NCM 112

Module

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FLUIDS, ELECTROLYTES, AND ACID-BASE IMBALANCES

2.2 Acid-Base Imbalances

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SANDRA M. COVARRUBIAS

WESTERN MINDANAO STATE UNIVERSITY

COLLEGE OF NURSING
ZAMBOANGA CITY
 INTRODUCTION

This module is intended to provide an introduction to the physiology of Acid-Base

Imbalances and the many pathological conditions that are associated with disturbance of that
balance. It provides health personnel specifically student nurses with the basis for
understanding how the result of arterial blood gas analysis are applied in the investigation of
patients whose acid-base balance is disturbed.

Learning Outcome / Objectives:

At the end of this lesson you should be able to:
1. Describe the importance of Acid-Base balance.
2. Identify the different compensatory mechanisms used to regulate the acid-base
status.
3. Distinguish between Acidosis and Alkalosis resulting from respiratory and
metabolic factors with nursing interventions using PICOT format with consideration
of Filipino culture, values, and practices
Topic Outline:
1. Importance of acid-base balance.
2. Different compensatory mechanisms used to regulate acid-base status.
3. The differences between acidosis and alkalosis resulting from respiratory and
metabolic factors with nursing interventions using PICOT format with
consideration of Filipino culture, values, and practices.
 ACID-BASE IMBALANCES
IMPORTANCE OF ACID-BASE BALANCE
Lesson 1

INTRODUCTION
To maintain homeostasis, the human body employs many physiological adaptations.
One of these is maintaining an acid-base balance. In the absence of pathological states, the
pH of the human body ranges between 7.35-7.45, with the average at 7.40. Why this number?
Why not a neutral number of 7.0 instead of a slightly alkaline 7.40? A pH at this level is
ideal for many biological processes, one of the most Important being the oxygenation of
blood.

Learning Outcomes/Objectives
At the end of this lesson you should be able to:
1. Identify the different types of acid-base balance
2. Site examples with regards to the Ph concentration
3. Compare the different acid-base balances.
 Try This! (remz)
The pH Scale

Identify and write on the space provided for whether the

item is an Acid or a Base and on the middle part the
neutral Ph.
Hydrochloric Acid Milk
Drain cleanser Tomato
Vinegar Lemon
Soap Spirit of ammonia
Blood Baking soda
Water Banana
Apple Soft drinks
Stomach acid

ACID BASE

NEUTRAL
pH
Adapted from : illustrations @google.com

Think Ahead ! (shanleh)

1. Based on the activity, what made you think that these items are Acidic in nature
(Specify the items that you consider to be acidic). Justify your answer.
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2. What items are alkaline in nature? (Specify the items that you consider to be base in
nature). Justify your answer.
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3. List the items that were considered to be Neutral. (Specify the Items that you
considered to be neutral in nature). Justify your Answer.
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4. Ever wonder what pH stand for? If so, Give the three different types of pH or
potential of ion concentration within the solution.
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Read and Ponder

 Acid- Is any proton donor (a molecule that releases a proton H+ In water ). Ex. Strong
acid: HCL, Weak acid: Carbonic and Lactic acids).
Base – Is a proton acceptor (A substance that accepts H+ often with the release of
hydroxyl (OH) ion. Ex. Strong acid: hydroxyl, Weak acid: Bicarbonate (HCO3 ).
pH - Is another term for H+ concentration that is generally used nowadays instead of
hydrogen ion concentration. An increase in the H+ ion concentration decreases the pH
(Acidosis ) and a reduction in the H+ concentration increases the pH ( Alkalosis ). In a
healthy person the pH is 7.40 and varies between 7.38-7.42. A slight change in the pH below
7.38 or above 7.42 will cause Serious threats to many physiological functions.

