Acid-Base Balance

Normal Acid-Base Balance

• Normal pH 7.35-7.45
• Narrow normal range
• Compatible with life 6.8 - 8.0
___/______/___/______/___
6.8 7.35 7.45 8.0
Acid Alkaline
 Maintenance of Balance
Balance maintained by:
• Buffering systems
H2CO3….
.HCO3

• Lungs

• Kidneys
 Buffer Systems
• Prevent major changes in pH
H+
• Act as sponges… H+

• 3 main systems H+

Bicarbonate-carbonic acid buffer

Phosphate buffer
Protein buffer
 Buffer Systems
• Bicarbonate buffer - most important
Active in ECF and ICF
• Phosphate buffer
Active in intracelluar (ICF) fluid
• Protein buffer - Largest buffer store
Albumins and globulins (ECF)
Hemoglobin (ICF)
Bicarbonate-Carbonic Acid
• Body’s major buffer
• Carbonic acid - H2CO3 (Acid)
• Bicarbonate - HCO3 (Base)

1.2 mEq/L 24 mEq/L

H2CO3 ……………… HCO3
1 20

pH = 7.4
Bicarbonate-Carbonic Acid
• Ratio important
• Not absolute values
• Person with COPD (CAL)
2.4 mEq/L 48 mEq/L
H2CO3 ……………… HCO3
1 20

7.4
 Regulation
• Key concept
• Carbonic anhydrase equation

CO2 +H2O H2CO3 H+ + HCO3

Carbon Carbonic Bicarbonate
Dioxide Acid

(ACID) (BASE)
• Acid
Substance that contains H+ ions
that can be released (H2CO3)
Carbonic acid releases H+ ions
• Base
Substance that can accept H+ ions
(HCO3)
Bicarbonate accepts H+ ions
• As CO2 increases, carbonic acid
increases, H+ ions increase
• pH drops….. becomes more acidic

CO2 +H2O H2CO3 H+ + HCO3

Carbonic Bicarbonate
Acid
CO2 H2CO3 H+ HCO3
(pH Acidic <7.35)
• As HCO3 increases, H+ decreases
• pH rises, becomes more alkaline

CO2 +H2O H2CO3 H+ + HCO3

Carbonic Bicarbonate
Acid
CO2 H2CO3 H+ HCO3
(pH Basic >7.45)
 Respiratory & Renal
Regulation

• Lungs control CO2

• Kidneys control HCO3

kidneys (bicarbonate)
• pH = lungs (carbon dioxide)
 Respiratory Regulation
Mechanisms of control …
• Hyperventilation -- blow off CO2
• Hypoventilation -- retain CO2
Regulation rapid...
• Seconds to minutes
Measured by PaCO2 - Normal
35-45 mm Hg
 Renal Regulation
Mechanism of control
• Excretion or retention of
H+ or HCO3
Regulation….. Slow
• Hours to days to change pH
Normal serum HCO3
• 22-26 mEq/L
 Acid-Base Imbalances
• Ratio of 20 to 1 out of balance
• Acidosis (acidemia)
• pH falls below 7.35
• Increase in blood carbonic acid
or
• Decrease in bicarbonate
 Acid-Base Imbalances
• Alkalosis (alkalemia)
• pH greater than 7.45
• Increase in bicarbonate
or
• Decrease in carbonic acid
 Acid-Base Imbalances
Primary cause or origin:
• Metabolic
Changes brought about by systemic
alterations (cellular level)
• Respiratory
Changes brought about by
respiratory alterations
 Acid-Base Imbalances
Compensation
• Corrective response of kidneys and/or
lungs
Compensated
• Restoration of pH and 20 : 1 ratio
Uncompensated
• Inability to adjust pH or 20 : 1 ratio
Four Basic Types of Imbalance
• Respiratory Acidosis
• Respiratory Alkalosis
• Metabolic Acidosis
• Metabolic Alkalosis
 Respiratory Acidosis
• Carbonic acid excess
• Exhaling of CO2
inhibited H2CO3
• Carbonic acid builds up
• pH falls below 7.35
• Cause = Hypoventilation (see chart)
 Acid-Base Imbalances
• Normal

