Acid-Base Balance and Imbalance

Definitions

pH
Measurement of how alkaline or acid a substance is Chemistry

Neutral ph = 7 pH < 7 is acid pH > 7 is alkaline

Normal human blood pH is slightly alkaline at 7.35 7.45

Definitions

An Acid is
A molecule that can donate a H+ ion Examples:

H2O H+ + OH H2CO3 H+ + HCO3

An acid can be weak, moderate, or strong depending on its pH

Weaker acids are closer to 7 Stronger acids are closer to 1

Definitions

A Base or alkali is
A molecule that can accept a H+ ion Examples:

H+ + OH- H2O H+ + HCO3- H2CO3

A base can be weak, moderate, or strong depending on its pH

Weaker bases are closer to pH 7 Stronger bases are closer to pH 14

An Important Equilibrium Equation

H2O + CO2 H2CO3 H+ + HCO3-

Water plus carbon dioxide equals carbonic acid which is broken down by carbonic anhydrase into a hydrogen ion and bicarbonate.

Types of Acids

Volatile acids
Easily move from liquid to gas state Within the body

Lung can remove H2CO3 + renal enzyme H2O + CO2 (both of which are exhaled)

Carbon dioxide is therefore considered an acid

KEY CONCEPT: As CO2 rises, there is more acid respiratory acidosis KEY CONCEPT: As CO2 drops, there is less acid respiratory alkalosis

Types of Acids

Nonvolatile acids
Cannot be changed to gas state Within the body

Must be removed by the kidneys (metabolic) Examples

Keto acids Lactic acids

Acid-Base Imbalance

Acid Imbalance

Too much CO2 leads to decreased pH and an acid condition Too little CO2 leads to increased pH and an alkaline condition PaCO2

Amount of CO2 dissolved in the blood Good indicator of respiratory and ventilatory function

Base Imbalance

Major base in body is bicarbonate (HCO3-) Regulated by the kidneys (metabolic) Too little HCO3- causes decrease in pH and acid conditions Too much HCO3- causes increase in pH and alkaline conditions

More definitions

Acidemia condition where blood is more acid than normal (pH < 7.35) Alkalemia condition where blood is more alkaline than normal (pH > 7.45) Acidosis the process causing acidemia Alkalosis the process causing alkalemia

Respiratory Imbalances

Respiratory mechanisms involve either

Retention of excess carbon dioxide Retention of insufficient carbon dioxide

Over- or Under-ventilation or respiration abnormalities are the main causes of this imbalance

Metabolic Imbalances

Metabolic mechanisms involve

Renal function alteration Production of acidic metabolic products Loss of acid from the body

The Normals

pH PaCO2 HCO3PaO2

7.35 7.45 35 45 mmHg 22 26 mEq/L 80 100 mmHg

The Abnormals

Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis

Respiratory Acidosis

pH < 7.35 PaCO2 > 45

Alveolar Hypoventilation CNS depression or disease Ventilatory/respiratory dysfunction Acute infections

Signs and Symptoms Dyspnea Restlessness Confusion/lethargy Dysrhythmias Headache Treatment Increase ventilation Treat the cause

Respiratory Alkalosis

pH > 7.45 PaCO2 < 35

Anxiety Pain Fever Thyrotoxicosis CNS lesions Improper vent management, hypoxia Pulmonary embolus

Signs and Symptoms

Alveolar Hyperventilation

Light headedness Confusion Muscle spasm / parasthesias Dysrhythmias / palpitations Sweating Dry mouth Blurred vision
Slow down breathing Paper bag breathing if anxiety or fear is cause Treat the cause!

Treatment

Metabolic Acidosis

pH < 7.35 HCO3- < 22 mEq/L

Increased acids from

Signs and Symptoms

Causes

Anaerobic metabolism Abn metabolic process (DKA, lactic acidosis) Starvation ASA or other acid ingestion

Headache Confusion/lethargy Stupor/coma Weakness Kussmaul respiration N/V Dysrhythmias Flushing Treat the cause!!! Give Bicarbonate Dialysis for renal failure

Excess HCO3- loss

Treatment

Diarrhea Renal Failure Intestinal Fistulae

Metabolic Alkalosis
pH > 7.45 HCO3- > 28 Cause

Signs and Symptoms

Increased base Excessive use of bicarb Lactate from dialysis Excessive antacid ingestion Acid loss Vomiting/Gastric suctioning Hypo- chloremia -kalemia Diuretics Large volume blood transfusion

Muscle spasms/tetany/seizure Dizziness Disorientation/lethargy/coma Weakness N/V Depressed respiratory drive

Treatments

Treat the cause!!!! Increase respirations

Finished