acid base lecture 2012 (1)
TRANSCRIPT
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Fluid, Electrolyte and Acid-baseBalance Block
ACID-BASE BALANCE
By Harliansyah, PhD2012
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HYDROGEN IONS, ACIDS,
AND BASES HYDROGEN IONS (H+)
ACIDS
BASES
PHNormal arterial pH is 7.35 7.45
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ACID-BASE BALANCESAcidosis pH < 7.35
Alkalosis pH > 7.45
Buffers
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PRIMARY BUFFER SYSTEMS
IN EXTRACELLULAR FLUID
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REGULATION OF ACIDS AND
BASES THE BIG THREE ACID-BASE
REGULATORS
Chemical regulation
Biological regulation
Physiological regulation
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PHYSIOLOGICAL
REGULATION
Alkalosis
Acidosis
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ACID
BASE IMBALANCESRESPIRATORY ACIDOSIS
RESPIRATORY ALKALOSISMETABOLIC ACIDOSIS
METABOLIC ALKALOSIS
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ARTERIAL BLOOD GASES NORMAL BLOOD GASVALUES
pH 7.35-7.45 PCO2 35-45mmHg
HCO3 22-27mEq/L
PO2 80-100
mmHg
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ARTERIAL BLOOD GASES RESPIRATORY IMBALANCES
Respiratory function indicator is PCO2
Opposite response between the pHand PCO2
pH is down in an acidotic condition
and is elevated in an alkaloticcondition
pH and PCO determines if thecondition is a respiratory problem
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ARTERIAL BLOOD GASES METABOLIC IMBALANCES
HCO3 is indicator for metabolic
functionA corresponding response between
the pH and the HCO3
pH is down in an acidotic conditionand is elevated in an alkaloticcondition
The pH and the HCO3
determines ifthe condition is a metabolic problem
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ANALYZING ARTERIAL BLOOD
GAS RESULTS PYRAMID STEPS
Look at the blood gas report
PYRAMID STEP 1 Look at the pH. Is it up or down? If it is up, it
reflects alkalosis. If it is down, it reflects acidosis.
PYRAMID STEP 2
Look at the PCO2. Is it up or down? If it reflectsan opposite response as the pH then you knowthat the condition is a respiratory imbalance. If itdoes not reflect an opposite response as the pH,then move on to Pyramid Step 3.
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ANALYZING ARTERIAL BLOOD
GAS RESULTS PYRAMID STEP 3
Look at the HCO3. Does the HCO3 reflect a
corresponding response with the pH? If it does,then the condition is a metabolic imbalance.
PYRAMID STEP 4
Remember, compensation has occurred if the pH
is in a normal range of 7.35-7.45. If the pH is not within normal range, look at the
respiratory or metabolic function indicators.
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FLUID, ELECTROLYTE & ACID
-BASE REMEMBER~~~~
NORMAL CHEMISTRY LABORATORY VALUES
Serum electrolyte levels
CBC (changes in Hct related to FVD & FVE)
BUN & Blood Creatinine Levels (kidney functions)
Urine Specific gravity (normal 1.003 1.023)
ABGs
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LUID, ELECTROLYTE & ACID -
BASE OVERALL GOALS/EVALUATION
NORMAL FLUID, ELECTROLYTE AND ACID BASEBALANCE
CAUSES OF IMBALANCES IDENTIFIED ORCORRECTED
NO COMPLICATIONS FROM THERAPIES NEEDEDTO RESTORE BALANCE
INCLUDE FAMILY IN PROCESS
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