MPhill Acid Base Disorder

Acid Base Balance
Muhammad Zeeshan Munir

Institute of Pharmaceutical Sciences, UVAS.
Lahore, Pakistan.
Content
• Concept of pH
• Acid-base theories
• Buffer systems
• Acid base homeostasis
• Acid base disorders
pH
• pH = - log 10 [H10]
• Definition of neutral pH
Blood pH
Less than 6.8 More than 7.8

Arterial ph
• Normal arterial ph – 7.37-7.42 (sl. alkaline)
▫ ph less than 7.37 – acidemia
▫ ph greater than 7.42 – alkalemia
• Arterial ph is product of volatile (CO2), non-volatile acids (fixed).

▫ Proteins and amino acids – sulfuric acid
▫ Phospholipids – phosphoric acid
Acid Base Balance
Lungs
Kidneys
pH
CO2 HCO3
ACID BASE BALANCE
CO2 +H2O  H2CO3  H+ + HCO3

LUNG BLOOD BLOOD
CO2 + H2O H+ + HCO3-

BUFFER
Excreted by Lungs Excreted by Kidneys

Buffers H+ H+
H+
• Solution with capability to resist changes in pH

• 3 major buffer systems : bicarbonate, phosphate,
proteins
Major ECF buffers are bicarbonate (HCO3-) and
phosphate (HPO4-)
Major ICF buffer is hemoglobin
Oxyhemoglobin releases O2 and takes up CO2 and
combines with H2O to form H2CO3
Organic phosphates (ATP, AMP, ADP) and
proteins
BICARBONATE-CARBONIC ACID
• Body’s major buffer
• Carbonic acid - H2CO3 (Acid)
• Bicarbonate - HCO3 (Base)
1.2 mEq/L 24 mEq/L

1 20
H2CO3 ……………… HCO3
pH = 7.4
BICARBONATE – CARBONIC ACID BUFFER
SYSTEM
CO2 +H2O  H2CO3  H+ + HCO3

LUNG BLOOD BLOOD
CO2 + H2O H+ + HCO3-

BUFFER
Excreted by Lungs Excreted by Kidneys

Lungs
• Cellular metabolism produces CO2

• Concentration of carbonic acid alter blood
pH
• pH changes results in lungs altering rate
and depth of ventilation
• Changes occurs minutes to hours
Kidneys
• Maintain blood pH by altering excretion of

HCO3
• When pH kidneys retain HCO3
• When pH kidneys excrete HCO3
• Changes occurs hours, to days, or months
Factors Affecting Balance
• Age
▫ especially infants and the elderly
• Gender and Body Size
▫ amount of fat tissue
• Environmental Temperature
• Lifestyle
▫ stress
Acid-Base Imbalances
• Respiratory Acidosis
• Respiratory Alkalosis
• Metabolic Acidosis
• Metabolic Alkalosis
Simple Acid-Base Disturbances
Acid-Base Primary Secondary Expected Degree of
Disturbance Abnormality Response Compensatory Response
Respiratory  PaCO2  [HCO3-]  [HCO3-] = 0.35 X  PaCO2
Acidosis
Respiratory  PaCO2  [HCO3-]  [HCO3-] = 0.50 X  PaCO2

Alkalosis
Metabolic  [HCO3-]  PaCO2 PaCO2 = (1.5 X [HCO3-]) + 8

Acidosis
Metabolic  [HCO3-]  PaCO2 PaCO2 = (0.9 X [HCO3-]) + 9
Alkalosis
Respiratory Acidosis
• Mechanism
▫ Hypoventilation or Excess CO2 Production
• Etiology
▫ COPD
▫ Neuromuscular Disease
▫ Respiratory Center Depression
▫ Late ARDS
▫ Inadequate mechanical ventilation
▫ Sepsis or Burns
▫ Excess carbohydrate intake
• Symptoms
▫ Dyspnea, Disorientation or coma
▫ Dysrhythmias
▫ pH < 7.35, PaCO2 > 45mm Hg
▫ Hyperkalemia or Hypoxemia
• Treatment
▫ Treat underlying cause
▫ Support ventilation
▫ Correct electrolyte imbalance
▫ IV Sodium Bicarbonate
Respiratory Alkalosis
• Risk Factors and etiology

