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Respiratory Module
Acid-Base Disturbances
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Regulation of Acid-Base balances
• Normal plasma pH– 7.35-7.45
• pH is the indicator of– H+ ion concentration
• pH range compatible with life– 6.8 – 7.8
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Learning Tip
• BASE – ALKALINE– pH– Base = alkaline = pH
• Acid– Acidic– pH– Acid = acidic = pH
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• 3 Bases• 3 Acids• 3B = 3A• pH =
– Homeostasis– 7.40
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• 4 Bases– High
• 4 Acids– High
• 4B = 4A• pH =
– Homeostasis– 7.40
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• 2 Bases– Low
• 2 Acids– Low
• 2B = 2A• pH =
– Homeostasis– 7.40
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• 4 Bases (alkaline)– High
• 3 Acids (acidic)– Normal
• 4B > 3A• pH =
– Alkalosis– > 7.45
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• 3 Bases (alkaline)– Normal
• 4 Acids (acidosis)– High
• 3B < 4A• pH =
– Acidosis– < 7.35
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• 3 Bases– normal
• 2 Acids– Low
• 3B > 2A• pH =
– Alkalosis– > 7.45
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• 2 Bases– low
• 3 Acids– normal
• 2B < 3A• pH =
– Acidosis– < 7.35
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Learning Tip
•Normal Acid & Base = pH = Alkalosis
•Normal Acid & Base = pH =Acidosis
• Acid & Normal Base = pH =Acidosis• Acid & Normal Base = pH = Alkalosis
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Chemical Buffers• The body’s major buffer system is
– The bicarbonate-carbonic acid buffer system• Bicarbonate
– HCO3-
– Base– Alkaline
• Carbonic acid– H2CO3
– Acid– Acidic
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Chemical Buffers
• Carbonic Acid– CO2 + H20 = H2CO3– When CO2 is increased
• Carbonic acid is increased
– When CO2 is decreased• Carbonic acid is decreased
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Kidneys
• The kidneys regulate – The bicarbonate level HCO3-
• The kidneys are able to reabsorb as well as excrete– Bicarbonate ions (HCO3-) from the renal tubules
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Kidneys
• If the kidneys retain / reabsorb bicarbonate– HCO3 plasma (base)– pH
• If the kidneys excrete bicarbonate– HCO3 plasma (base)– pH
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Kidneys
• If the plasma pH is acidic (pH: A > B) the kidneys will compensate by…– Retain / reabsorb bicarbonate (HCO3
-) to help restore balance
– HCO3- in the blood
– serum pH– 4A > 3B 4A = 4B
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Kidneys
• If the plasma pH is alkaline (pH 3A > 4B or 2A >
3B) the kidneys will…– Excrete bicarbonate (HCO3-) to help restore
balance– HCO3– pH– 2A < 3B 2A = 2B
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Kidneys
• Restoration of a balances pH is called:– COMPENSATION
• Renal compensation is:– Relatively slow– Takes hours - days
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Lungs
• The lungs regulate – The Carbonic acid level / CO2
• The lungs are able to retain as well as excrete – CO2
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Lungs
• Decrease in respiratory rate– CO2 (acid)– pH
• Increase in respiratory rate– CO2 (acid)– pH
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Lungs
• If the plasma pH is acidic ( pH = 4A > 3B or 3A > 2B) the lungs will try to restore balance by…– Hyperventilating– CO2– pH– 4A > 3B 3A = 3B
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Lungs
• If the plasma pH is alkaline ( pH = 3A < 4B or 2A < 3B) the lungs will try to restore balance by…– Hypoventilating– CO2– pH– 3A < 4B 4A = 4B
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Learning Tip
Respiratory = Lungs = CO2 = Acid
Metabolic = Kidneys = HCO3 = Base
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Practice Questions
1. HCO3- : 45
2. HCO3- : 24
3. PaCO2: 60
4. HCO3- : 18
5. PaCO2: 20
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Practice Questions
1. HCO3-: 322. PaCO2: 40 3. HCO3-: 124. PaCO2: 535. PaCO2: 24
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More practice questions
1. PaCO2: 652. PaCO2: 353. PaCO2: 524. PaCO2: 205. HCO3: 186. HCO3: 247. HCO3: 308. HCO3: 12
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Respiratory Acidosis:Characteristics
• pH– < 7.35
• PaCO2– > 45 mmHg– Hypercapnia
• Metabolic Compensation– HCO3-– Kidneys reabsorb and retain HCO3
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Respiratory Acidosis:Clinical Manifestations
• Feeling of fullness in the head• pulse and BP• Mental cloudiness• Weakness
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Respiratory Acidosis:Etiology
Always d/t inadequate excretion of CO2• Hypoventilation• Pulmonary edema• Aspiration• Atelectasis• Overdose of sedatives
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Respiratory Acidosis:Management
