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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


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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