ACIDOSIS AND ALKALOSIS

TERMINOLOGI :

• ACIDOSIS :
TERM USED TO DESCRIBE
PATIENTS WITH AN INCREASED
HYDROGEN ION IN THE BLOOD,
WITH pH BELOW 7,36
• ALKALOSIS :
TERM USED TO DESCRIBE
PATIENTS WITH A HYDROGEN
ION IN THE BLOOD BELOW NOR-
MAL, WITH pH ABOVE 7,44
 pH PLASMA :

• NORMAL RANGE : 7,36 - 7,44

• EXTREME RANGE ( COMPATIBLE

WITH LIFE ) : 6,7 - 7,9
UNCOMPENSATED AND COMPENSATED
ACIDOSIS AND ALKALOSIS:

• WHEN AN ACIDOSIS OR ALKALOSIS

DEVELOPS, COMPENSATORY
MECHANISM HELP RESTORE THE pH
TOWARD PREVIOUS NORMAL LEVEL.
• IN THE PROCESS MARKED CHANGE
IN THE CONCENTRATION H₂CO₃, pCO₂
AND BICARBONATE OCCUR
 RESPIRATORY ACIDOSIS :

• UNCOMPENSATED RESPIRATORY
ACIDOSIS :
ACCUMULATION OF CARBONIC ACID
DUE HYPOVENTILATION → CAUSED
pCO₂ PLASMA RISE → RATIO
BICARBONATE/CARBONIC ACID FALL
→ pH TO FALL
• COMPENSATED RESPIRATORY
ACIDOSIS :

BICARBONATE IS RETAIN IN THE

BODY → CONC. BICARBONATE RI-
SE → RATIO BICARBONATE : CAR-
BONIC ACID RISE → pH RISE AND
MAY RETURN TO NORMAL.
 UNCOMPENSATED AND COMPEN-
SATED RESPIRATORY ACIDOSIS :

NORMAL UNCOMP. COMP.

BICARB. : 24 mEq/l 24 mEq/l 38 mEq/l

CARB.AC : 1,2 mEq/l 2,7 mEq/l 2,7 Meq/L
RATIO : 20 : 1 8,8 : 1 14 : 1
pCO₂ : 40 mm.Hg 90 mm.Hg 90 mmHg
pH : 7,4 7,2 7,32
 RESPIRATORY ALKALOSIS :

• UNCOMPENSATED RESPIRATORY
ALKALOSIS :
THERE IS LOSS OF CARBONIC
ACID, DUE HYPERVENTILATION →
pCO₂ FALLS → RATIO BICARBO-
NATE : CARBONIC ACID RISE →
THE pH RISE
COMPENSATORY RESPIRATORY
ALKALOSIS :

• BICARBONATE IS EXCRETED BY
KIDNEY → RATIO BICARBONATE :
CARBONIC ACID FALL → THE pH
FALL TOWARD NORMAL
 METABOLIC ACIDOSIS

• UNCOMPENSATED METABOLIC
ACIDOSIS :
EXCESS OF ACID OR LOSS OF
BASE → RATIO BICARBONATE :
CARBONIC ACID TO FALL → THE
pH TO FALL.
COMPENSATED METABOLIC ACIDOSIS
:

• CARBONIC ACID IS EXCRETED BY

THE LUNG ( IN THE FORM OF CO₂ ) →
BICARBONATE IS RETAINED BY THE
KIDNEY → pCO₂ FALLS → RATIO
BICARBNATE : CARBONIC ACID RISE
→ THE PH RISE TOWARD NORMAL
UNCOMPENSATED AND COMPENSATED
METABOLIC ACIDOSIS
NORMAL UNCMP.MA COMP.MA

BICARBONATE: 24 mEq/l 15 mEq/L 15 mEq/L

CARBONIC ACID: 1,2 mEq/l 1,2 mEq/L 0,75 mEq/l
RATIO BC:CA: 20 : 1 12,5 : 1 20 : 1
PCO₂ : 40 mm..Hg 40 mm.Hg. 25 mm.Hg.
pH : 7,4 7,2 7,3
 METABOLIC ALKALOSIS :

• UNCOMPENSATED METABOLIC
ALKALOSIS :
THERE IS AN EXCESS OF BASE OR
LOSS OF ACID → RATIO BC : CA TO
RISE → THE pH TO RISE ( BUT NO
CHANGE IN THE PCO )
• COMPENSATED METABOLIC ALKA-
LOSIS :

THERE IS EXCESS BICARBONATE

→ BICARBONATE EXCRETED BY
THE KIDNEY AND RETAIN CO₂ BY
THE LUNG → RATIO BC : CA TO
FALL ( STILL GREATER THAN
NORMAL ) → THE pH TO FALL
 UNCOMPENSATED AND COMPENSATED
METABOLIC ALKALOSIS :

NORMAL UNCOMP. MAL COMP.MAL

BICARBONATE : 24 mEq/L 36 mEq/l 34,5 mEq/L

CARBONIC ACID : 1,2 mEq/l 1,2 mEq/l 1,35 mEq/L
RATIO BC : CA 20 : 1 31,6 : 1 25,6 : !
PCO₂ : 40 mm.Hg. 40 mm.Hg. 45 mm.Hg.
pH : 7,4 7,6 7,55
OBSERVATIONS ARE IMPORTANT FOR
SEVERAL REASON :

• SEVERE RESPIRATORY ACIDOSIS, A

NORMAL BICARBONATE MAY BE
PRESENT
• SEVERE METABOLIC ACIDOSIS,
BICARBONATE IS LOW AND IT
REMAIN LOW EVEN WHEN
COMPENSATION OCCURS.
 CLINICALLY :

• THE RESPIRATORY CHANGE ARE

INDICATED BY pCO₂.

• THE METABOLIC CHANGE ARE

INDICATED BY SERUM
BICARBONATE.
THANK’S