• Improve ventilation• Bronchodilators, antibiotics, pulmonary
hygiene measures
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Metabolic Alkalosis:Characteristics
• pH– > 7.45
• Bicarbonate / HCO3-– > 26 mEq/l
• Respiratory compensation– CO2 by
• Hypoventilation
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Metabolic Alkalosis:Clinical Manifestations
• Ca+• Tingling of the fingers • Hypertonic muscles• Atrial tachycardia• Tetany
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Metabolic Alkalosis:Etiology
• #1– Vomiting or gastric suction
• Long term diuretics
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Metabolic Alkalosis:Management
• Reverse underlying disorder• Restore normal fluid & electrolytes
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Respiratory Alkalosis:Characteristics
• pH– > 7.45
• PaCO2– < 35 mmHg
• Metabolic Compensation– ↓ HCO3 by
• The kidney will excrete HCO3
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Respiratory Alkalosis:Clinical Manifestations
• Lightheadedness• concentration• LOC
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Respiratory Alkalosis:Etiology
• Hyperventilation– Extreme anxiety– Gram-negative bacteria– Excessive ventilation by mechanical ventilators
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Respiratory Alkalosis:Management
• If anxiety breath more slowly• Breath into a closed system
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Metabolic Acidosis: Characteristics
• pH – < 7.35
• Bicarbonate - HCO3– < 22
• Respiratory Compensation– CO2 by
• Hyperventilation
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Metabolic Acidosis: Clinical Manifestations
• Confusion, H/A, drowsy• N&V• Cold clammy skin• Dysrhythmias• Hyperkalemia• Shock
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Metabolic Acidosis: Etiology
• Renal failure• Diabetic ketoacidosis• Lactic acidosis• Salicylate poisoning• Diarrhea
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Metabolic Acidosis:Management
• Correct metabolic defect• Watch K+ levels
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Mixed acid-base disorders
• Is it possible to pat to have both respiratory and metabolic imbalances at the same time?– YES!
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Compensation
• The pulmonary system and the renal will compensate for each other to return to pH to normal
• The lungs compensate for metabolic disturbances by altering the PaCO2 levels by Hyper/hypoventilation
• The kidneys compensate for respiratory disturbances by altering the HCO3- levels by reabsorbing retaining or excreting HCO3
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Compensation
• Respiratory acidosis– Kidneys retain HCO3
• Respiratory alkalosis– Kidneys excrete HCO3
• Metabolic acidosis– Lungs excrete CO2 (hyperventilate)
• Metabolic alkalosis– Lungs retain CO2 (hypoventilate)
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Medications & acid-base disturbances
• Diuretics – Metabolic Alkalosis
• Steroids– Metabolic alkalosis
• Narcotics– Respiratory acidosis
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Blood Gas Analysis
pH 7.35 – 7.45
PaO2 80-100 mmHg
PaCO2 35-45 mmHg
HCO3- 22-26 mEq/l
Base Excess
-2 to +2
Si02 95 – 100%
• pH– Acidity / alkalinity
• PaO2– Not primary in acid-
base regulation– Change with O2
administration– < 60 acidosis– < 80 Hypoxemia
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Blood Gas Analysis
pH 7.35 – 7.45
PaO2 80-100 mmHg
PaCO2 35-45 mmHg
HCO3- 22-26 mEq/l
Base Excess
-2 to +2
Si02 95 – 100%
• PaCO2– Effective ventilation– PaCO2
• Hypoventilation– PaCo2
• Hyperventilation
• HCO3-– Renal component– Kidney excrete or
retain
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Blood Gas Analysis
pH 7.35 – 7.45
PaO2 80-100 mmHg
PaCO2 35-45 mmHg
HCO3- 22-26 mEq/l
Base Excess
-2 to +2
Si02 95 – 100%
• Base Excess– Amount of blood
buffer• High
– Alkalosis
• Low– Acidosis
• SiO2– % of Hgb saturated
with O2
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Steps to Blood Gas Analysis
1. Label the pH, PaCO2 & HCO3-
• Serum pH > 7.4– Alkalosis
• Serum pH < 7.4– Acidosis
• Serum pH = 7.4– Homeostasis
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Steps to Blood Gas Analysis
• Label the PaCO2 & HCO3-– PaCO2
• Acidosis– PaCO2
• Alkalosis– HCO3-
• Alkalosis– HCO3-
• Acidosis
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Steps to Blood Gas Analysis
2. Find the Cause of the acid-base disturbance• pH > 7.4 Alkalosis
– If the PaCO2 is < 40 = respiratory alkalosis– If the HCO3- is > 24 = metabolic alkalosis
• pH < 7.4 Acidosis – If the PaCO2 > 40 = respiratory acidosis– If the HCO3- is < 24 = metabolic acidosis
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Steps to Blood Gas Analysis
3. Check for compensation• The body tries to restore balance by altering
the buffer of the system that is not involved in the imbalance
• If compensation has occurred the values will move in the same direction as the other component.
