ACID-BASE REGULATION

pH
• (potential of Hydrogen) measurement reveals if
a solution is acidic or alkaline (also base or
basic). If the solution has an equal amount of
acidic and alkaline molecules, the pH is
considered neutral.
• N = 7.35-7.45
• Inversely proprotional (pH = H+)
• Acidic = ph 6.9 and Below
• Base = pH 7.1 and Above
Regulators of Acid-Base
• Chemical Buffers
• Prevents major changes in the pH by
removing/releasing H concentrations.
• Lungs
• 2nd line of defense
• Release carbonic acid in the form of Water and
Carbon Dioxide
• Kidneys
• Ultimate correction of acid-base balance
ACIDOSIS
• pH below 7.35
• Cannot be tolerated; requires immediate
attention
• Dec. in LOC, muscle weakness, disorientation,
coma and death
ALKALOSIS
• pH is above 7.45
• Pt. can tolerable mild alkalosis
• Hyperexcitability, muscle spasms, convulsion
and death
RESPIRATORY ACIDOSIS
• “Carbonic Acid excess”
• Causes:
▫ Always due to inadequate release of CO2 and
inadequate ventilation
▫ Elevation of CO2 will elevate the carbonic acid
levels
• Manifestation:
▫ Cerebrovascular vasodilation
▫ Inc. RR, HR, BP
RESPIRATORY ACIDOSIS
• Management:
▫ Tx is directed in promoting ventilation
▫ Use of broncho dilators
▫ O2 inhalation
▫ Mechanical ventilation
RESPIRATORY ALKALOSIS
• “Carbonic Acid deficit”
• Causes:
▫ Hyperventilation resulting to excessive blowing off
of CO2
▫ Anxiety
▫ Hypoxemia
▫ Gram (-) bacteremia
▫ Excessive ventilation from MV
RESPIRATORY ALKALOSIS
• Manifestation:
▫ Lightheadedness
▫ LOC
▫ Numbness and tingling
• Management:
▫ Breathing exercises
▫ Sedatives
▫ Brown Bag
▫ MV- correct pO2
▫ Antibiotics
METABOLIC ACIDOSIS
• “Base Bicarbonate Deficit”
• Causes:
▫ Bicarbonate deficit (<22mEq/L)
▫ Diabetic ketoacidosis
▫ Uncontrolled diarrhea
▫ Shock
▫ Renal failure
METABOLIC ACIDOSIS
• Manifestations:
▫ Headache
▫ Confusion
▫ Drowsiness
▫ N/V
• Management:
▫ Admin. Of Sodium Bicarb or Ca Bicarb
METABOLIC ALKALOSIS
• “Bicarbonate excess”
• Causes:
▫ Produced by excess gain of bicarbonate and loss of
H+ ions
▫ Gastric suction and vomiting
• Management:
▫ Anti-emetics
▫ 0.9 Nacl
DETERMINING ACID-BASE BALANCE
NORMAL VALUES INDICATION

pH 7.35-7.45

pCO2 35-45 mmHg

HCO2 22-26 mEq/L

Base Excess +2 to -2

pO2 80-100 mmHg

O2 Saturation 96-100%
INTERPRETATION

Formula: Degree of Compensation + Parameter +

pH + O2
DEGREE of COMPENSATION
• INDICATORS:
• UNCOMPENSATED – U
▫ One of the parameter is N except pH
• PARTIALLY COMPENSATED – PC
▫ All the Parameters is Abnormal
• FULLY COMPENSATED – FC
▫ When the pH is N
PARAMETER
• Respiratory = R
• Metabolic = M
• Mixed = Mx (one direction)
• Ux = Undetermined (opposite direction)
pH
• 7.4 = N
• 7.35 – 7.39 = Primary Acidosis
• 7.41 – 7.45 = Primary Alkalosis

• Ac= Acidosis
• Alk = Alkalosis
• Pac = Primary Acidosis
• PAlk = Primary Alkalosis
OXYGENATION
• 80-100 = N
• H = Hyper
• N = Normal
• h = Hypo
• mh = mild hypo (60-79)
• Mh = mod. Hypo (40-59)
• Sh = severe hypo (20-39)
RULE of AGING
• For above 60 y.o
• Subtract clients age from 60 then subtract their
difference from the lowest and highest range of
N value of pO2
• Then apply the rule of 20
• 70 – 60 = 10
• 100 -10 = 90
• 80-10 = 70
• 70-90 = N range
• mh = 50-69
• Mh = 30-49
• Sh = 10-29
• 85 y.o
• 85-60 = 25
• 100 – 25 = 75
• 80-25 = 55
• 55-75 = Normal Range (New)
• mh = 35-54
Mh = 15-34
• Sh = 0-14