Acid Base Balance

Ms. Annie George

 What is pH?
pH is a measurement of acidity.
It just measures how acidic something is.
When referencing acidity, we're talking
about excess hydrogen ions (H+), but
we're just going to use the general term
"acid."
The pH scale goes from 0-14,
so neutral is 7 (water is
neutral.)
The body needs a pH of 7.35-
7.45 to maintain homeostasis.
 You want to keep the body neither too
acidic or too alkaline, you want to balance
it.
This is all Acid-Base balance means.
 So...
ACIDIC - TOO MUCH ACID - Lower than
7.35 means that there is too much acid in
your system.
NORMAL - Just right! pH between 7.35
and 7.45 is perfect for homeostasis.
ALKALINE - NOT ENOUGH ACID - It just
means NOT acidic enough. pH higher than
7.45 is considered Alkaline.
 Test yourself!
Your patient has a ph of 6.9 Is he acidic or
alkalotic?
Your patient has a ph of 7.4 Is he acidic or
alkalotic?
Your patient has a ph of 7.7 Is he acidic or
alkalotic?
Your patient has a ph of 7.25 Is he acidic or
alkalotic?
Your patient has a ph of 7.43 Is he acidic or
alkalotic?
Your patient has a ph of 8.0 Is he acidic or
alkalotic?
 Really important....!!
You take in oxygen by inhaling, your body
turns oxygen into carbon dioxide, you exhale
and remove the carbon dioxide from your
body.
Carbon dioxide is "respiratory acid."
When you're not breathing adequately, you
are not getting rid of this "respiratory acid"
and it builds up in the tissues.
The extra CO2 molecules combine with water
in your body to form carbonic acid and makes
your pH go up.
This is bad.
 How do we measure it?

We can measure the amount of respiratory

acid in the arterial blood using blood
gases.
They measure the amount of each gas in
your blood.
We measure the pH, the amount of carbon
dioxide (PaCO2) and the amount of
oxygen in the blood (PaO2).
 Respiratory Acid Check!
PaCO2 is the partial pressure of carbon
dioxide.
We can measure it to see how much
respiratory acid (CO2) there is in the
blood.
We use arterial blood gas tests to check it.
How much respiratory acid (CO2) should
there be?
The normal value is 35-45 mmHg
 The (a) in PaCO2 just stands for
arterial.
If you measured venous blood
gasses, the levels are different and
PvCO2 is used.
If CO2 is HIGH, it means there is a
buildup of respiratory acids
because he's not breathing
enough CO2 away.
If your pH is acidic, and your CO2 is
HIGH, its considered respiratory
acidosis.
 If CO2 is LOW, it means there are not
enough respiratory acids because he's
probably hyperventilating too much CO2
away.
When pH is high, and CO2 is low, this is
called Respiratory Alkalosis.
 Information Tip....!
pETCO2 (End Tidal Carbon Dioxide) is
sometimes used and is expressed as a
percentage.
A pETCO2 of 5-6% roughly equates to a
PaCO2 of 35-45mmHg, so titrate your
ventilations to achieve 5-6% pETCo2.
 Quick Rule for testing!
Inadequate breathing - Respiratory
Acidosis - PH will be low, CO2 level will be
high, because he's not breathing it off.

Hyperventilating patients - Respiratory

Alkalosis - PH will be high, CO2 levels will
be low, because they're breathing off too
much CO2.
 Making it simple:::::!

If your CO2 is LOW, then DECREASE rate

and depth of ventilations.

If your CO2 is HIGH, then INCREASE rate

and depth of ventilations.
Review...!
 Respiratory Acidosis

NOT Breathing adequately - NOT exhaling

enough means you aren't getting rid of CO2
therefore pCO2 (percent of Co2 is HIGH!)
Clinical Presentation: Altered LOC,
Tachycardic, Diaphoresis, headache
Causes: Crappy or no respirations (COPD,
Overdose, Pneumonia, Smoke inhalation,
Pneumothorax, airway obstruction)
Treatment - Increase rate and depth of
ventilations - Bag them, so you get rid of some
CO2 for them.
 Respiratory Alkalosis