See if you can do this! (andan)

Do you still recall the differences in the Ph concentration of an acid, base, and a
neutral ph. Name the 3 most important pH concentration and differentiate one from the other.
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ACID-BASE IMBALANCES
Different Compensatory Mechanism used to regulate acid-base status
Lesson 2
 INTRODUCTION
Have you ever wondered how the body regulates Acid-base status by binding the H+
ion, eliminates carbon dioxide ( CO2 )and conserves the bases ( HCO3 ) thus maintaining the
acid-Base Balance. The body has three different mechanisms to regulate acid- base status.
1. Acid- base buffer – Is a combination of a weak acid and a base. Wherein its pH changes
very little when a small amount of Strong acid or base is added.
Three types of Acid-Base buffer system:
a. Bicarbonate buffer system – Is present in the extracellular fluid (Plasma) ex.
HCO3, which is regulated by the kidney.
b. Phosphate buffer system – Is useful in the intracellular fluid (RBC or other cells).
Mostly concentrated in the ICF than in the ECF. Is useful in the tubular fluids of
kidneys
c. Protein buffer system – Are present in the blood; both in the plasma and
electrolytes.
2. Regulation of acid-base balance by respiratory mechanism
- Entire reaction is reverse in the lungs when CO2 diffuses from the blood into the
alveoli of lungs. When the metabolic activity increases, more amount of CO2 is produced in
the tissues and the concentration of H+ increases thus increasing Pulmonary ventilation
(Hyperventilation ) thereby the excess CO2 is removed From the body.
3. Regulation of acid-base balance by renal mechanism
- Kidney maintains the acid-base balance of the body by The secretion of H+ and
retention of HCO3. Among the three mechanisms the acid-base buffer is the Fastest one and
it readjust the pH within seconds, The respiratory mechanism does it in minutes, whereas the
Renal mechanism is slower, and it takes few hours to few days to bring the pH to normal.
However, the renal mechanism is the most powerful in maintaining acid-base balance of the
body fluids.

Learning Outcomes/Objectives
At the end of this lesson you should be able to:
1. Discuss the different mechanisms involved to regulate acid-base status
2. Compare the different acid-base buffer system
3. Identify which compensatory mechanism is the most important in regulating acid-base
balance

. Try This ! (antolin and andan)

Have you ever thought what parts or organs of your body are involved in the compensatory
mechanism to regulate the acid-base status and which of these buffer system works the fastest or
the slowest?

Name the parts or organs that are involved in the compensatory mechanism to regulate acid-
base balance and opposite to that, write which among these buffer system or mechanism works the
fastest or the slowest. (Acid-base buffer system, respiratory mechanism, Renal mechanism, and
(carries blood)

(carries blood)

Adapted from illustrations of internal organs @ Google.com

ACID-BASE BUFFER RESPIRATORY RENAL MECHANISM

SYSTEM MECHANISM

Organ Involved? Organ Involved? Organ Involved?

How it works? How it works? How it works?

Duration and Rationale? Duration and Rationale? Duration and Rationale?

 Think Ahead! (barlas)
1. How would you describe a buffer system?

2. Can you name the three different types of buffer system under the acid-base system and
differentiate one from the other.

3. How is CO2 removed from the body?

4. Which organ is responsible for the regulation of acid-base Balance by renal mechanism
and how is it made possible?

Read and Ponder

Respiratory Acidosis - caused by accumulation of CO2 due to pulmonary hypoventilation.
Main Causes are:

- Respiratory failure as a result of pulmonary diseases such as

Bronchopneumonia, emphysema, asthma and COPD.

- Neuromuscular disease.

- CNS depression

- Certain drugs e.g. morphine and barbiturates

Signs and Symptoms :

* Headache * Rapids shallow respiration
 * Muscle Weakness * Decrease BP
* Skin, pale/Cyanotic * Hyperkalemia
* Dysrhythmias * Changes in LOC

Respiratory Alkalosis – caused by excessive loss of CO2 as a result of hyperventilation.

