ACID-BASE DISTURBANCES

Question 1

❖ SYSTEMS THAT MAINTAIN BALANCE

▪ Quick to act; however, just like respiratory system it can’t bring the pH within the normal range

Answer 1

Buffer System

Question 2

❖ SYSTEMS THAT MAINTAIN BALANCE
▪ It can immediately act (occurs within minute) but can’t bring back the pH level within the normal range.

▪ It regulates carbon dioxide.
➢ CO2 is a combination of water and carbonic acid.

Answer 2

Respiratory System (Lungs)

Question 3

❖ SYSTEMS THAT MAINTAIN BALANCE
▪ It takes 24-48 hours to make a difference and only system that can the pH within the normal range.

▪ Main Functions:
➢ urine formation
➢ removes creatinine, urea, uric acid
➢ maintains fluid & electrolyte balance
➢ mainly control the base which is Carbonic Acid

Answer 3

Renal System (Kidneys)

Question 4

ROME

Answer 4

Respiratory – Opposite; Metabolic – Equal

Question 5

ROME
Carbonic Acid HCO3 -

Answer 5

22-26mmHg

Question 5

ROME
pH -

Answer 5

7.35 to 7.45

Question 6

ROME
Partial Carbonate PaCO2 -

Answer 6

35-45mmHg

Question 7

ROME
❖ RESPIRATORY ACIDOSIS
→ Primary Disturbance:
→ Respiratory Compensation:
→ Respiratory Compensation:
→ Conditions:

Answer 7

→ Primary Disturbance:
▪ ↓pH and ↑ PaCO2

→ Respiratory Compensation:
▪ None

→ Renal Compensation:
▪ ↑H+ excretion and ↑HCO3- reabsorption

→ Conditions:
▪ Depressed Central Respiratory Centers
➢ Respiratory centers are located at the brain stem.
➢ Due to: over sedated, head trauma, general anesthesia, COPD, increased ICP, pneumonia, pulmonary effusion
▪ Results from Hypoventilation
➢ accumulation of CO2 in the lung

→ Treatment: Oxygen Therapy and Oral Airway

→ Clinical Manifestations: hypoventilation>hypoxia, rapid-shallow respirations, hypotension, pale to cyanotic skin, headache, hyperkalemia, dysrhythmias, drowsiness, dizziness, disorientation, muscle weakness, hyperreflexia

Question 8

ROME
❖ RESPIRATORY ALKALOSIS
→ Primary Disturbance:
→ Respiratory Compensation:
→ Respiratory Compensation:
→ Conditions:

Answer 8

→ Primary Disturbance:
▪ ↑pH and ↓ PaCO2

→ Respiratory Compensation:
▪ None

→ Renal Compensation:
▪ ↓ H+ excretion and ↓ HCO3- reabsorption

→ Conditions:
▪ Results from Hyperventilation – releasing too much CO2
▪ Fever (increased RR and CR)
▪ Hyperthyroidism
➢ producing of plenty thyroid hormone (T3, T4, and Calcitonin)
➢ Increases metabolism due to T3 and T4 = all VS increases
▪ Shock
➢ Lack of oxygen > anaerobic metabolism > produces lactic acid > hyperventilation
▪ Pulmonary Embolism
▪ Over ingestion of Salicylates (Aspirin)
▪ Anxiety
▪ Fear

→ Treatment: Use brown paper bag

→ Clinical Manifestations: hyperventilation (increased RR), tachycardia, hypotension or normal BP, hypokalemia, numbness and tingling of extremities, hyper reflexes and muscle cramping, seizures, anxiety, irritability

Question 9

ROME
❖ METABOLIC ACIDOSIS
→ Primary Disturbance:
→ Respiratory Compensation:
→ Respiratory Compensation:
→ Conditions:

Answer 9

→ Primary Disturbance:
▪ ↓pH and ↓HCO3

→ Respiratory Compensation:
▪ ↑ ventilation and ↓ PCO2

→ Renal Compensation:
▪ ↑ H+ excretion and ↑ HCO3− reabsorption

→ Conditions:
▪ Bodily Gain of a Strong Acid
➢ Diabetic Ketoacidosis (DKA)
✓ It is a complication of Type 1DM.
* 1 Parent = ¼ children
* Both = ¾ children
✓ In type 1 DM, the pancreas produces zero insulin, therefore glucose is not absorbed. Resulting to breakage of proteins and fats in the liver = glucose. Too much breakdown of fats results to
ketones (acid).
▪ Loss of Bicarbonates
➢ plenty in GIT
➢ Ex: Diarrhea, Ileostomy
▪ Decreased Acid Excretion
➢ Renal Failure

→ Clinical Manifestations: headache, hypotension, hyperkalemia, muscle twitching, warm-flushed skin, nausea and vomiting, decreased muscle tone and reflexes, confusion, drowsiness

Question 10

ROME
❖ METABOLIC ALKALOSIS
→ Primary Disturbance:
→ Respiratory Compensation:
→ Respiratory Compensation:
→ Conditions:

Answer 10

→ Primary Disturbance:
▪ ↑pH and ↑HCO3

→ Respiratory Compensation:
▪ ↓ventilation and ↑ PaCO2

→ Renal Compensation:
▪ ↓H+ excretion and ↓HCO3- reabsorption

→ Conditions:
▪ Loss of Acid from the plasma.
➢ Vomiting (HCL & Pepsin)
➢ GI Suctioning
➢ diuretics
▪ Large intake of Antacid (baking soda)

→ Clinical Manifestations: restlessness followed by lethargy, tachycardia, compensatory hypoventilation, confusion, dizzy, irritable, nausea, vomiting, diarrhea, tremors, muscle cramps, tingling of fingers and toes, hypokalemia