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EMT Paramedic Fall 2007
And Now! Acids and Bases Yippy!
The biological and chemical processes occurring in our bodies depend on a consistent environment.
Homeostasis is our body’s system for maintaining that consistency.
Homeostasis & Acid-Base
Metabolic processes within our bodies function within a very narrow pH range.
Many diseases and environmental influences can greatly impact this delicate range.
Lets First Review
SpO2 = 90-100 (measures saturated hemoglobin through skin) SaO2 = 90-100 (measures saturated hemoglobin in arterial blood)
More review PaCO2 = 35-45 (dissolved CO2 in blood) PaO2 = 80-100 for adult and child 40-70 for newborn 60-80 for geriatric (measures dissolved oxygen in blood) .
Matilda Matilda is 87 years old. These are her labs. Her doctor has called and told her to come down because her blood gasses were off in her labs. SpO2 = 68 PaCO2 = 50 PaO2 = 55 .
.Who cares? You do! Because the more we know about acid-base derangements the better we can treat patients in order to correct the derangements.
Acids and Bases Here we go! .
Acids A substance that releases H+ Ions when dissolved in water Lactic acid Ketones Carbonic acid .
Bicarbonate is most common base. these are H+ seekers and also dissociate in water.Bases Also known as alkalis. When bases dissolve in water the hydroxyl ion is released (OH-) this little guy actively seeks out and attaches itself to acids floating around in the blood-stream. OH.+ CO2 = HCO3 .
Acid-Base Physiology During energy production. byproducts are released. Carbon dioxide (CO2) Hydrogen (H+) . Two of these main byproducts effect acid-base.
.Control that Hydrogen The key to acid-base regulation is controlling hydrogen ion concentrations.
The hydrogen ion concentration outside the cell is typically 4x10-8 mols/L or 0.00000004 equivalents per liter. . That number is to small to work with so we use the pH scale instead.pH P-what? I thought we were talking about hydrogen.
pH Scale Potential of Hydrogen 1-14 7 is mid-range 7.45 is normal for human body.35-7. Hmm? So are we acidic or alkaloid? .
H+ decreases. .pH and Hydrogen pH levels are inversely proportional to H+ This means as H+ increases pH decreases and as pH increases.
Condition pH H+ Alkalosis increases decreases Acidosis decreases increases .
45 is alkaloid.4 .35 to 7.35 is acidotic to humans and anything above 7. 0. About 6.8 alkalin.45 and that is considered slightly alkaloid then at what point are we acidotic? Anything below 7.9 acid and 7. either way is as far as we like to go.Hmm So? If we are normally 7.
Fatal Values pH of less than 6.8 are typically not conducive with life.9 and pH of greater than 7. .
Picky Picky The body must maintain a fairly narrow alkaline environment in order for things to go smoothly. Any imbalances can be very serious. .
Back to Matilda So here are her values from before and now what do you think that means to her pH? SaO2 = 68 PaCO2 = 50 PaO2 = 55 pH= 7.23 .
How do we keep it all balanced? .
Balancing Systems Buffer System Respiratory System Renal System .
Or. need more give it a squeeze) It can collect hydrogen ions when they are over-abundant and release them when they are scarce. .Buffer System Fastest acting (nano-seconds) Considered the chemical sponge (too much H+ use a sponge to clean it up.
The buffer system will change those two through chemical reactions to keep things balanced. H+ <-> HCO3 <-> .How does it work? Basically the cells produce CO2 and H+ during metabolism.H2CO3 <-> .H2O <-> CO2 Hydrogen Bicarb Carbonic Acid Water Carbon Dioxide .
Then carbonic acid can be split apart to make bicarbonate and hydrogen. the buffer system takes water and carbon dioxide and makes carbonic acid (with the help of the enzyme carbonic anhydrase). This can go both directions .Gosh! What’s that mean? Easy…if the body needs more acid.
Respiratory System Second fastest to respond (usually within minutes) Triggered by Chemoreceptors in the vessels. Example Diabetic keto-acidosis .
It tells them whether to breathe faster and harder or slower and more shallow.Breathe! When the pH gets a little out-o-wack a message is sent to the lungs. .
How does that work? Hydrogen binds with bicarbonate. In red blood cells carbon dioxide is carried to the lungs and exchanged for oxygen. Carbonic acid then breaks down into water and carbon dioxide. The majority of CO2 is transported as bicarbonates in the plasma . This makes carbonic acid.
.So in the lungs? Oxygen has an affinity to hemoglobin and it climbs on board kicking off the CO2 The CO2 and water are displaced and through osmosis and diffusion are blown out with expiration of air.
