Respiratory Respiratory Metabolic Acidosis Metabolic

Acidosis Alkalosis Alkalosis

• Where there is CO2 • Where there is rapid • Where there is • Where there is a
retention in the lungs loss of CO2 from the decreased ability of the decreased ability of
lungs than is retained kidney to excrete acid the kidney to excrete
Or or conserve base base or conserve
acid
• Where the body
produces CO2 faster
than the lungs can
expel

• S/S: • S/S: • S/S: • S/S:

1. HYPOventilation 1. HYPERventilatio 1. Decreased BP 1. Compensatory
-> Hypoxia n (increased rate HYPOventilatio
and depth) • HYPERkalemia n
• Rapid, shallow
respirations • Tachycardia 3. Muscle twitching • Dysrhythmias
(tachycardia)
3. Low BP 3. Decreased or 4. Warm, flushed
normal BP skin (vasodilation) 3. Tremors,
4. Pale to cyanotic muscle cramps,
skin and/or 4. Numbness and 5. Changes in LOC tingling of
mucosa tingling of (confusion and fingers and toes
extremities increased
5. Headache drowsiness) 4. HYPOkalemia
5. Hyper-reflexes
6. Drowsiness, and muscle 6. Nausea, vomiting 5. Restlessness
dizziness and cramping and diarrhea followed by
disorientation lethargy
6. Increased 7. Kussmaul
7. Muscle anxiety respirations 6. Confusion,
weakness (compensatory decreased
hyperreflexia 7. Increased HYPERventilation LOC, dizzy and
irritability ) irritable
8. HYPERkalemia
8. HYPOkalemia
9. Dysrhythmias
(due to
increased
potassium
levels)

• Causes: • Causes: • Causes: • Causes:

1. Respiratory 1. HYPERventilatio 1. DKA 1. Severe
depression due n (due to anxiety, vomiting
to anesthesia, fear and • Severe diarrhea
drug overdose Pulmonary • Diuretics
(opioids, Edema) 3. Renal failure (you're losing a
benzodiazepines lot of
4. Shock potassium,
 ) and increased • Mechanical except for the
ICP ventilation 5. Lactic acidosis potassium-
sparing
• Airway medications)
obstruction
3. Excessive
3. Decreased NaHCO3
alveolar capillary (bicarbonate)
diffusion (in
pneumonia, 4. Excessive GI
COPD, ARDs, suctioning
PE)
5. Excess steroid/
antacid use

• Relationship between potassium and acid-base balance=> https://acutecaretesting.org/en/journal-

scans/on-the-relationship-between-potassium-and-acid-base-balance/

• Acid-base imbalances alter the potassium transport;

• Acidosis causes increased reabsorption of potassium in the collecting duct
• Alkalosis causes decreased reabsorption of potassium in the collecting duct

• In general acidemia (reduced blood pH) is associated with increased plasma

potassium concentration (hyperkalemia), whilst alkalemia (increased blood pH) is
associated with reduced plasma potassium concentration (hypokalemia).

• Why does Cushing syndrome cause metabolic alkalosis? Cushing syndrome is

when there is excessive cortisol produced. Under various chemical reactions, it is
due to the excessive cortisol that leads to hypokalemia, which in turn leads to
alkalosis

• Tips:
1. Acidosis leads to HYPERkalemia
2. Alkalosis leads to HYPOkalemia

• 6 components in an ABG:
1. pH: 7.35 - 7.45 (7.40 as the absolute normal)
2. PaO2: 75 to 100 mmHg
3. PaCO2: 35 - 45 mmHg (respiratory parameter)
4. HCO3: 22 - 26 mEq/L (metabolic parameter)
5. O2 sat.: 94 to 100%
6. Oxygen