 Two by-products:

 Carbon dioxide
 Hydrogen
 Hydrogen ions = inversely proportional to pH
 Compensatory mechanisms:
 Chemical buffers
 Respiratory reactions
 Kidney reactions
 ABG VALUES

 pH  7.35-7.45
 PaO2  80-100 mmHg
 PaCO2  35-45 mmHg
 HCO3  22-26 mEq/L
 Base excess  -2 / +2 (acidosis/alkalosis)
 O2 Sat (SpO2)  95%-100%
 RESPIRATORY ACIDOSIS METABOLIC ACIDOSIS

 Underelimination of  Overproduction of
hydrogen ions hydrogen ions
 Overelimination of  Underproduction of
bicarbonate ions bicarbonate ions
 RESPIRATORY ACIDOSIS METABOLIC ACIDOSIS
 Neuromuscular problems  Overproduction of ketones
 Guillain-Barre Syndrome
 Myasthenia gravis
(body has used up glucose
 Poliomyelitis suppplies; draws in fat
 Diaphragmatic paralysis stores for energy; converts
 Respiratory center depression in
CNS
fatty acids to ketone
 Trauma bodies)
 Lesions  DM
 Obesity  Chronic alcoholism
 Drugs
▪ Anesthetics
 Starvation
▪ Hypnotics  Renal insufficiency
▪ Opioids
▪
 Renal failure
Sedatives
 RESPIRATORY ACIDOSIS METABOLIC ACIDOSIS

 Lung disease  Excessive GI losses

 COPD  Diarrhea
 Asthma  Intestinal malabsorption
 Chronic bronchitis  Toxicity
 ARDS  Salicylate ingestion
 Pulmonary edema
 Airway obstruction
 Retained secretions
 Laryngeal spasm
 Tumors
 RESPIRATORY ACIDOSIS
 Headache
 Cerebral blood vessel dilation
 Altered LOC
 CNS depression
 Rapid, shallow breathing,
dyspneic and diaphoretic
 Increased CO2
 Decreased RR
 CNS trauma or lesions
 Tachycardia and ventricular
arrhythmias
 Hyperkalemia and hypoxemia
METABOLIC ACIDOSIS
 Headache
 Cerebral blood vessel dilation
 Altered LOC
 CNS depression
 Rapid, deep breathing
(Kussmaul’s respirations)

Fruity breath odor (fat
catabolism=excretion of
acetone in the lungs)
 Decreased DTR
 Anorexia, nausea, vomiting
 RESPIRATORY ACIDOSIS
 ABG:
 pH = < 7.35
 PaCO2 = >45 mmHg
 HCO3 = >26 mEq/L (chronic)
 CXR
 Pneumonia, pneumothorax,
pulmonary edema
 Serum electrolyte
 Hyperkalemia
 Drug screening
 Overdose
METABOLIC ACIDOSIS
 ABG:
 pH: <7.35
 PaCO2: <35 mmHg
 HCO3: <22 mEq/L
 Serum electrolyte
 Hyperkalemia
 ECG changes associated with
hyperkalemia
 Blood glucose and serum
ketones
 RESPIRATORY ACIDOSIS
 Treatment focus: symptoms
and underlying cause:
 Bronchodilators
 Supplemental oxygen
 Drug therapy to treat
hyperkalemia
 Antibiotic therapy to treat
infection
 Chest physiotherapy
 Removal of foreign body from
the patient’s airway
METABOLIC ACIDOSIS
 Treatment focus:
symptoms and underlying
cause
 For patients with DM: rapid-
acting insulin (reverse DKA
and drive K into the cell)
 Sodium bicarbonate
 Antidiarrhea
 Dialysis
 RESPIRATORY ACIDOSIS METABOLIC ACIDOSIS

 Impaired gas exchange  Decreased cardiac output

 Ineffective airway  Risk for fluid volume excess
clearance  Risk for injury
 Risk for injury
 RESPIRATORY ACIDOSIS METABOLIC ACIDOSIS
 Monitor VS (RR and CR)  Same
 Monitor neurologic status  Same
 Report any variations in  Same
ABG levels 
 Same
Give medications as
prescribed
  Prepare for mechanical
Administer oxygen as
ordered (COPD alert!!!) ventilation or dialysis
 Perform tracheal  Position the patient to
suctioning promote chest expansion
 Institute safety measures  Same
RESPIRATORY ALKALOSIS METABOLIC ALKALOSIS

 Acid deficit  Base excess

RESPIRATORY ALKALOSIS METABOLIC ALKALOSIS
 Hyperventilation  Excessive acid loss from
 Anxiety or panic attack
 Drugs the GIT
 Nicotine, salicylates,  Vomiting
aminophyllines  Prolonged NG suctioning
 Hypermetabolic state
 Diuretics
 Fever, sepsis
 Conditions affecting  Thiazide and loop
respiratory center  Antacids that contain
 High progesterone levels
during pregnancy (stimulate) sodium bicarbonate
 Trauma (injure)  Kidney disease
 Hypoxia
 High altitude, pulmonary
disease, severe anemia
RESPIRATORY ALKALOSIS METABOLIC ALKALOSIS

 Alternating periods of  Results in neuromuscular

apnea and hyperventilation excitability
  Muscle twitching, weakness,
Complains of tingling in
tetany
fingers and toes  Increased DTR
(paresthesia)  Paresthesia
 Restlessness  Apathy and confusion
 GIT
 Anorexia, nausea, vomiting
 GUT
 Polyuria
RESPIRATORY ALKALOSIS METABOLIC ALKALOSIS

 ABG result:  ABG result:

 pH: >7.45  pH: >7.45
 Bicarbonate: <22 mEq/L  Bicarbonate: >26 mEq/L
(chronic)  PaCO2: >45 mmHg
 PaCO2: <35 mmHg  Serum electrolytes
 Serum electrolytes  Low K, Ca
 Low K, Ca  Elevated HCO3
RESPIRATORY ALKALOSIS METABOLIC ALKALOSIS

 Treatment: treat  Discontinuation of thiazide

underlying cause diuretics and NG suctioning
 Remove causative agent  Antiemetic
(salicylate)  Acetazolamide (Diamox)
 Antipyretic, antibiotic
 Oxygen therapy
 Anxiolytics
 Paper bag breathing
RESPIRATORY ALKALOSIS METABOLIC ALKALOSIS

 Allay anxiety  Monitor VS (RR, CR)

 Help the patient breath  Assess LOC
into a paper bag or cupped  Administer oxygen as
hands ordered
 Provide undisturbed rest  Institute seizure
periods after the RR precautions
returns to normal  Irrigate NG tube with
 Institute safety measures normal saline instead of
tap water