ACID BASE BALANCE

COMPONENTS TO DETERMINE ACID BASE BALANCE

 pH ( Sorenson introduces )

 paCO2

 paO2

 Oxygen Saturation

 Base Excess

 Bicarbonate
CALCULATION OF FREE H+ IONS

Henderson-Hasselbalch equation
 COMPENSATORY MECHANISM
 Buffer System

 Respiratory Mechanism

hyperventilation

hypoventilation

 Renal Mechanism

kidney movement of bicarbonate

formation of acids

formation of ammonium
 HOW TO DIAGNOSE ACID BASE DISORDER

STEPS

 Obtain ABG and Electrolyte simultaneously

 Compare HCO3 on ABG and electrolytes to verify accuracy
 Calculate Anion gap (AG)
 Know four causes of high AG acidosis( ketoacidosis, lactic acid acidosis,
renal failure& toxins)
 Know two causes of hyperchloremic or non gap acidosis
 Estimate compensatory response
 Compare AG and HCO3
 Compare change in cl- with change in Na+
 Metabolic Acidosis
Clinical Manifestations

 Increased ventillation
 Peripheral arterial vasodilation
 Pulmonary Oedema
 CNS depression with headache,Lethargy,Stupor
 Glucose intolerance
 HIGH ANION GAP ACIDOSIS
ASSESSMENT

 History Collection and ABG analysis

 Check for Diabetes Mellitus

 Check for evidence of alcoholism

 Observation of clinical signs of uremia determination of BUN &

Creatinine

 Check for hypotension,shock,cardiacfailure,leukemia,cancer,drug or

toxin ingestion
 Lactic Acidosis
CAUSES

 Circulatory insufficiency
 Severe anemia
 Malignancies
 Thiamine deficiency
 Infections
 Drugs or toxins
 Infarction
 Metabolic Alkalosis
CAUSES
 Exogenous HCO3- loads

 Effective ECFV contraction, normotension, K+ deficiency, and

secondary hyperrenimic hyperaldosternism

Gastrointestinal Origin

Renal origin

 ECFV expansion, hypertension, k+ deficiency, mineralocorticoid

excess
 Metabolic Alkalosis
CLINICAL MANIFESTATIONS

 Mental confusion

 Seizures

 Paresthesia

 Muscular cramping

 Tetany

 Arrhythmias

 Hypoxemia

 Hypokalemia

 Hypophosphatemia
 Respiratory Acidosis
CLINICAL MANIFESTATIONS

 Hypoxemia

 Dyspnoea

 Confusion

 Psychosis

 Hallucinations

 Loss of Memory

 Personality changes

 Motor disturbances( tremor, Myoclonic jerks)

 Respiratory Alkalosis
CLINICAL MANIFESTATIONS
 Dizziness

 Mental confusion

 Seizures

 Cardiac Arrhythmias

 Hypokalemia

 Paresthesia
 Laboratory Profile
paCO
Imbalance pH HCO3 K+ Ca2+ Cl-
2
Metabolic Acidosis ˅ ˅ ˅ ˄ N ˄
or
N
Respiratory Acidosis ˅ ˄ ˄ ˄ N ˄˅

Metabolic Alkalosis ˄ ˄ ˄ ˅ ˅ ˅
Respiratory Alkalosis ˄ ˅ ˅˅ ˅ ˅ ˄
 NURSING MANAGEMENT
Assessment

 Assess the neurological status

 Assess the cardiological status

 Assess the respiratory status

 Assess for any skin manifestations

 Check ABG values

 Assess for any behavioural changes

 Assess the musculoskeletal system

 Nursing Diagnosis
 Ineffective Breathing Pattern related to reduced gas
exchange

 Decreased cardiac output related to poor cardiac

contractility decreased vascular volume

 Deficient fluid volume related to dehydration

 Acute pain related to muscle spasm

 Risk for falls related to muscle weakness

 PROBLEMS
 pH=7.18
 pCO2=18
 HCO3=9
 k+ = 4.1
 Cl- = 110
 AG = 23.1

Ans: Increased AG metabolic acidosis

 pH = 7.1
 pCO2 = 50
 HCO3 = 15
 Na = 140
 K+ = 5
 Cl- = 105
 AG = 23

Ans: Increased AG Metabolic acidosis

 pH =7.55
 Pco2 = 66
 pO2 = 68
 HCO3 = 36

Ans: Metabolic alkalosis

 pH = 7.25
 pCO2 = 65
 pO2 = 55
 HCO3 = 28

Ans: Respiratory acidosis

THANK YOU