ACID

II. ACID-BASE BALANCE A. Major chemicals you have to remember: 1. Bicarb - BASE, Hydrogen ACID, CO2- ACID 2. Lung chemicals → CO2 → ACID 3. Kidney chemicals → BICARB and HYDROGEN 4. These chemicals can either make you sick or compensate. It depends on which imbalance you have. B. pH: 1. What does pH tell you about the blood? If the blood is ACIDIC, alkaline, or neutral. 2. Normal pH range 7.35-7.45. 3. pH below 7.35 ACIDOSIS 4. pH above 7.45 ALKALOSIS If pH is messed up it can be dangerous 5. The BALANCE does not like it when the pH is messed up. 6. Here’s how the body keeps the pH within normal range: Compensating Organs Kidneys Lungs Remove acid through URINE. One way to get rid of CO2 Bicarb? HOLD ON What is it? EXHALE OR Hypoventilation retain CO2 Hyperventilation eliminate CO2 Kidney takes hours to days to do their job C. Respiratory Acidosis: 1. Pathophysiology: a. Is this a lung problem or a kidney problem? LUNG PROBLEM b. What chemical is causing the problem? CO2 c. Do we have too much or too little of this chemical in the body? TOO MUCH d. Hypoventilating or hyperventilating? HYPOVENTILATING

e. Who’s going to compensate? KIDNEYS f. How, with what chemicals? BICARB and hydrogen g. The body must EXCRETE the acid. h. The body will secrete bicarb. i. Is the pH high or low? LOW 2. Causes: Retain CO2. Mid abdominal incision, narcotics, sleeping pills, pneumothorax, collapsed lung, pneumonia 3. S/S: a. Headache,CONFUSED,sleepy b. If not corrected, could lead to a COMA. c. Hypoxic Give them OXYGEN. Early sign and symptoms of hypoxia? RESTLESSNES & TACHYCARDIA 4. Tx: a. Fix the BREATHING problem. b. Treat pneumonia, get rid of secretions by postural drainage, percussion (vibration therapy), deep breathing exercises, suctioning, fluids, elevate HOB, incentive spirometry. c. Pneumothorax client will have CHEST tubes d. Encourage post op to turn, cough and DEEP BREATHE. Normal Lab Values pH: 7.35-7.45 PaO2: 80-100 mmHg PaCO2: 35-45 mmHg HCO3: Bicarbonate: 22-26 mEq/L *TESTING STRATEGY* Restlessness think Hypoxia FIRST *TESTING STRATEGY* ↑CO2 = ↓LOC ↑CO2 = ↓O2 CO2 and O2 have inverse relationship. D. Respiratory Alkalosis: 1. Pathophysiology: a. Who’s sick? Who’s going to compensate? KIDNEYS b. Kidneys excrete BICARB. Retain HYDROGEN.

c. Problem chemical? C02 d. Gaining or losing CO2. LOSING e. Hypoventilating or hyperventilating? HYPERVENTILATING f. pH? HIGH 2. Causes: a. Problem? C02 b. Hysterical The client is breathing too FAST and GETTING RID OF CO2, c. Acute aspirin overdose therefore, removing C02. d. Situation: Hysterical client 3. S/S: Lightheaded, faint, peri-oral numbness, numbness and tingling in fingers and toes. 4. Tx: a. Do not wait for kidneys to kick in. b. Breathe into a PAPERBAG. c. May SEDATE client to decrease respiratory rate. d. Treat the cause e. Monitor ABG’s E. Metabolic Acidosis: 1. Pathophysiology: a. Who’s sick? KIDNEYS Who’s going to compensate? LUNGS b. With what chemical? C02 c. Problem chemical? BICARB & HYDROGEN This client is retaining HYDROGEN or do not have enough bicarb. d. pH? LOW e. Respiratory rate will INCREASE 2. Causes: a. DKA Cells are starving for GLUCOSE, so the body will b. Starvation break down protein and FATS, produce KETONES, ketones are ACIDS. c. Renal failure d. Severe DIARRHEA . 3. S/S: a. Depend on the CAUSE. b. Hyperkalemia Muscle twitching, muscle weakness, flaccid paralysis, ARRYTMIAS. c. Increased respiratory rate

4. Tx: a. Treat the PROBLEM. b. Drug to help acidosis? IV PUSH SODIUM bicarb Hurst Review Services 19 F. Metabolic Alkalosis: 1. Pathophysiology: a. Who’s sick? KIDNEYS Who’s going to compensate? LUNGS b. With what chemical? BICARB AND HYDROGEN c. Problem chemical? BICARB & hydrogen d. The client is in alkalosis, so they are retaining too much BICARB and excreting hydrogen. e. pH? HIGH 2. Causes: a. Loss of upper GI content b. Too many antacids…. Too much BASE. c. Too much IV bicarb, YES. 3. S/S: a. Depend on cause b. Observe LOC c. Serum K+ will go UP in metabolic acidosis and go DOWN in metabolic alkalosis. d. Monitor for MUSCLE CRAMPS. 4. Tx: a. Fix the problem. b. Replace POTASSIUM. *TESTING STRATEGY* Metabolic Acidosis = Hyperkalemia Metabolic Alkalosis = Hypokalemia G. ABG Interpretation Practice Problems: 1. Problem: pH: 7.32 ACIDOSIS PCO2: 41 NORMAL HCO3: 20 ACIDOSIS Interpretation: METABOLIC ACIDOSIS 2. Problem: pH: 7.56 ALKALOSIS PCO2: 31 ACID HCO3: 25 NORMAL Interpretation: RESPIRATORY ALKALOSIS 3. Problem: pH: 7.26 ACIDOSIS PCO2: 51 ACID HCO3: 29 BASIC

Interpretation: RESPIRATORY ACIDOSIS WITH PARTIAL COMPENSATION 4. Problem: pH: 7.45 NORMAL PCO2: 52 ACID HCO3: 35 BASIC Interpretation: METABOLIC ALKALOSIS – FULLY COMPENSATED Normal: pH: acidosis ↓ 7.35 – 7.45↑ alkalosis PCO2: basic ↓ 35 – 45 ↑ acidic HCO3: acidic ↓ 22 - 26↑ basic Normal: pH: acidosis ↓ 7.35 – 7.45 ↑ alkalosis PCO2: basic ↓ 35 – 45 ↑ acidic HCO3: acidic ↓ 22 – 26 ↑ basic Normal: pH: acidosis ↓ 7.35 – 7.45 ↑ alkalosis PCO2: basic ↓ 35 -45 ↑ acidic HCO3: acidic ↓ 22 – 26 ↑ basic Normal: pH: acidosis ↓ 7.35 – 7.45 ↑ alkalosis PCO2: basic ↓ 35- 45 ↑ acidic HCO3: acidic ↓ 22 – 26 ↑ basic