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If the lungs are sick, which organ is going to compensate for malfunctioning lungs? The kidneys!

If the lungs cannot get rid of the excess carbon dioxide, then the kidneys are going to go to work to try to correct the problem. The kidneys goal right now is to get the pH back into normal range. The kidneys use bicarbonate (base) and hydrogen (acid) in an effort to correct the pH. In this instance, when there is too much CO2 (acid), the kidneys will kick in and secrete bicarbonate into the blood and excrete hydrogen out of the body. _ If the lungs are getting rid of too much CO2 (acid), as with hyperventilation, then the patient will become alkalotic. Now, the pH is out of range so the kidneys will try to correct it with the same two chemicals, bicarb and hydrogen. Since the kidneys are trying to correct alkalosis, they will excrete bicarb from the body and retain hydrogen. If the kidneys are sick, which organ/organs are going to compensate for the malfunctioning kidneys? The lungs! The lungs are going to compensate by either blowing off the excess carbon dioxide (by increasing respirations) or retaining carbon dioxide (by slowing respirations). How the respiration will change, depends on whether the client is experiencing metabolic acidosis or alkalosis.

Metabolic acidosis and alkalosis overview HCO3 and H+


_ The problem ORGANS in metabolic acidosis and metabolic alkalosis are the kidneys. Bicarbonate and hydrogen are considered the problem chemicals when the kidneys are sick.

Respiratory acidosis and alkalosis overview CO2


_ The lungs have one chemical: carbon dioxide. _ In an acidbase imbalance such as respiratory acidosis or alkalosis, the lungs are sick. That is why the name respiratory is included in the name of the disorder. _ Anytime the lungs are sick and are causing respiratory acidosis or respiratory alkalosis, the problem is due to carbon dioxide.

CALCIUM AND ACIDBASE IMBALANCES


Blood calcium levels can be significantly affected by acid base imbalances. Lets looks at how calcium is affected during acidosis and alkalosis. There are two kinds of calcium in the blood; Calcium that is bound to a plasma protein and calcium that is not bound to plasma protein. When calcium is bound, it might as well be invisible/absent/not present/ doesnt count. Its the unbound calcium that can have an effect on our body. Unbound calcium is active. Bound calcium is inactive. Note: Hydrogen ions will not let calcium bind to plasma proteins. The more H_ ions that are present, more free/unbound calcium will be present as well. Acidosis: If the blood is acidotic there must be a lot of hydrogen (acid) too. The more acid the blood, the more unbound calcium is present. Therefore, acidosis makes serum calcium go up! Remember, calcium acts like a sedative on all muscles of the body. Hypercalcemia

Acidosis = Hypercalcemia

Alkalosis: Alkalosis causes calcium to bind with plasma proteins. Therefore, alkalosis causes serum calcium to go down! Since, calcium (sedative) is low - Hypocalcemia, the muscles will not be relaxed; instead, the muscles will be tight and begin to twitch. Hypocalcemia = Trousseaus sign and Chvosteks sign

Alkalosis = Hypocalcemia (trousseaus sign and Chvostek sign)


Respiratory acidosis
What is it?
Respiratory acidosis is an acidbase imbalance that occurs when the pH is decreasedbelow 7.35and the partial pressure of carbon dioxide (PCO2) is increasedgreater than 45 mm Hg. (Note: Anytime you see the words partial pressure you are to know we are talking about arterial blood.)
DEFINE TIME Hypercapnia is a buildup of carbon dioxide in the blood to levels greater than 45 mm Hg.1 Anytime poor gas exchange exists, CO2 builds up in the blood. Respiratory acidosis will likely Occur

Hyperkalemia - Acidosis causes K_ to increase in the blood. To compensate for the respiratory acidosis, H_ (acid) moves out of the blood into the cell where K_ is now living. Now the blood is less acid. However, K_ does not want to live with H_ inside the cell, so K_ moves into the bloodstream causing the serum K_ to go up In respiratory acidosis the client is breathing too slowly, too shallow, or not breathing at all. In all 3 situations, the client is retaining CO2. Think hypoventilation first!

Quickie tests and treatments


Tests and treatments vary. They depend on the patient and/or the problem. _ Treat the cause. _ Airway clearance: possible intubation. _ Mechanical ventilation with PEEP. _ Goal is to have the client blow off the excess CO2.

_ Administer drugs to open up the airways and thin out secretions so they can be coughed up. _ Increase fluids to liquefy secretions so they can be coughed up more easily. _ Oxygen therapy. _ Respiratory therapy: breathing treatments. _ Elevate head of bed (HOB) for lung expansion. _ Monitor ABGs. _ Monitor for electrolyte imbalances. _ Monitor pulse oximetry. _ Administration of Pulmocare: a tube feeding sometimes used to decrease CO2 retention.
Hypoxia may be the first sign of respiratory acidosis. The early signs of hypoxia are restlessness and tachycardia. Early hypoxia: restlessness, tachycardia. Hypoxia causes the heart rate to increase to pump what little oxygen is left to the vital organs. Bradycardia occurs because the heart is not receiving enough oxygen. Late hypoxia: cyanosis, bradycardia.