1.2 mEq/L 24 mEq/L

H2CO3 ……………… HCO3
1 20

7.4
 Respiratory Acidosis

24 mEq/L
Eq / L O 3
1 . 84 m
…… … H C
3 ………
H2CO
1 13
7.21
 Respiratory Acidosis
• Compensation: How?
• Opposite regulating mechanism
• Problem = depressed breathing,
build up of CO2 in blood
• Response - Kidney retains HCO3
(Response ….. Slow)
 Respiratory Alkalosis
• Carbonic acid deficit
• Increased exhaling
of CO2
H2CO3
• Carbonic acid decreases
• pH rises above 7.45
• Cause = hyperventilation (see chart)
 Acid-Base Imbalances
• Normal

1.2 mEq/L 24 mEq/L

H2CO3 ……………… HCO3
1 20

7.4
 Respiratory Alkalosis

0.6 mEq
/L
H2CO3 24 mEq
/L
…………
…… HC
O3
1 40
7.70
 Respiratory Alkalosis
• Compensation:
• Problem = excess “blowing off” of
CO2
• Result = decrease in carbonic acid
and increase in HCO3
• Response: Kidney excretes excess
bicarbonate
 Metabolic Acidosis
• Base-bicarbonate deficit
• Low pH (< 7.35)
• Low plasma bicarbonate (base)
• Cause = relative gain in H+
(lactic acidosis, ketoacidosis)
or actual loss of HCO3
(renal failure, diarrhea)
 Acid-Base Imbalances
• Normal

1.2 mEq/L 24 mEq/L

H2CO3 ……………… HCO3
1 20

7.4
 Metabolic Acidosis
• Kidney failure (decrease in bicarbonate)

1 2 mE q/L
m Eq /L 3
1. 2
… … H C O
3 …………
H2CO
1 10
7.10
 Metabolic Acidosis
• Lactic acidosis, keto acidosis (increase
acid… no change in bicarbonate)

2 4 mE q/L
m Eq /L 3
2. 4
… … H C O
3 …………
H2CO

1 10
7.10
 Metabolic Acidosis
• Compensation:
• Problem = low HCO3 (base) or high
H+ ion (acid)
• Response: Lungs hyperventilate
• Get rid of CO2
(decrease PaCO2 and therefore raise
level of HCO3)
 Metabolic Alkalosis
• Bicarbonate excess
• High pH (> 7.45)
• Loss of H+ ion or gain of HCO3
• Most common causes vomiting,
gastric suctioning (NG tube)
• Other: Abuse of antacids, K+
wasting diuretics
 Acid-Base Imbalances
• Normal

1.2 mEq/L 24 mEq/L

H2CO3 ……………… HCO3
1 20

7.4
 Metabolic Alkalosis

1.2 mEq
/L
H2CO3 36 mEq/
L
…………
… … HCO3

1 30
7.58
 Metabolic Alkalosis
• Compensation:
• Problem = too much base
• Response: Lungs compensate by
hypoventilating
• Retain CO2, increase PaCO2
• Increase acid level in blood
 Assessing ABGs
• pH 7.35 - 7.45
• PaCO2 35 - 45 mmHg
• HCO3 22 - 26 mEq/L
• Base Excess -2 - +2 mEq/L
• PaO2 80 - 100 mm Hg
• O2 saturation 95 - 100 %
 Interpreting ABGs
1. Start with pH
– Normal?
– Acidosis?
– Alkalosis?
___/______/___/______/___
6.8 7.35 7.45 8.0
Acidosis Alkalosis
 Interpreting ABGs
2. Assess PaCO2
(respiratory value)
_____/________/______
35 45
Respiratory Respiratory
Alkalosis Acidosis (Note reversal)
(See Chart)