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Acid Base Imbalance Peggy D. Johndrow 2009
Must it be so complicated! ,[object Object],[object Object],[object Object],[object Object]
What I need to know Components ,[object Object],[object Object],[object Object]
What I need to know Respiratory ,[object Object],[object Object],[object Object]
What I need to know Metabolic ,[object Object],[object Object]
Why do we care? ,[object Object],[object Object],[object Object]
Let’s Review ,[object Object],[object Object],[object Object],[object Object]
Normal Blood pH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acid-Base Chemistry ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
pH Control ,[object Object],[object Object]
Acid pH ,[object Object],[object Object]
Sources of Acids ,[object Object],[object Object],[object Object]
Alkaline pH  ,[object Object],[object Object]
Acid Base Balance Table
Mechanisms Regulate Acid Base Balance ,[object Object],[object Object],[object Object]
Bicarbonate-Carbonic Acid Buffer System ,[object Object],[object Object],[object Object]
What is carbonic acid? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Respiratory Acid-Base Control Mechanisms  ,[object Object],[object Object],[object Object]
Respiratory Mechanism Diagram
Lungs Alkaline ,[object Object],[object Object],[object Object]
Lungs Acid ,[object Object],[object Object]
Renal Acid-Base Control Mechanisms ,[object Object],[object Object],[object Object],[object Object],[object Object]
Kidneys ,[object Object],[object Object],[object Object],[object Object]
Compensation ,[object Object],[object Object],[object Object],[object Object]
Respiratory Compensation  ,[object Object],[object Object]
Renal Compensation  ,[object Object],[object Object]
Acidosis and Alkalosis ,[object Object],[object Object]
Normal Arterial Values Parameter Arterial Sample pH 7.35-7.45 PaC02 35-45 mmHg Pa02 80-100 mmHG Oxygen Saturation 95-100% Base Excess + or - 2 HC03- 22-26 mEq/L
Acid Base Guide Disorder Initial Event Compensation Respiratory Acidosis PaC02  or normal HC03  pH Kidneys eliminate H+ and retain HCO3- Respiratory Alkalosis PaC02  or normal HC03  pH Kidneys conserve H+ and excrete HC03- Metabolic Acidosis or normal PaC02  HC03-  pH Lungs eliminate C02 conserve HC03- Metabolic Alkalosis or normal Pac02  HCO3-  pH Lungs  ventilation to  PC02 kidneys conserve H+ to excrete HC03-
Acid Base Key Concept ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Metabolic Acidosis ,[object Object],[object Object]
Metabolic Acidosis Causes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Metabolic Acidosis Symptoms  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Metabolic Acidosis Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Metabolic Alkalosis ,[object Object]
Metabolic Alkalosis Causes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Metabolic Alkalosis Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object]
Metabolic Alkalosis Treatment ,[object Object],[object Object],[object Object]
Respiratory Acidosis ,[object Object]
Respiratory Acidosis Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Respiratory Acidosis Treatment ,[object Object],[object Object],[object Object]
Respiratory Alkalosis ,[object Object]
Respiratory Alkalosis Causes   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Respiratory Alkalosis Treatment ,[object Object],[object Object],[object Object],[object Object]
Let’s Practice ,[object Object],[object Object]
Acid Base References ,[object Object],[object Object],[object Object]

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Chapter 14 Acid Base Concepts

  • 1. Acid Base Imbalance Peggy D. Johndrow 2009
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  • 28. Normal Arterial Values Parameter Arterial Sample pH 7.35-7.45 PaC02 35-45 mmHg Pa02 80-100 mmHG Oxygen Saturation 95-100% Base Excess + or - 2 HC03- 22-26 mEq/L
  • 29. Acid Base Guide Disorder Initial Event Compensation Respiratory Acidosis PaC02 or normal HC03 pH Kidneys eliminate H+ and retain HCO3- Respiratory Alkalosis PaC02 or normal HC03 pH Kidneys conserve H+ and excrete HC03- Metabolic Acidosis or normal PaC02 HC03- pH Lungs eliminate C02 conserve HC03- Metabolic Alkalosis or normal Pac02 HCO3- pH Lungs ventilation to PC02 kidneys conserve H+ to excrete HC03-
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Editor's Notes

  1. Respiratory acidosis results from: Impaired respiratory function that reduces the exchange of oxygen & carbon dioxide Retention of carbon dioxide that causes increased production of free hydrogen ions
  2. Metabolic Acidosis results from: Overproduction of hydrogen ions Under-elimination of hydrogen ions Underproduction of bicarbonate ions Over-elimination of bicarbonate ions
  3. Acidosis is: Arterial blood pH level < 7.35 Can be caused by metabolic problems, respiratory problems, or both Clients at greatest risk for acute acidosis: those with problems that impair breathing Major changes in body function: an increase in hydrogen ions creates imbalances of electrolytes, especially potassium
  4. These may vary somewhat from IW; use IW for exam purposes
  5. Overproduction of hydrogen ions Under-elimination of hydrogen ions Underproduction of bicarbonate ions Over-elimination of bicarbonate ions
  6. History Physical assessment/clinical manifestations Central nervous system Neuromuscular Cardiovascular Respiratory (Kussmaul respiration) Skin Psychosocial assessment Laboratory assessment Metabolic acidosis Hydration Medications to control or treat problem causing acidosis Increase aerobic metabolism. Monitor for changes.
  7. Arterial blood pH is > 7.45. Acid-base balance of the blood is disturbed by an excess of bases, especially bicarbonate. Problems of alkalosis are serious and potentially life threatening.
  8. Base excess results from excessive intake of bicarbonates, carbonates, acetates, citrates, and lactates. Acid deficit is caused by disease processes or medical treatments, or by prolonged vomiting, excess cortisol, or hyperaldosteronism.
  9. Hallmark is an increased bicarbonate level with a rising partial pressure of arterial carbon dioxide. Serum potassium level decreases. Calcium binding increases and hypocalcemia results. Most of the serious problems are caused by the resulting hypocalcemia.
  10. Physical assessment/clinical manifestations Central nervous system Neuromuscular Cardiovascular Respiratory Laboratory assessment
  11. Impaired respiratory function reduces exchange of oxygen and carbon dioxide Retention of carbon dioxide causes increased production of free hydrogen ions
  12. Respiratory depression Chemical depression Physical depression Inadequate chest expansion Skeletal problems Respiratory muscle weakness External conditions Airway obstruction Reduced alveolar-capillary diffusion
  13. History Physical assessment/clinical manifestations Central nervous system Neuromuscular Cardiovascular Respiratory Skin Psychosocial assessment Laboratory assessment Respiratory acidosis Maintain a patent airway and enhance gas exchange Medication therapy to increase airway diameter and to thin pulmonary secretions Oxygen therapy, pulmonary hygiene, ventilation support
  14. Classic profile: Reduced bicarbonate level Low pressure of arterial carbon dioxide Low serum potassium level Low serum calcium level
  15. Physical assessment/clinical manifestations Central nervous system Neuromuscular Cardiovascular Respiratory Laboratory assessment