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Acid/ Base Review. NR-75 D Diana Diaz RN MSN. Objectives. Review the basic mechanisms of acid/base Recall the 4 major types of Acid/base imbalances Analyze a set of blood gas values. pH and Hydrogen Ion. Indirect measure of H+ ion concentration Ratio of base (HCO 3 ) to acid (CO 2 )

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acid base review

Acid/ Base Review

NR-75 D

Diana Diaz RN MSN

objectives
Objectives
  • Review the basic mechanisms of acid/base
  • Recall the 4 major types of Acid/base imbalances
  • Analyze a set of blood gas values
ph and hydrogen ion
pH and Hydrogen Ion
  • Indirect measure of H+ ion concentration
  • Ratio of base (HCO3) to acid (CO2)
  • Acids give up (donate) H+ ions, while

bases pick up H+ ions

slide4
pH
  • Body maintains a slightly alkaline pH

of 7.35 - 7.45

  • Metabolic and respiratory processes work together to keep hydrogen (H+) levels in a normal range
regulators of acid base
Regulators of Acid/Base
  • Buffers
  • Respiratory system
  • Renal system
acid base balance
Acid – Base Balance

CO2 + H20H2CO3H+ + HCO3-

Kidneys

Lungs

Respiratory

Metabolic

Fast

Slow

abg normal values
ABG Normal Values
  • pH 7.35 - 7.45 overall state
  • PaCO2 35 - 45 mm Hg (respiratory component)
  • HCO3 22 - 26 mEq/L (metabolic component)
abg normal values1
ABG Normal Values
  • PaO2 80 - 100 mmHg partial pressure

of oxygen in arterial blood

  • SaO2 96 - 100% arterial O2 saturation
abg normal values2
ABG Normal Values
  • pH 7.35 - 7.45 overall state
  • PaCO2 35 - 45 mm Hg (respiratory component)
  • HCO3 22 - 26 mEq/L (metabolic component)
acid base imbalances
Acid-Base Imbalances
  • Alkalemia
    • Alkalosis
  • Acidemia
    • Acidosis
metabolic acidosis
Metabolic Acidosis
  • Causes
    • Anaerobic metabolism
    • Lactic acidosis
    • Anoxia
    • Poisoning
    • Overdose
metabolic alkalosis
Metabolic Alkalosis
  • Causes
    • Vomiting
    • Poisoning
    • Overdose
respiratory acidosis
Respiratory Acidosis
  • Causes
    • Hypoventilation
    • Respiratory failure
  • - Long-standing respiratory insufficiency, COPD
respiratory alkalosis
Respiratory Alkalosis
  • Causes
    • Hyperventilation
interpretation of abgs
Interpretation of ABGs
  • Evaluate pH: this determines acidosis or alkalosis
  • 7.40 is in the middle of the normal range of 7.35 - 7.45
  • Value below 7.40 is moving towards acidosis
  • Value above 7.40 is moving towards alkalosis
interpretation of abgs1
Interpretation of ABGs
  • Evaluate respiratory component (PaCO2)
    • If PaCO2 < 35, the value is alkalotic
    • If PaCO2 > 45, the value is acidotic
interpretation of abgs2
Interpretation of ABGs
  • Evaluate the metabolic component (HCO3)
    • If HCO3 > 26 mEq/L, the value is alkalotic
    • If HCO3 < 22 mEq/L, the value is acidotic
interpretation of abgs3
Interpretation of ABGs
  • Determine which component (PaCO2 or HCO3) matches the pH
  • If pH is decreased or increased is the underlying disorder respiratory or metabolic?
interpretation of abgs4
Interpretation of ABGs
  • Respiratory
    • ↑ pH, ↓ PaCO2
    • ↓ pH, ↑ PaCO2
  • Metabolic
    • ↑ pH, ↑ HCO3
    • ↓ pH, ↓ HCO3
compensation
Compensation
  • Determine the degree of compensation

Absent:

      • pH is not within normal range
      • The component that does not match the pH imbalance is still within its normal range
compensation1
Compensation
  • Determine the degree of compensation

Complete:

    • pH is within the normal range and both components are either above or below normal range
compensation2
Compensation
  • Determine the degree of compensation

Partial:

    • pH is not within normal range
    • The component that does not match the pH disorder is above or below the normal range
acid base mnemonic rome
Acid/Base Mnemonic- ROME
  • R (respiratory)
  • O (opposite)
    • pH PaCO2 alkalosis
    • pH PaCO2 acidosis
  • M (metabolic)
  • E (equivalent)
    • pH HCO3 acidosis
    • pH HCO3 alkalosis
more fun with acid base
More Fun with Acid - Base
  • Mixed diagnoses
    • More than one problem
      • Acute and compensated

respiratory acidosis

      • Respiratory and metabolic

acidosis

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