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Acid-Base
Balance
Respiratory Alkalosis
pH > 7.45, PaCO2 <35mm Hg.
Causes
Salicylate toxicity (early phase),
anxiety, hysteria, tentany,
strenuous exercise (swimming,
running), fever, hyperthyroidism,
delirium tremens, PE
Per Kee
Metabolic Acidosis
pH < 7.35, HCO3 <24 mEq/l
Causes:
Diabetic ketoacidosis, severe
diarrhea, starvation/malnutrition,
shock, burns, kidney failure, acute
myocardial infarction
Per Kee
Metabolic Alkalosis
pH > 7.45, HCO3 > 28 mEq/l
Causes:
Severe vomiting, gastric suction, peptic
ulcer, K loss, excess administration of
bicarbonate, hepatic failure, cystic fibrosis
Drug Influence:
NaHCO3 (sodium bicarbonate)
K oxalate
Clinical Manifestations -
Acidosis
Neuro
Drowsiness: Resp
or Metab
Disorientation:
Resp
Confusion: Metab
Headache: Resp or
Metab
Dizziness: Resp
Coma: Resp or
Clinical - Acidosis
Cardiovascular
< BP: Resp or Metab
Warm flushed skin (related to
peripheral vasocilation): Resp
or Metab
V Fib (related to >K from
compensation): Resp
Arrhythmias (related to >K
from compensation): Metab
Clinical - Acidosis
GI
N/V, diarrhea, abd pain: Metab
Nothing significant: Resp
Neuromuscular
Seizures: Resp
Nothing significant: Metab
Resp
Hypoventilation w/hypoxia: Resp
Deep, rapid resp
(compensation): Metab
Clinical Manifestations -
Alkalosis
Neuro
Cardiovascular
Lethargy: Resp
Tachycardia: Resp
or Metab
Light-headedness:
Resp
Arrhythmias
(related to <K
Confusion: Resp or
from
Metab
compensation):
Dizziness: Metab Resp or Metab
Irritability: Metab
Nervousness:
Metab
Clinical - Alkalosis
GI
Neuromuscular
Tetany: Resp or Metab
Nausea: Resp Seizures: Resp or Metab
or Metab Numbness: Resp
Vomiting: Resp Tingling of extremities:
or Metab Resp
Epigastric pain: Tingling of fingers/toes:
Resp Metab
Anorexia:
Hyperreflexia: Resp
Metab
Muscle cramps: Metab
Hypertonic muscles:
Clinical - Alkalosis
Respiratory
Hyperventilation
(lungs unable to
compensate):
Resp
Hypoventilation
(compensatory
action by lungs):
Metab
Arterial vs Venous values
ABG vs VBG
Parameter ABG VBG
pH 7.35-7.45 7.32-7.42
pCO2 35-45 45-55
HCO3 20-30 20-30
PO2 80-100 40-50
O2 Sat 96-100% 60-
85%
BE ±2.0 ±2.0
A few questions to ponder
In respiratory
acidosis, does
Is this metabolic carbonic acid
acidosis or alkalosis? increase or
Respiratory Alkalosis decrease?
pH < 7.35,
can be caused by
HCO3 <24 mEq/l
hyper- or hypo-
ventilation?
Functional Health Patterns
Health perception-Health management
pt currently has F,E, or A/B problem
Obtain description of illness including
Onset, course, treatment
Nutritional-metabolic
Questions re diet
Any special diets? (weight-loss, low-Na, fad)
Determine ability to comply with dietary
prescriptions
More patterns
Elimination
Usual b/b habits
Any deviations? Diarrhea?
Nocturia? Polyuria?
Activity-exercise
Usual level
activity/exercise
Excessive perspiration?
Exposure to high temps?
What do they do to
replace lost F/E?
One more pattern
Cognitive-perceptual
Any changes in sensations?
Numbness? Tingling? Fasciculations
(uncoordinated twitching of a single muscle
group)?
Ask pt and family
Any changes in mentation or alertness?
Confusion? memory impairment? Lethargy?