▫ Hyperventilation due to
▫ extreme anxiety, stress, or pain
▫ elevated body temperature
▫ overventilation with ventilator
▫ compensatory response to hypoxia or hypoxemia
▫ salicylate overdose
▫ CNS trauma or tumor
• Symptoms
▫ Tachypnea
▫ Complaints of SOB, chest pain
▫ Light-headedness, syncope, coma, seizures
▫ Numbness and tingling of extremities
▫ Difficult concentrating, tremors, blurred vision
▫ Weakness.
▫ Lab findings
 pH above 7.45
 CO2 less than 35
• Treatment
 Monitor VS and ABGs

 Treat underlying disease
 Assist client to breathe more slowly
 Help client breathe in a paper bag or apply
rebreather mask
 Sedation
Metabolic Acidosis
• Risk Factors/Etiology
▫ Conditions that increase acids in the blood
 Renal Failure
 DKA
 Starvation
 Lactic acidosis
▫ Prolonged diarrhea
▫ Toxins (antifreeze or aspirin)
▫ Carbonic anhydrase inhibitors - Diamox
• Symptoms
▫ Kussmaul’s respiration
▫ Lethargy, confusion, headache, weakness
▫ Nausea and Vomiting
▫ Lab:
 pH below 7.35
 Bicarb less than 22
• Treatment
▫ treat underlying cause
▫ monitor ABG, I&O, VS, LOC Sodium Bicarb?
Metabolic Alkalosis
• Risk Factors/Etiology
▫ Acid loss due to
 vomiting
 gastric suction
▫ Loss of potassium due to
 steroids
 diuresis
▫ Antacids (overuse of)
• Symptoms
▫ Hypoventilation (compensatory)
▫ Dysrhythmias, dizziness
▫ Paresthesia, numbness, tingling of extremities
▫ Hypertonic muscles, tetany
▫ Lab: pH above 7.45, Bicarb above 26
 CO2 normal or increased w/comp
 Hypokalmia, Hypocalcemia
• Treatment
▫ I&O, VS, LOC
▫ give potassium
▫ treat underlying cause
Interpreting ABGs
• 1. Look at the pH
 is the primary problem acidosis (low pH) or alkalosis (high pH)
• 2. Check the CO2 (respiratory indicator)
 is it less than 35 (alkalosis) or more than 45 (acidosis)
• 3. Check the HCO3 (metabolic indicator)
 is it less than 22 (acidosis) or more than 26 (alkalosis)
• 4. Which is primary disorder (Resp. or Metabolic)?
 If the pH is low (acidosis), then look to see if CO2 or HCO3 is acidosis
(which ever is more acidotic will be primary).
 If the pH is high (alkalosis), then look to see if CO2 or HCO3 is
alkalosis (which ever is more alkalotic is the primary).
 The one that matches the pH (acidosis or alkalosis), is the primary disorder.
Compensation
• The Respiratory system and Renal systems
compensate for each other
▫ attempt to return the pH to normal
• ABG’s show that compensation is present when
▫ the pH returns to normal or near normal
• If the nonprimary system is in the normal range (CO2
35 to 45) (HCO3 22-26), then that system is not
compensating for the primary.
• For example:
▫ In respiratory acidosis (pH<7.35, CO2>45), if the HCO3 is >26,
then the kidneys are compensating by retaining bicarbonate.
▫ If HCO3 is normal, then not compensating.

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Acid Base Balance

Muhammad Zeeshan Munir

Less than 6.8 More than 7.8

• Arterial ph is product of volatile (CO2), non-volatile acids (fixed).

CO2 +H2O  H2CO3  H+ + HCO3

CO2 + H2O H+ + HCO3-

Excreted by Lungs Excreted by Kidneys

• Solution with capability to resist changes in pH

1.2 mEq/L 24 mEq/L

CO2 +H2O  H2CO3  H+ + HCO3

CO2 + H2O H+ + HCO3-

Excreted by Lungs Excreted by Kidneys

• Cellular metabolism produces CO2

• Maintain blood pH by altering excretion of

Respiratory  PaCO2  [HCO3-]  [HCO3-] = 0.50 X  PaCO2

Metabolic  [HCO3-]  PaCO2 PaCO2 = (1.5 X [HCO3-]) + 8

• Risk Factors and etiology

 Monitor VS and ABGs

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