ACID BASE BALANCE

By
Mahendra Varma R
8th sem
2015 batch
• Normal pH of blood is 7.36 – 7.44
• Factors that control pH in body are: buffer, renal
control of pH , respiratory control of pH
• Buffer is a combination of weak acid and conjugate
base
• Buffers in our body include bicarbonate buffer ,
phosphate buffer , protein buffer(these are
extracellular natural buffers)
• Intracellular natural buffer include hemoglobin and
other protein buffer
• Acidosis is pH < 7.35
• Alkalosis is pH > 7.45
• pH of blood is calculated by Henderson- Hasselbalch
equation
• pH = pKa + log HCO3-/H2CO3
• pCO2 > 45 mmHg ( respiratory acidosis )
• pCO2 < 35 mmHg ( respiratory alkalosis )
• HCO3 > 27 mmol/L ( metabolic alkalosis )
• HCO3 < 22 mmol/L ( metabolic acidosis )
1. A patient was operated for intestinal obstruction
and had gastric aspiration for 3 days .
• Blood pH – 7.55
• pCO2 – 50 mmHg
• HCO3 – 30 mEq/L
Interpret the data and comment on acid – base balance
 METABOLIC ALKALOSIS
• A standard bicarbonate above 27 mmol/litre
Causes are :
1. Repeated vomitting ,seen comonly in pyloric
stenosis ( hypokalaemic alkalosis )
2. Excess alkali ingestion
3. Cushing syndrome or excess cortisol intake
• Clinical features are Cheyne stokes breathing &
tetany
• investigations include serum electrolyte assessment
& arterial blood gas analysis
• Treatment :
1. Normal saline or double strength saline IV infusion ,
with slow IV KCl 40mmol/litre in saline
2. If pH > 7.7 rapid correction using HCl or ammonium
chloride infusion
2. Interpret the data and give the type of acid base
disturbance :

Blood pH - 7.54
pCO2 – 20 mmHg
HCO3 – 26 mEq/L
 RESPIRATORY ALKALOSIS
• Arterial PCO2 below normal ( < 35 mmHg )
• Causes are :
1. Hyperventilation during anaesthesia
2. High altitude
3. Hyperpyrexia
• Clinical features & management :
1. Headache , tingling , tetany , arrhythmias
2. Low PaCO2 , low HCO3 and high pH
• Managed by oxygen therapy
• Treatment of underlying cause, acetazolamide
therapy in high altitude
• Respiratory suppression due to alkalosis is treated
by CO2
3. Female suffering from insulin dependent diabetes
with pH of 7.2 , HCO3 – 17 mmol/L & pCO2 – 20
mmHg
 METABOLIC ACIDOSIS
• It is an excess acid or base deficit.
• A standard bicarbonate below 21 mmol/litre
• Causes :
1. Diabetic ketoacidosis
2. Starvation
3. Hypoxia
4. Renal insufficiency
• Above causes are examples for increased acid
concentration
• Loss of base is seen in following conditions :
1. Diarrhoea
2. Ulcerative colitis
3. Gastrocolic fistula
4. Intestinal fistula
• Clinical features :
1. Rapid, deep, noisy breathing (air-hunger)-
kussmaul’s breathing
2. Cold clammy skin, tachycardia
3. Urine is strongly acidic.
4. Low standard HCO3 level.
5. Base deficit
• Evaluated by arterial blood gas analysis (ABG)
• Showing low HCO3 , low pH , anion gap
• Treatment :
 Correction of hypoxia
 50 mmol of 8.4 % sodium bicarbonate infusion IV
• Sodium bicarbonate required in mEq/L = Body
weight in kg × Base deficit × 0.3
 correction of electrolytes
 Specific treatment for lactic acidosis
 Specific treatment for diabetic ketoacidosis ,
alcoholic acidosis etc
4. Interpret the data and give the type of acid base
disturbance :

Blood pH - 7.12
pCO2 – 80 mmHg
HCO3 – 26 mEq/L
 RESPIRATORY ACIDOSIS
• It is a feature of respiratory failure with high arterial
PCO2 causing fall in pH ( > 45 mmHg )
• Causes :
During and after anaesthesia.
Chronic bronchitis.
Emphysema.
Thoracic diseases
Myasthenia gravis
• Features & management :
• Dyspnoea , confusion , hallucination
• Tremors , jerks , sleep disturbances
• Managed by oxygen therapy , ventilator support
• Oxygen therapy should not be used in chronic
hypercapnoea unless respiration is suppressed
• Alkali therapy not required unless in severe acidosis
ie ., pH < 7.15
THANK YOU