Gee Whiz! After the CO2 has been blown away in the lungs…what happens? Exactly! The pH increases. . bringing the body back to normal.
Renal System If the lungs and buffers are not able to keep up with the amount of acids. . then the kidneys must take action. It may take the kidneys hours or days to react to an imbalance.
When they expel one ion they will exchange it for another. The kidney tubules are smart. .What do the kidneys do to help? They regulate pH by expelling excess hydrogen or bicarbonate ions.
Kidneys work OT with COPD When someone chronically retains CO2 the kidneys become the primary balancing system. They rely entirely on the renal system to maintain pH. . Example is the chronic emphysema patient.
More Values Base Excess BE = +or.6 Bicarb HCO3 = 22-26mEq/L .
Acid-Base Derangements Respiratory: Acidosis Alkalosis Metabolic: Acidosis Alkalosis .
illness.Respiratory Acidosis Hypoventilation Retained CO2 pH decreases Causes: Trauma. You guys can treat this! . medications.
trauma Inadequate lung expansion – skeletal trauma. FBAO Respiratory depression – anesthesia. ascites . – Mucous plug. atelectasis. Pneumonia. Acidosis Lungs – COPD. OD.Causes of Resp. ARDS Airway obst. pneumothorax.
S/S for Resp. K+) Cardiac arrhythmias (hyperkalemia) Decr. Acidosis H/A (cerebral vasodilation) Tachycardia (hypercapnia) Bradycardia (incr. CNS – confusion to coma neuromuscular weakness .hyporeflexia. flaccid paralysis .
Tx: for Resp Acidosis Adequate hydration Bronchodilators OXYGEN .
Respiratory alkalosis Hyperventilation Pain. anxiety Blows off CO2 pH Increase O2 or Rebreathe CO2??? .
or hypoxia due to epi release Febrile ASA OD Brain trauma/tumor Septic shock (early) .Causes of Resp Alkalosis Anxiety. pain.
S/S of Resp. K+ and Ca++) . tingling in fingers. Alkalosis Dizziness Numbness. around mouth Cardiac arrhythmias (decr.
Tx for Resp. Alkalosis Rebreathe CO2 OXYGEN .
DM. Rx pH Decreased CO2 Normal Sometimes NaHCO3- EMS tx is ventilation .Metabolic acidosis Excessive acid production N/V/D.
Metabolic rate Poisoning Severe diarrhea .Causes of Metabolic Acidosis Ketoacidosis Lactic acidosis Renal failure Incr.
flushed Cardiac arrhythmias (decr.S/S of Metabolic Acidosis Skin warm. Contractility and inotropic response to catecholamines) Lethargy to coma Decr. dehydration (GI losses) . CO) Decr. BP. Pulse (decr.
Tx for Metabolic Acidosis DKA – insulin. fluids Alcoholism-related ketoacidosis – glucose and saline Diarrhea – correct fluid and electrolyte imbalances Acute renal failure – dialysis Lactic acidosis – correct hypoxia and hypoperfusion .
2 Potassium replacement – when acidosis is corrected. cont. compensatory hyperventilation . K+ will shift back into cells = hypokalemia Mechanical ventilation. Sodium bicarb. IV when pH is <7. Admin.Tx for Metabolic acidosis.
vomiting Too much IV bicarb H+ + HCO-3 <----> H2CO3 <---> H20 + CO2 .Metabolic alkalosis Infrequent pH Increased CO2 Normal HCO3 Increased Diuretics.
Ringer’s lactate .Causes of Metabolic Alkalosis Persistent vomiting Gastric suctioning Thiazide diuretics Antacid over-use Hyperal.
calcium .S/S of Metabolic Alkalosis Postural hypotension Muscle weakness due to hypokalemia Severe dizziness. toes due to decr. tingling fingers.
9% NS .45% or 0.Tx for Metabolic Alkalosis Fluids and electrolytes 0.
html .au/paedanaes/javaman/respiratory/ab/AcidBase.com http://www.acid-base.health.edu.adelaide.Cool Web-Sites http://www.
Elderly Edna Vomiting profusely for 24 hours pH = 7.46 PCO2 = 45 SpO2 = 92 .
38 PCO2 = 50 SpO2 = 88 .Emphysemic Eddy Chronically SOB secondary to COPD pH = 7.
Heroin Holly Found unconscious in the 7-11 restroom pH = 7.20 PCO2 = 55 SpO2 = 50 .
48 PCO2 = 20 SpO2 = 100 .Panicky Pat Freaking out about an acid/base quiz pH = 7.
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