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Practice #1
pH 7.53
PaO2
PaCO2 42
HCO3- 34
Base Excess
SiO2
• Metabolic Alkalosis with NO respiratory compensation
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Practice #2
pH 7.27
PaO2
PaCO2 38
HCO3- 14
Base Excess
SiO2
• Metabolic Acidosis with NO respiratory compenstation
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Practice #3
pH 7.54
PaO2 50
PaCO2 30
HCO3- 25
Base Excess
SiO2
• Respiratory Alkalosis with NO metabolic compensation
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Practice #4
pH 7.50
PaO2 85
PaCO2 40
HCO3- 30
Base Excess
SiO2
• Metabolic Alkalosis with NO respiratory compensation
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Practice #5
pH 7.30
PaO2 40
PaCO2 56
HCO3- 26
Base Excess
SiO2
• Respiratory acidosis with NO metabolic compensation
![Page 59: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/59.jpg)
Practice #6
pH 7.23
PaO2 90
PaCO2 40
HCO3- 16
Base Excess
SiO2
• Metabolic Acidosis with NO respiratory compensation
![Page 60: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/60.jpg)
Practice #7
pH 7.30
PaO2 50
PaCO2 60
HCO3- 30
Base Excess
SiO2
• Respiratory Acidosis with partial metabolic compensation
![Page 61: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/61.jpg)
Practice #8
pH 7.45
PaO2 50
PaCO2 50
HCO3- 34
Base Excess
SiO2
• Metabolic Alkalosis with complete/full respiratory compensation
![Page 62: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/62.jpg)
Practice #9
pH 7.35
PaO2 85
PaCO2 64
HCO3- 34
Base Excess
SiO2
• Respiratory acidosis with complete/full metabolic compensation
![Page 63: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/63.jpg)
Practice #10
pH 7.45
PaO2 80
PaCO2 35
HCO3- 24
Base Excess
SiO2
• Normal
![Page 64: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/64.jpg)
Practice #11
pH 7.27
PaO2 95
PaCO2 55
HCO3- 24
Base Excess
SiO2
• Respiratory acidosis with NO metabolic compensation
![Page 65: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/65.jpg)
Practice #12
pH 7.50
PaO2 85
PaCO2 40
HCO3- 30
Base Excess
SiO2
• Metabolic Alkalosis with NO respiratory compensation
![Page 66: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/66.jpg)
Practice #13
pH 7.14
PaO2 80
PaCO2 80
HCO3- 19
Base Excess
SiO2
• Respiratory & Metabolic Acidosis with no respiratory or metabolic compensation
![Page 67: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/67.jpg)
Practice #14
pH 7.56
PaO2
PaCO2 40
HCO3- 45
Base Excess
SiO2
• Metabolic Alkalosis with NO respiratory compensation
![Page 68: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/68.jpg)
Practice #15
pH 7.35
PaO2
PaCO2 58
HCO3- 31
Base Excess
SiO2
• Respiratory acidosis with complete/full metabolic compensation
![Page 69: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/69.jpg)
Practice #16
pH 7.31
PaO2
PaCO2 22
HCO3- 14
Base Excess
SiO2
• Metabolic Acidosis with partial respiratory compensation
![Page 70: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/70.jpg)
Practice #17
pH 7.49
PaO2
PaCO2 51
HCO3- 29
Base Excess
SiO2
• Metabolic Alkalosis with partial respiratory compensation
![Page 71: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/71.jpg)
Practice #18
pH 7.43
PaO2
PaCO2 31
HCO3- 18
Base Excess
SiO2
• Respiratory Alkalosis with complete/full metabolic compensation
![Page 72: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/72.jpg)
Practice #19
pH 7.29
PaO2
PaCO2 50
HCO3- 15
Base Excess
SiO2
• Respiratory & Metabolic Acidosis with NO respiratory or metabolic compensation
![Page 73: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/73.jpg)
Practice #20
pH 7.25
PaO2
PaCO2 59
HCO3- 15
Base Excess
SiO2
• Respiratory & metabolic acidosis with no respiratory or metabolic compensation
![Page 74: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/74.jpg)
Practice #21
pH 7.40
PaO2
PaCO2 60
HCO3- 35
Base Excess +12
SiO2
• Metabolic Alkalosis with complete/full respiratory compensation
![Page 75: Respiratory Module Acid-Base Disturbances. Regulation of Acid-Base balances Normal plasma pH – 7.35-7.45 pH is the indicator of – H+ ion concentration](https://reader030.vdocument.in/reader030/viewer/2022012316/56649d0b5503460f949dde59/html5/thumbnails/75.jpg)
Practice #22
pH 7.40
PaO2
PaCO2 60
HCO3- 35
Base Excess -12
SiO2
• Respiratory acidosis with complete/full metabolic compensation