ACID BASE BALANCE

PETER S. AZNAR M.D., F.P.S.P.

Normal value of pCO
2

Partial pressure of carbon dioxide
40 mm Hg
Normal value of pH
7.35 to 7.45

Normal Bicarbonate(HCO
3
)
values
20 to 28 mmol/L
mean 24
36
34
32
30
28
26
24
22
20
18
16
14
12
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
HCO
3

pH
Legend:
20
60
40
pCO
2

HCO
3
= bicarbonate
pCO
2
= partial
carbon
dioxide
tension
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Metabolic Acidosis
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Respiratory Acidosis
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Metabolic Alkalosis
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Respiratory Alkalosis
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Normal
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Metabolic Acidosis Compensated
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Respiratory Alkalosis Compensated
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Respiratory Acidosis Compensated
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Metabolic Alkalosis Compensated
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Metabolic Acidosis Uncompensated
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Respiratory Alkalosis Uncompensated
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Respiratory Acidosis Uncompensated
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Metabolic Alkalosis Uncompensated
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Combined Alkalosis
HCO
3

pH
RAC
RAL
MAL
MAC
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Combined Acidosis
HCO
3

pH
RAC
RAL
MAL
MAC
60
40
20
HCO
3
= 14.0
pH = 7.37
pCO
2
= 30.0
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Metabolic Acidosis Compensated
HCO
3

pH
RAC
RAL
MAL
MAC
60
40
20
HCO
3
= 22.0
pH = 7.40
pCO
2
= 38.0
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Normal
HCO
3

pH
RAC
RAL
MAL
MAC
60
40
20
HCO
3
= 13.0
pH = 7.60
pCO
2
= 10.0
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Combined Alkalosis
HCO
3

pH
RAC
RAL
MAL
MAC
60
40
20
HCO
3
= 26.0
pH = 7.41
pCO
2
= 42.0
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
36
34
32
30
28
26
24
22
20
18
16
14
12
Normal
HCO
3

pH
RAC
RAL
MAL
MAC
60
40
20
HCO
3
= 25.0
pH = 7.53
pCO
2
= 30.0
36
34
32
30
28
26
24
22
20
18
16
14
12
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
Metabolic Alkalosis Uncompensated
HCO
3

pH
RAC
RAL
MAL
MAC
60
40
20
HCO
3
= 34.0
pH = 7. 21
pCO
2
= 70.0
36
34
32
30
28
26
24
22
20
18
16
14
12
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
Combined Acidosis
HCO
3

pH
RAC
RAL
MAL
MAC
60
40
20
HCO
3
= 26.0
pH = 7.38
pCO
2
= 45.0
36
34
32
30
28
26
24
22
20
18
16
14
12
7.20 7.25 7.30 7.35 7.40 7.45 7.50 7.55 7.60
Compensated Respiratory Acidosis
Normal Bicarbonate: Carbonic Acid Ratio
HCO
3
: H
2
CO
3
= 20:1

Respiratory Acidosis
Causes:
A. Inadequate Alveolar Ventilation
a1. Central Respiratory Depression & Other CNS
Problems

CNS trauma, infarct, haemorrhage or tumour

a2. Nerve or Muscle Disorders

Guillain-Barre syndrome, Myasthenia gravis




Respiratory Acidosis
Causes:
a3. Lung or Chest Wall Defects

Pneumothorax, Pulmonary oedema, ARDS

a4. Airway Disorders

Upper Airway obstruction, Laryngospasm

a5. External Factors

Inadequate mechanical ventilation




Respiratory Acidosis
Causes:
B. Over-production of Carbon Dioxide

Hypercatabolic Disorders (Malignant
Hyperthermia)

C. Increased Intake of Carbon Dioxide

c1. Rebreathing of CO
2
-containing expired gas
c2. Addition of CO
2
to inspired gas



Respiratory Alkalosis
Causes:
A. Central Causes (direct action via respiratory centre)

a1. Anxiety-hyperventilation syndrome (psychogenic)
a2. Other 'supra-tentorial' causes (pain, fear, stress)

B. Hypoxaemia (act via peripheral chemoreceptors)

b1. Respiratory stimulation via peripheral
chemoreceptors


Respiratory Alkalosis
Causes:
C. Pulmonary Causes (act via intrapulmonary
receptors)
c1. Pulmonary Embolism
c2. Pulmonary oedema (all types)

D. Iatrogenic (act directly on ventilation)
d1. Excessive controlled ventilation
Metabolic Acidosis
Associated with decreased concentration
of HCO
3


Causes:
Renal failure
Ketoacidosis
Salicylate Ingestion

Metabolic Acidosis
Associated with decreased concentration of
HCO
3


Causes:
Shock (Cardiogenic, haemorrhagic)
Severe dehydration
Sepsis
Toxic ingestion
Renal failure


Metabolic Alkalosis
Causes:
Excessive vomiting
Diuretic therapy
Alkali ingestion
Cushings syndrome
Hyperaldosteronism
Thank
You!