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

while bases pick up H+ ions .pH and Hydrogen Ion • Indirect measure of H+ ion concentration • Ratio of base (HCO3) to acid (CO2) • Acids give up (donate) H+ ions.

7.pH  Body maintains a slightly alkaline pH of 7.35 .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 .

26 mEq/L (metabolic component) .ABG Normal Values • pH 7.35 .45 overall state • PaCO2 35 .7.45 mm Hg (respiratory component) • HCO3 22 .

100 mmHg partial pressure of oxygen in arterial blood • SaO2 96 .100% arterial O2 saturation .ABG Normal Values • PaO2 80 .

26 mEq/L (metabolic component) .45 overall state • PaCO2 35 .ABG Normal Values • pH 7.7.35 .45 mm Hg (respiratory component) • HCO3 22 .

Acid-Base Imbalances • Alkalemia – Alkalosis • Acidemia – Acidosis .

Metabolic Acidosis • Causes – – – – – Anaerobic metabolism Lactic acidosis Anoxia Poisoning Overdose .

Metabolic Alkalosis • Causes – Vomiting – Poisoning – Overdose .

COPD - .Respiratory Acidosis • Causes – Hypoventilation – Respiratory failure Long-standing respiratory insufficiency.

Respiratory Alkalosis • Causes – Hyperventilation .

40 is moving towards alkalosis .Interpretation of ABGs • Evaluate pH: this determines acidosis or alkalosis • 7.45 • Value below 7.40 is in the middle of the normal range of 7.7.40 is moving towards acidosis • Value above 7.35 .

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

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

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? .

↑ PaCO2 • Metabolic – ↑ pH. ↓ PaCO2 – ↓ pH. ↑ HCO3 – ↓ pH.Interpretation of ABGs • Respiratory – ↑ 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 .