Acid Base Balance

What are the 3 major chemicals to know for Acid Base balance?

Bicarb (base), Hydrogen (acid), and CO2 “carbonic acid” (acid mixed with water)

Which major chemical resides in the lungs?

CO2

What major chemicals resides in the kidneys?

Hydrogen and BIcarb

What is the normal pH level?

7.35-7.45

How does a person feel in acidosis?

lethargic

How does a person feel in alkalosis?

excitable

How do the kidneys compensate in an imbalance?

They remove excess acid and bicarb through urine or retain hydrogen and bicarb to return it to the blood.

How do the lungs compensate in an imbalance?

Exhale to remove CO2

-Hyperventilate to decrease CO2 = alkalosis

-Hypoventilate to increase CO2 = acidosis

What organ has the problem in Respiratory acidosis?

Which organ compensates?

The lungs

The kidneys compensate

What chemical is causing the problem?

Are we hypo or hyperventilating?

Too much CO2

Hypoventilating/breathing too slow

How are the kidneys compensating in respiratory acidosis?

Retaining bicarb and excreting hydrogen

Is the pH low or High in Respiratory acidosis?

Low

How does the increase of CO2 affect LOC and O2?

O2 and CO2 have an inverse relationship. LOC decreases as CO2 increases.

What causes Respiratory acidosis?

Retaining CO2 d/t Mid abdominal incisions, narcotics, sleeping pills, pneumothorax, collapsed lung, and pneumonia.

What are signs and symptoms of Respiratory acidosis?

Headache, confusion, sleepy (hard to arouse = coma), Hypoxia (esp. if restless!)

What is the treatment for Respiratory acidosis?

Fix the breathing problem!

Prevent pneumonia

• If pneumonia, Liquefy and mobile secretions by postural drainage, percussion, deep breathing exercises, suctioning, fluids, elevate HOB, incentive spirometer.

• If pneumothorax, Chest tube present.

What organ is the problem is respiratory alkalosis?

What organ is compensating?

The lungs

The kidneys are compensating

What chemical is causing the problem?

Are we hypo or hyperventilating?

Too little CO2

Hyperventilating

How are the kidneys compensating in respiratory alkalosis?

Retaining hydrogen and excreting bicarb

Is the pH high or low in respiratory alkalosis?

High

What causes respiratory alkalosis?

Hyperventilating d/t hysterical client or acute aspirin overdose

What are signs and symptoms of respiratory alkalosis?

Lightheaded, feeling faint, peri oral numbness, numbness and tingling of fingers and toes.

What is the treatment for respiratory alkalosis?

Sedation to decrease respiratory rate

Treat the cause

Monitor ABG’s

What organ is the problem in metabolic acidosis?

What organ is compensating?

The kidneys

The lungs are compensating

What chemical is causing the problem?

Too much hydrogen and too little Bicarb

How will the lungs compensate in metabolic acidosis?

Increase respiratory rate to get rid of acid

Is the pH high or low is metabolic acidosis?

Low

What causes metabolic acidosis?

DKA and starvation

• Cells starve because glucose is unavailable. The body breaks down fats for energy causing ketones to be produced causing acidosis.

Renal failure

Severe diarrhea (losing base)

What are signs and symptoms of metabolic acidosis?

Depends on cause!

Hyperkalemia (muscle twitching, muscle weakness, flaccid paralysis, arrhythmias)

Increased respiratory rate (Kussmauls)

How do we treat metabolic acidosis?

Treat the problem

What organ is the problem in metabolic alkalosis?

What organ is compensating?

The kidneys

The lungs compensate

What chemical is the problem in metabolic alkalosis?

Too much bicarb and too little hydrogen

Is the pH high or low in metabolic alkalosis?

High

What causes metabolic alkalosis?

Loss of upper GI contents

Too many antacids or too much base

What are signs and symptoms of metabolic alkalosis?

Depends on cause!

Observe the LOC

Hypokalemia (muscle cramps and arrhythmias)

What is the treatment for metabolic alkalosis?

Fix the problem

Replace potassium