Blowing off too much CO2, as in

hyperventilation.
When there is not enough CO2 in the
blood, the body uses bicarb to
compensate for the lack of respiratory
acid. (Metabolic compensation)
Clinical Presentation: Numbness or
muscle twitch in fingers, toes, seizures
 Contd...
Cause: Shock, DKA Kussmaul
Respirations - Deep and FAST breathing!
(The body is trying to compensate for its
metabolic acidosis by producing a
respiratory alkalosis on purpose.) Caused
by (anxiety, pain, fever, hypotension,
hypoxia, CHF, PE, Sepsis)
Treatment: decrease rate and depth of
ventilations. (Calm them down or stop
bagging so fast.)
 Test Yourself!
Is it Respiratory Acidosis,
Respiratory Alkalosis, or Normal?
Your patient's PH is 7.25, and his PaCO2 is
20mmHg.
Your patient's PH is 7.75, and his PaCO2 is
20mmHg.
Your patient's PH is 6.25, and his PaCO2 is
45mmHg.
Your patient's PH is 7.55, and his PaCO2 is
69mmHg.
 Metabolic...!
Metabolic just means it has to do with
metabolism.
Metabolism just means the chemical
changes that sustain life.
Oxygen combines with glucose to create
energy.
Carbon dioxide is a waste product of this
process.
CO2 is then carried from the blood to the
alveoli to the lungs for expiration.
 We blow off this respiratory acid when
ventilations are sufficient. Your body
produces a buffer known as bicarbonate
that is alkaline and it binds up with excess
acids and turns it neutral.
Bicarbonate is like Tums for your
bloodstream.
 Bicarbonate....
HCO3 is the amount of bicarbonate in the
bloodstream.
HCO3 is just the chemical name for
bicarbonate.
Normal is 22-26/mEq/l (milliequivalents
per liter)
This measures how much Tums are in
your blood binding up the excess acid.
 Abnormalities...!
If your HCO3 (Tums) level is 10, it means
that there is not enough of it, and so the
acid in your blood just builds up and the
overall pH of your body goes DOWN!
This is called Metabolic Acidosis.
To fix it, we bring bicarbonate levels up by
administering Bicarb via IV!
 Abnormalities...!
If there's too much, it binds up too much
acid and there isn't enough, so now your
pH goes alkaline!
This is called Metabolic Alkalosis.
Fix it by keeping your patient stable long
enough for the bicarb to work itself out.
Review...!
 Metabolic Acidosis
Acid in the blood is used to combine with
oxygen and metabolize it. If you do not
have enough oxygen rich blood circulating,
the acid is not used and builds up.
Clinical Presentation: Tachycardia,
Pulmonary edema, Tachypnea, confusion
or coma
 Cause: Cardiac arrest, renal failure, DKA,
diarrhea for a long time, ASA or antifreeze
Overdose
Treatment - Increase rate and depth of
Ventilations. Consider Bicarbonate - Its
like Tums for your blood. It binds up the
acid in your body and turns it neutral.
 Metabolic Alkalosis

Too much bicarbonate, not enough acid

Clinical Presentation: Seizures, Headache,
Dysrhythmias
Cause: Diuretics, cystic fibrosis, chewing
tobacco, penicillin, overzealous bicarb
administration
Treatment: Keep them alive long enough
for their body to use up the excess bicarb.
Handy Dandy Quick Reference
 Test Yourself!

If you have blood gases, first consider

whether your patient is acidotic or alkalotic
by evaluating the pH.
Then, determine whether the cause is
respiratory or metabolic.
 What is your Diagnosis?
Your patient has a PH of 7.25, a CO2 of
60mmHg and HCO3 22
Your patient has a PH of 7.25, a CO2 of
45mmHg and HCO3 40
Your patient has a PH of 7.4, a CO2 of
40mmHg and HCO3 25
Your patient has a PH of 7.25, a CO2 of
50mmHg and HCO3 21
Your patient has a PH of 7.45, a CO2 of
24mmHg and HCO3 22
 Kidneys
The kidneys also have a fail safe switch on
them.
If your pH is too high when it hits the kidney
filter, your kidney senses it and flushes
MORE acid out with your urine.
Similarly, if your kidneys sense that you
don't have enough acid, they kick out less
acid into your urine.
Unfortunately, the kidneys take awhile to
process it, so it takes hours or days for it to
compensate.
 Reference
https://medictests.com/acid-base-balance/
See you in the next class!
BYE....till then!