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1. ACID & BASE
IMBALANCE
BY: MUHAMMAD HALMII
FB: MUHAMMAD HELMI
WHATSAPP:0163626470
TWITTER:@CHALDEAPRINCE

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5. THE BODY PRODUCES MORE ACIDS
THAN BASES
• Acids take in with foods
• Acids produced by metabolism of lipids and proteins
• Cellular metabolism produces CO2.
• CO2 + H20 ↔ H2CO3 ↔ H+ + HCO3
-
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7. PH CHANGE DEFENDERS
• Buffers
• Chemical Resistors
• Lungs
• Excrete Acids (Volatile)
• Kidney
• Excrete Acids/Bases (Non-Volatile/Titratable)
• Produce NEW Bases
• Most Powerful But Slowest Response

12. Le Chatelier’s
Principle

15. COMPENSATION
• If underlying problem is metabolic, hyperventilation or
hypoventilation can help : respiratory compensation.
• If problem is respiratory, renal mechanisms can bring about
metabolic compensation.
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27. RESPIRATORY
ACIDOSIS

28. RESPIRATORY ACIDOSIS
• Carbonic acid excess caused by blood levels of CO2 above 45
mm Hg
• Hypoventilate
• Hypercapnia – high levels of CO2 accumulation in blood
• Never due to ↑ CO2 production {Metabolism is usually stable}
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32. COMPENSATION FOR RESPIRATORY
ACIDOSIS
• Kidneys eliminate hydrogen ion and retain bicarbonate ion
32

33. SIGNS AND SYMPTOMS OF
RESPIRATORY ACIDOSIS
• Breathlessness
• Restlessness
• Lethargy and disorientation
• Tremors, convulsions, coma
• Respiratory rate rapid, then gradually depressed
• Skin warm and flushed due to vasodilation caused
by excess CO2 33

34. TREATMENT OF RESPIRATORY
ACIDOSIS
• Restore ventilation
• IV lactate solution
• Treat underlying dysfunction or disease
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35. RESPIRATORY ALKALOSIS

36. RESPIRATORY ALKALOSIS
• Hyperventilate
• Carbonic acid deficit
• pCO2 less than 35 mm Hg (hypocapnia)
• Most common acid-base imbalance
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37. RESPIRATORY ALKALOSIS
• Conditions that stimulate respiratory center:
• Oxygen deficiency at high altitudes
• Pulmonary disease and Congestive heart failure – caused
by hypoxia
• Acute anxiety
• Fever, anemia
• Early salicylate intoxication {Respi Stimulants}
• Cirrhosis
• Gram-negative sepsis
• Hysterical Breathing
37

38. COMPENSATION OF RESPIRATORY
ALKALOSIS
• Kidneys conserve hydrogen ion
• Excrete bicarbonate ion
38

39. SYMPTOMS OF RESPIRATORY
ALKALOSIS
• Dizziness
• Cramps Due To Hypocalcemia {Competes With H+
Binding With
Albumin}
• Tetany
39

40. TREATMENT OF
RESPIRATORY ALKALOSIS
• Treat underlying cause
• Breathe into a paper bag
• IV Chloride containing solution –
Cl- ions replace lost bicarbonate ions
40

41. METABOLIC ACIDOSIS
• Bicarbonate deficit
• Causes:
• Loss of bicarbonate through diarrhea or renal dysfunction {RTA}
• Accumulation of acids (lactic acid or ketones) (Non Volatile)
{MUDPILES}
• Failure of kidneys to excrete H+
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43. SYMPTOMS OF METABOLIC ACIDOSIS
• Headache, lethargy
• Nausea, vomiting, diarrhea
• Coma
• Death
43

44. COMPENSATION FOR METABOLIC
ACIDOSIS
• Increased ventilation
• Renal excretion of hydrogen ions if possible
• K+ exchanges with excess H+ in ECF
• ( H+ into cells, K+ out of cells)
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45. TREATMENT OF METABOLIC ACIDOSIS
• IV lactate solution
45

46. METABOLIC ALKALOSIS
• Bicarbonate excess
• Causes:
• Acid Loss = Excess vomiting ; Nasogastric Suction
• Excessive use of alkaline drugs
• HypoK {Transcelullar Shift}
• Excessive HCO3- Reabsorption {Hypraldosteronism}
46

47. COMPENSATION FOR METABOLIC
ALKALOSIS
• Alkalosis most commonly occurs with renal dysfunction, so
can’t count on kidneys
• Respiratory compensation difficult – hypoventilation limited by
hypoxia
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48. SYMPTOMS OF METABOLIC ALKALOSIS
• Respiration slow and shallow
• Hyperactive reflexes ; tetany
• Often related to depletion of electrolytes
• Atrial tachycardia
• Dysrhythmias
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49. TREATMENT OF METABOLIC ALKALOSIS
• Electrolytes to replace those lost
• IV chloride containing solution
• Treat underlying disorder
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50. DIAGNOSIS OF ACID-BASE IMBALANCES
1. Note whether the pH is low (acidosis) or high (alkalosis)
2. Decide which value, pCO2 or HCO3
- , is outside the normal
range and could be the cause of the problem. If the cause is
a change in pCO2, the problem is respiratory. If the cause is
HCO3
- the problem is metabolic.
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