acid base imbalances

normal pH

7.35 - 7.45

normal pCO₂

35 - 45 mmHg

normal [HCO₃]

24 - 28 mEq/L

acidosis

low ph symptoms due to Na+ channels clocking —> signals cannot be started or propagated (nerve firing)

decreased in nerve firing causes

vasodilation (headache, warmed flushed skin), decreased HR and BP, weakness, tremors, stupor, confusion, hallucinations

acidosis complications

increased cerebral pressure, paralysis —> respiratory insufficiency, cardiac arrythias, coma

alkalosis

high pH, Na channels too open (not enough h+ to close door)—> signals excessivelt started or propagated

symptoms of alkalosis

vasoconstriction (high BP), increased nerve firing, overactive GI, paresthesias (tingling), tetany &/or seizures, cardiac dyshrythmia & increased HR, dizziness & syncope

metabolics

changes in acid of base concentration (has proportionate relationship with CO2)

respiratiry

CO₂ changes (has an inverse relationship with CO2)

respiratory acidosis

pCO2 increases and forms h2co3 carbonic acid, bicarb buffer is normal or elevated

why would HCO3 be normal or elevated in respiratory acidosis

to compensate by kidney retention pancrease bicarb and diet. large source of bicarb. carbonic acid turns to carbonate when neutralized then to bicarb

CO2 is elevated in respiratory acidosis because of

pt cannot get rid of CO2/ increase production (fever, sepsis, burns, exercise), ventilation disorders.

metabolic acidosis

release H+ into blood, H+ interacts with bicarb to become carbonic acid to become CO2 and H2O. more of this less bicarb in blood, decreased pH and HCO3, CO2 normal

examples of nonvitile or metabolic

lactic acid, amino acids (from proteins), free fatty acids (from fats), hydrochloric acid (from GI), ketones (ketoacidosis)

lactic acid

fermentaiton due to hypoxia or figorous exercise

ketones/ ketoacidosis

alternatice energy source common in diabetes of keto diet or starvation

Kidney failure and metabolic acidosis

distrupts excretion of H- and retention of HCO3, excess acid production

respiratory alkalosis

increase pH, decreased CO2 loss of carbonic acid, hyperventilation, anxiety, pain, fever, sepsis, aspirin posioning

metabolic alkalosis

elevated HCO3, elevate pH, CO2 normal, loss of acid (vomiting, suction, diuretics, hyperaldosteronism), excess HCO3 (antacids, IV, calcium carbonate)

compensation for respiratoy imbalance

kidneys retain or excrete HCO3 and retain or excrete H+ to bring pH back to normal. use cells H+/K+ exchange to bring pH back to normal

respiratory acidosis compensation

kidneys maintain bicarb raising its levels, kidney excrete H+ in urine —> acidic urine, cells in body take in H+ in exchange for K+ (put out potassium, hyperkalemia)

respiratory alkalosis compensation

kidney excrete bicarb to lower bicarb levels, kidneys retain H+ in the blood —> alkaline urine, cells put out H+ in exchange for K+ (take in K, hypokalemia)

compensation for metabolic imbalance

respiratory system changes pCO2 and bring pH back to normal, kidney retain or excrete HCO3 and H to bring pH back to normal, cell H/K exchange to bring pH back to normal

metabolic acidosis compensation

lungs breath faster lowers CO2 (hypocapnia) —> lower carbonic acid —> bring pH up, kidney retain bicarb —> bicarb is used up, kidney excretes H in urine —> acidic urine, cells in body take in H in exchange for k —> hyperkalemia

metabolic alkalosis compensation

lungs breathe slower to raise CO2 —> raise carbonic acid —> pH down, kidney excrete bicarb —> lower bicarb in blood, kidneys retain H in blood —> alkaline urine, cells in body put out H in exchange for K —> hypokalemia