Acid/Base Imbalances Flashcards
Acidic
<7
Alkaline
> 7
Normal Blood pH
7.35-7.45
Homeostasis
state of equilibrium within the body: in regard to
- fluid balance
- electrolyte balance
- acid/base balance
External respiration
what happens when you breathe oxygen into your lungs and breathe out CO2 and H2O (as vapour)
Internal Respiration
what happens at the tissue level when the arterial capillary beds allow diffusion of O2 into the cell and the venule capillary beds release CO2 into the plasma for return back to the lungs
Acid-base regulation (3)
- buffer system (reacts immediately)
- respiratory system - responds in minutes; maximum effectiveness reached within hours
- renal system - takes 2-3 days to reach maximum response can maintain balance for a long period of time
Buffer System
- how do lungs and kidneys influence acid/base balance
- electrolyte exchange in the cells. K+ is exchanged with H+
- alkalosis leads to –> hypokalemia because there is not enough H+ in the blood so the cells will trade their H+ for potassium from the bloodstream leading to a hypokalemic state in the blood
- acidosis leads to –> hyperkalemia because there is too much H+ in the bloodstream so it will move into the cells and the potassium will move out putting the body in a hyperkalemic state
(lungs - exhalation of CO2 decreases acidity)
(kidneys - excretion and/or retention of acids and bicarbonate)
Lungs
- rapid respirations (exhalation of CO2 -> decreased acidity)
- slow respirations (retention of CO2 -> increased acidity)
Kidneys
- excretion of H+ and reabsorption of HCO3 -> decreased acidity
- electrolyte exchanges
- hypokalemia (alkalosis)
- hyperkalemia (acidosis)
the lungs…
“blow off” CO2 to increase pH in response to metabolic acidosis
- kidneys excrete H+ and reabsorb HCO3 to increase pH in response to respiratory acidosis
Kidney ->
Respiratory ->
metabolic
Respiratory component
Respiratory acidosis: causes (12)
- anything that causes hypoventilation
- COPD
- Barbiturate or sedative overdose
- severe pneumonia
- atelectasis
- respiratory muscle weakness
- mechanical hypoventilation
- sleep apnea
- head trauma
- post op
- pneumonia
- asthma
Respiratory Acidosis: Lab values
- increased PCO2 and decreased pH if uncompensated
Resp acidosis: manifestations (4)
- drowsiness, dizziness, headache, disorientation, coma
- decreased BP, ventricular fib, warm flushed skin from peripheral vasodilation
- dyspnea, hypoventilation with hypoxia
- seizures
Resp acidosis: interventions
treat underlying cause: give narcan, oxygen therapy (low flow), respiratory therapy (Bipap)
Resp alk: causes
- anything causing hyperventilation
- 2nd degree to hypoxia, fear/anxiety, fever
- stimulated resp center - sepsis, brain injury, salicylate poisoning
- mechanical overventilation
Resp alk: lab values
- decreased PCO2 and increased pH if uncompensated
Resp alk: manifestations
- lethargy, light-headedness, confusion
- increased HR, dysrhythmias
- nausea, vomiting, epigastric pain
- tetany, numbness. tingling, hyperreflexia, seizures
- rapid, shallow breathing (kussmauls breathing)
- fast resps
Resp alk: interventions (6)
treat underlying cause
rebreather mask
assist client to slow respirations
decreased anxiety
oxygen therapy if hypoxia is the underlying cause
monitor VS, ABGs and electrolyte imbalances
Metabolic acidosis: causes
- accumulation of acid
- DKA
- septic shock (lactic acid accumulation)
- starvation
- loss of bicarbonate
- diarrhea
- renal failure
Met acidosis: lab values
- decreased HCO3 and decrease in pH if uncompensated
- resp system is going to try and compensate to blow off the CO2 and increase the pH (Kussmauls breathing happens)
Met: acidosis manifestations
- drowsiness, confusion, headache, coma
- Decreased BP, dysrhythmias, warm, flushed skin (vasodilation)
- nausea, vomiting, diarrhea, abdominal pain
- deep, rapid respirations (kussmauls resps)
Interventions: met acidosis
- treat underlying cause
- respiratory support
- administer sodium bicarbonate to neutralize acid
Metabolic alk: causes
- loss of acid - NG suctioning, prolonged vomiting
- loss of K+ to diuretic therapy
- gain of bicarbonate - ingestion of baking soda
Met alk: lab values
- HCO3 increased and increased pH if uncompensated
met alk: manifestations
- dizziness, irritability, nervousness, confusion
- tachycardia, dysrhythmias
- anorexia, nausea, vomiting
- tremors, hypertonic muscles, muscle cramps
- hypoventilation
Met alk: interventions (4)
- treat underlying cause
- replace lost fluids and electrolytes
- support renal function (dialysis)
- administer acetazolamide - promotes loss of bicarb in urine (diuretic)
Mixed
- two or more simple disorders present at the same time
- pH will depend on type, severity and acuity
- respiratory acidosis and metabolic alkalosis
- mixed acidosis
- mixed alkalosis
Normal ABG values
pH: 7.35-7.45
PaCO2: 35-45 mmHg
PaO2: 80-100 mmHg
HCO3: 22-26 mEq/L
vomiting and diarrhea
- vomiting will decrease acidity because of the stomach acid being lost
- stool contains bicarbonate so when you have diarrhea - you will become acidotic
Fully Compensated
- pH returned to normal despite the presence of abnormalities in both resp and/or metabolic systems
- acidosis because it is more leading towards acidosis
