Acid & Base Imbalances

ABG Range Table

1. pH

2. PaCO2

3. HCO3

4. O2 sat

Resp. Acidosis

Resp. Alkalosis

Metabolic Acidosis

Metabolic Alkalosis

1. 7.35-7.45

2. 45-35

3. 22-26

4. 95-100

too much rentention of CO2

too much loss of CO2

Excess acis + decrease in base

Decrease in acids + excess base (diuretic therapy)

1. low pH, high PaCO2

2. low pH, low HCO3

3. high pH, low PaCO2

4. high pH, high HCO3

1. R. Acidosis

2. M. Acidosis

3. R. alkalosis

4. M. Alkalosis

Respiratory Acidosis

1. Big sign

Causes

1. Conditions that affect pulmonary function:

2. Respiratory Depression

Recognize Cues:

Take Action:

1. Alveolar Hypoventilation

2. COPD, Pneumonia, Atelectasis, PE, Respiratory virus

3. Opioid overdose, Anesthesia, head Injuries, Spinal cord injury

Hypoventilation, Restlessness/confusion, SOB, increased RR (early hypoxia), Wheezing/rhonchi

High fowlers, incentive spirometry, Oxygen titration, Hydration (break up mucus), monitor respiratory status and effort

Respiratory Alkalosis

1. Big sign

2. Causes:

3. Recognize Cues:

4. Take Action:

1. Hyperventilation

2. Fever, Infection, sepsis trauma, pain, severe stress

3. Hyperventilation, lightheadedness, Tachycardia,

4. Slow breathing, breathing mask, sedation?, Anxiolytics, Monitor respiratory status

Metabolic Acidosis

1. Too much Acid causes:

2. Too little bicarb causes:

3. Other causes:

4. Recognize Cues:

5. Take Action:

1. Lactic acidosis (not enough O2), Ketoacidosis (no carbs), Renal failure, Ingestion of acids

2. Diarrhea and renal failure

3. Hepatic failure, pancreatitis, dehydration, salicylate intoxication

4. Kussmaul respirations, headaches/confusion, Tachycardia, Loss of appetite, Nausea/Vomit

5. Underlying cause?, Lung sounds, ! Intake and Output !

Metabolic Alkalosis

1. Too much base causes:

2. Too little acid causes:

3. Other causes/effects:

4. Recognize Cues:

5. Take action:

1. Excessive intake and Excessive retention (hyperaldosterone)

2. Loss of stomach acid (vomiting,NG suctioning) and Overexcretion of hydrogen (diuretics)

3. renal impairment, hypokalemia, hypovolemia

4. muscle twitching, n/v, Tremors, tingling, lightheadedness, Severe (seizures, arrythmias, agitation)

5. Irrigate NG with NS, Intake & Output, IV fluids w/ electrolytes, give antiemetics, equipment for seizures, Evaluate VS/ cardiiac/ LOC

Key Assessment FIndings

1. R. Acidosis

2. R. Alkalosis

3. M. Acidosis

4. M. Alkalosis

1. Slow breathing, drowsiness

2. fast breathing, tingling, dizziness

3. Kussmaul respirations, diarrhea, DKA

4. Vomiting, suction, muscle weakness

Practice

1. ph- 7.26

2. HCO3 - 17

3. PaCO2 - 42

Metabolic acidosis

Practice

1. pH- 7.49

2. HCO3- 23

3. PaCO2 - 30

Respiratory Alkalosis

Practice

1. pH- 7.6

2. PaCO2- 31

3. HCO3- 25

Respiratory alkalosis- hyperventilation, dizziness

Practice

1. pH- 7.5

2. PaCO2- 40

3. HCO3- 34

Metabolic alkalosis-

Practice

1. pH- 7.21

2. PaCO2- 70

3. HCO3- 24

Respiratory acidosis