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Acid/ Base Review

NR-75 D Diana Diaz RN MSN

Objectives
Review the basic mechanisms of acid/base Recall the 4 major types of Acid/base imbalances Analyze a set of blood gas values

pH and Hydrogen Ion


Indirect measure of H+ ion concentration Ratio of base (HCO3) to acid (CO2) Acids give up (donate) H+ ions, while bases pick up H+ ions

pH
Body maintains a slightly alkaline pH

of 7.35 - 7.45 Metabolic and respiratory processes work together to keep hydrogen (H+) levels in a normal range

Regulators of Acid/Base
Buffers Respiratory system Renal system

Acid Base Balance


CO2 + H20
Lungs

H2CO3

H+ + HCO3Kidneys

Respiratory

Metabolic

Fast

Slow

ABG Normal Values


pH 7.35 - 7.45 overall state
PaCO2 35 - 45 mm Hg (respiratory component)

HCO3 22 - 26 mEq/L (metabolic component)

ABG Normal Values


PaO2 80 - 100 mmHg partial pressure of oxygen in arterial blood
SaO2 96 - 100% arterial O2 saturation

ABG Normal Values


pH 7.35 - 7.45 overall state
PaCO2 35 - 45 mm Hg (respiratory component) HCO3 22 - 26 mEq/L (metabolic component)

Acid-Base Imbalances
Alkalemia
Alkalosis

Acidemia
Acidosis

Metabolic Acidosis
Causes

Anaerobic metabolism Lactic acidosis Anoxia Poisoning Overdose

Metabolic Alkalosis
Causes

Vomiting Poisoning Overdose

Respiratory Acidosis
Causes

Hypoventilation Respiratory failure


Long-standing respiratory insufficiency, COPD
-

Respiratory Alkalosis
Causes

Hyperventilation

Interpretation of ABGs
Evaluate pH: this determines acidosis or alkalosis 7.40 is in the middle of the normal range of 7.35 - 7.45 Value below 7.40 is moving towards acidosis Value above 7.40 is moving towards alkalosis

Interpretation of ABGs
Evaluate respiratory component (PaCO2) If PaCO2 < 35, the value is alkalotic If PaCO2 > 45, the value is acidotic

Interpretation of ABGs
Evaluate the metabolic component (HCO3) If HCO3 > 26 mEq/L, the value is alkalotic If HCO3 < 22 mEq/L, the value is acidotic

Interpretation of ABGs
Determine which component (PaCO2 or HCO3) matches the pH If pH is decreased or increased is the underlying disorder respiratory or metabolic?

Interpretation of ABGs
Respiratory pH, PaCO2 pH, PaCO2 Metabolic pH, HCO3 pH, HCO3

Compensation
Determine the degree of compensation Absent: pH is not within normal range The component that does not match the pH imbalance is still within its normal range

Compensation
Determine the degree of compensation Complete: pH is within the normal range and both components are either above or below normal range

Compensation
Determine the degree of compensation Partial: pH is not within normal range The component that does not match the pH disorder is above or below the normal range

pH

PaCO2

HCO3

Respiratory Acidosis
Compensated Respiratory Acidosis

Respiratory Alkalosis
Metabolic Acidosis Metabolic Alkalosis

Acid/Base MnemonicROME
R (respiratory) O (opposite)

pH pH

PaCO2 PaCO2

alkalosis acidosis

M (metabolic) E (equivalent)

pH pH

HCO3 HCO3

acidosis alkalosis

More Fun with Acid Base


Mixed diagnoses More than one problem Acute and compensated respiratory acidosis Respiratory and metabolic acidosis

Lets Practice

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