o Kussmaul’s respiration – breathing is rapid and deep, RISK FACTORS

SOB
 ↓HCO3, ↑H ions (kidneys will excrete H ions  Commonly associated with use of thiazides,
and retain bicarbonate) furosemide, other diuretics that deplete
 For body to compensate, body will eliminate potassium stores, hydrogen and chloride ion
 carbon dioxide loss from kidneys
o Headache  Excessive acid loss from GI tract – most
 ↑CO2 → cerebral vasodilation → Headache common cause
o Signs of hyperkalemia MANIFESTATIONS AND COMPLICATIONS
o ECG:
 Tall T waves a. Electrolyte Imbalance: Hypocalcemia, Hypokalemia
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b. Dizziness, Confusion, Muscle Twitching, Paresthesia

c. Headache

d. Decreased LOC

e. Nausea/ Vomiting

f. Late sign: Tetany, convulsions

OVER ALL MANAGEMENT

a. Administer O2 as ordered

b. Seizures precautions

c. Maintain patent IV

d. Administer diluted potassium solutions with an

infusion pump (hypokalemia)

e. Monitor I and O

f. Infuse ammonium chloride no faster than 1L over 4

hours. Don’t administer to patients with hepatic or renal
disease.

 Rapid administration = hemolysis or RBC

destruction

g. Carbonic Anhydrase Inhibitors (Diamox): increases

renal excretion of HCO3

PATHOPYSIOLOGY

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