Main Causes are:
Adult respiratory

- Salicylate intoxication

- Head injury

- Hysteria

- Maybe due also to hyperventilation as a result of anxiety attack and response to

severe pain.
Signs and Symptoms:
* Seizures * Rapids shallow respiration
* Numbness or tingling of extremities * Decrease or normal BP
* Lightheadedness * Hypokalemia
* Tachycardia * Lethargy and confusion
Metabolic Acidosis – caused by accumulation of net acid ( Most encountered in the clinical
practice ).
Main Causes are :

- Ingestion of acid e.g. aspirin intoxication

- Excessive production of acids e.g. ketoacidosis

- Decrease excretion of acids e.g. renal failure

- Excessive loss of HCO3 e.g. diarrhea

- Due to cardiac arrest and any condition associated with

Hypovolemic shock ( Severe blood loss )

Signs and Symptoms :
 * Headache * Kussmaul respiration
* Nausea, vomiting, diarrhea * Decrease BP
* Muscle twitching * Hyperkalemia
* Warm flushed skin * Confusion, drowsy

Metabolic Alkalosis – caused by loss of H+ or increase in base

Main causes are
- Diuretic use causing volume depletion (K and CL )
- Increase HCO3 reabsorption and increase H+ secretion
- Other causes maybe due to recurrent vomiting,
- Dietary CL deficiency and chronic K depletion.
- Occurs in patients with pyloric stenosis due to severe projectile vomiting.
Signs and Symptoms :
* Compensatory hypoventilation
* Nausea, vomiting, diarrhea
* Tremors, muscle cramps and tingling of fingers and toes
* Hypokalemia
* Tachycardia
* Dizzy, irritable, Restless

See if you can do this! (cambel)

1. Can you still remember the different types of acidosis and alkalosis?

2. Name the different types and distinguish one from the other
 ACID-BASE IMBALANCE

DIFFERENT ACID-BASE IMBALANCES THEIR CAUSES AND THEIR CLINICAL

SIGNS AND SYMPTOMS
Lesson 3

INTRODUCTION

When you breathe, your lungs removes excess

Carbon dioxide from your body. When they cannot
do so, your blood and other fluids becomes too
acidic, or when your kidneys are unable to remove
it. For now, we should be able to realize the
Importance of knowing the main causes and clinical
Manifestations or signs and symptoms of these
acid-Base imbalances.
 Learning Outcomes/Objectives

At the end of the lesson you should be able to :

1. Identify the different acid-base imbalances

2. Determine the different acid-base imbalances based on their
Causes and clinical signs and symptoms.
3. Interpret the different arterial blood gases results.
4. Formulate a nursing care plan using PICOT format in clinical
Questioning

Try This ! (camins, arwa and joli)

Differentiate the four acid-base status resulting from either

respiratory or metabolic factors with regards to their main
causes and clinical signs and symptoms.
 Main Causes
Respiratory acidosis is usually caused by a lung disease or condition that affects normal
breathing or impairs the lungs’ ability to remove CO2. Some common causes of the chronic
form are:
Respiratory
Asthma, chronic obstructive pulmonary disease (COPD), acute pulmonary edema, severe
Acidosis obesity (which can interfere with expansion of the lungs), neuromuscular disorders (such as
multiple sclerosis or muscular dystrophy), scoliosis
(Camins)
Some common causes of the acute form are:

lung disorders (COPD, emphysema, asthma, pneumonia, conditions that affect the rate of
breathing, muscle weakness that affects breathing or taking a deep breath, obstructed airways
(due to choking or other causes), sedative overdose and cardiac arrest

Signs and Symptoms

Initial signs of acute respiratory acidosis include:

 Headache, anxiety, blurred vision, restlessness and confusion

Without treatment, other symptoms may occur. These include:

 sleepiness or fatigue, lethargy, delirium or confusion, shortness of breath and coma

The chronic form of respiratory acidosis doesn’t typically cause any noticeable symptoms. Signs
are subtle and nonspecific and may include:

 memory loss, sleep disturbances and personality changes

Main Causes

Respiratory
Alkalosis

Signs and Symptoms

 Main Causes

Metabolic
Acidosis

Signs and Symptoms

Main Causes

Metabolic
Alkalosis

Signs and Symptoms

 Think Ahead ! (Alanis)
1. What are the four types of acid-base imbalance and which type is the most common
imbalance encountered in the clinical practice ?

2. How does metabolic alkalosis occur ?

3. Which type of acid-base imbalance causess kussmaul Respiration and what could
probably be the cause for it?
 4. What causes rapid shallow respiration in respiratory acidosis ?

Your kidneys and lungs works to maintain acid-base Balance. Even slight
variations from the normal range can have a significant effect .

Read and Ponder !