Dont forget anything leading to respiratory problems or heart attack or shock and also look for decrease in LOC. Acute respiratory acidosis causes hyperkalemia. With chronic respiratory acidosis, the Kmay be normal as the kidneys have time to readjust and get the Kback into the normal range

Respiratory alkalosis
What is it?
Respiratory alkalosis is an acidbase imbalance where the PCO2 is less than 35 mm Hg and the pH is greater than 7.45. Basically, the pH is increased and the CO2 is decreased. As in respiratory acidosis, the lungs are the cause of the problem in respiratory alkalosis. _ The only way the PCO2 can decrease in the blood is through excessive exhalationhyperventilation. _ When the lungs are impaired, the kidneys compensate with their own chemicalsbicarbonate and H. _ The kidneys will retain Hbecause this is acid. We want to keep acid in order to replace the acid being lost from the hyperventilation. _ The kidneys will excrete bicarbonate because this is base. This

excretion of the base will help raise acid levels and restore the body to a normal pH. _ Respiratory alkalosis means that the client has lost excessive CO2 (acid), thus making the client alkalotic.
DEFINE TIME Hypocapnia occurs when the CO2 is low; hypercapnia occurs when the CO2 is high. Hyperapnia is hyperventilation.

You can get hypokalemia (low potassium) Hypokalemia H_ ions move out of the cell into the bloodstream to decrease alkalinity. K_ moves into the cells trying

to get away from H_, which decreases serum K_ The name respiratory tips you off to the fact that a lung problem exists Since it is a lung problem, the problem chemical is the acid carbon dioxide (CO2) Excessive exhalation causes PCO2 to decrease in the blood. Acid is lost When the lungs are impaired, the kidneys compensate with their own chemicalsbicarbonate and H. The kidneys will retain Hbecause this is acid. We want to keep acid since the body is losing acid from the excessive exhalation. The kidneys will excrete bicarbonatea basein order to create a more acidic environment and return the pH to normal Respiratory alkalosis means that the client has lost excessive CO2 (acid), thus making the client alkalotic

Metabolic acidosis
What is it?
Metabolic acidosis is an acidbase imbalance where the pH is less than 7.35 and the bicarbonate level is less than 22 mEq/L. Acid (Hions) builds up in the body, or too much bicarbonate has been lost from the body. Basically, the pH is decreased and the bicarbonate level is decreased. The less bicarb you have in the body, the more acid you will be. _ In metabolic disorders, the problem is not with the lungs but with the kidneys. _ Which chemicals are associated with the kidneys? Bicarbonate and H. _ The decrease in the alkaline substances (bases) causes a build up of acids in the body, causing acidosis. _ Which organ will compensate? The lungs will compensate by increasing respirations in an effort to blow off excess CO2 (acid) and therefore increase pH. _ The lungs will start compensating in just few minutes, but its not enough to correct the imbalance at this point.

Metabolic alkalosis
What is it?
Metabolic alkalosis is an acidbase imbalance where the pH is greater than 7.45 and the bicarbonate level is greater than 26 mEq/L. There is an excess of base in the body and a loss of acid. Basically, pH is increased and bicarbonate is increased. _ The lungs did not cause the problem; that is why it is a metabolic problem and not a respiratory one. _ Metabolic means the kidneys, which involve bicarbonate and H. _ The lungs compensate by retaining CO2 by means of hypoventilation. This compensates for the alkalosis and helps the pH go down into normal range. Causes

The two most common causes of metabolic alkalosis are loss of stomach acid and diuretics.

Hypokalemia Vomiting may have caused initial imbalance. As Kmoves into the cells, serum Kdrops. Hmoves into the bloodstream, increasing serum acidity

The ABGs of metabolic alkalosis will look like: pH greater than 7.45 and HCO3 greater than 26 mEq/L. If compensation has begun, PCO2 will increase.

Acidosis: Think hyperkalemia and hypercalcemia. Alkalosis: Think hypokalemia and hypocalcemia. Recap of metabolic alkalosis The problem is with the kidneys, not the lungs Bicarbonate (base) and H(acid) are associated with the kidneys Metabolic alkalosis can be caused by increased bicarbonate through diuretic therapy, prolonged nasogastric suctioning, and excessive vomiting, resulting in  pH levels

The lungs compensate by retaining CO2 by means of hypoventilation. This compensates for the alkalosis