Acid-base balance is very important for the homeostasis of the body and almost all
physiological activities depend upon the acid-base status of the body. Acids are constantly
produced in the body however, acid production is balanced by the production of bases so that
the acid-base status of the body is maintained. Acid-base disturbance can be determined by
the Patient’s blood gases and electrolytes.
Normal Values are:
pH- Refers to the potential or power or hydrogen concentration within the solution.
Low pH – If the pH number is lower than 7,the solution is an acid.
High pH – If the pH is greater than 7, a solution is basic or alkaline.
Neutral pH – If the pH is 7, then the solution is neutral.
* Blood PH = 7.35-7.45
* paO2 = 80-100 mm Hg
* PaCO2 ( CO2 content ) = 35-45 mm Hg
*HCO3 ( Bicarbonate content ) = 22-26 mEqL
*O2 Saturation = 95-100%
* BE/BD ( Base Excess / Base Deficit ) = -2 to +2
RESPIRATORY ACIDOSIS – Occurs when breathing is Inadequate and PaCO2 builds up.
RESPIRATORY ALKALOSIS – Occurs as a result of Hyperventilation or excess aspirin
intact.

METABOLIC ACIDOSIS – In Metabolic acidosis,

Metabolism is impaired, causing a decrease in bicarbonates and a buildup of lactic acid.

METABOLIC ALKALOSIS – Occurs when bicarbonate Ion concentration increases, causing

an elevation in the blood pH.

● ABG ANALYSIS ( arterial blood gas )

pH
RESPIRATORY ACIDOSIS
PacO2

pH
RESPIRATORY ALKALOSIS

PacO2

pH
METABOLIC ACIDOSIS

HCO3

pH
METABOLIC ALKALOSIS
HCO3

❖ NMENOMICS :
R- Respiratory
❖ : Better think about O – Opposite
M- Metabolic
E – Equal

❖ NOTE : If the pCO2 is affected it is ALWAYS, RESPIRATORY

If HCO3 is affected it is ALWAYS, METABOLIC

UNCOMPENSATED: Co2 or HCo3 normal results.

PARTIALLY COMPENSATED : Nothing is normal
COMPENSATED : pH is normal ( 7-4 baseline/neutral
Courtesy of : * https://acutecare testing.org.
 STEPS IN ABG ANALYSIS USING THE TIC-TAC-TOE METHOD:
1. Memorize the normal values.
2. Determine if the pH is NORMAL, ACIDOSIS
Or ALKALOSIS.
3. Determine if the PaCO2 is under NORMAL,
ACIDOSIS or ALKALOSIS.
4. Determine if the HCO3 is under NORMAL,
ACIDOSIS, or ALKALOSIS.
5. Determine if the values interpret : ACIDOSIS
or ALKALOSIS.
6. Determine if the values define: METABOLIC
or RESPIRATORY.
7. Lastly, determine the compensation if it is:
FULLY COMPENSATED, PARTIALLY
COMPENSATED Or UNCOMPENSATED.

See if you can do this ! (Jeybi, Iazel)

Let us exercise your skills in analyzing step by step instructions, Using the
tic-tac-toe grid method. Do you still remember the process of distinguishing between acidosis
and alkalosis resulting from either respiratory and metabolic factors and whether it is
Compensated, Partially compensated or Uncompensated?
Write down the datas on the tic-tac-toe Grid Method (Adapted from:
https://nurseslabs.com)base on the ff: results that were given with your corresponding
analysis for each problem.

Problem # 1.
pH=7.26
PaCO2=32
HCO3=18

Create your own tic-tac-toe grid:

ACIDOSIS NORMAL ALKALOSIS

pH

paCO2 HCO3

Analysis :_________________________________________
 Problem # 2.
pH=7.44
PaCO2=30
HCO3=21

Create your own tic-tac-toe grid:

ACIDOSIS NORMAL ALKALOSIS

pH

PaCO HCO3

Analysis : ________________________________
 Problem # 3.
pH=7.1
PaCO2=40
HCO3=18

Create your own tic-tac-toe grid:

ACIDOSIS NORMAL ALKALOSIS

pH

PaCO2 HCO3

Analysis : _________________________________