ACID BASE BALANCE
RULE OF THE B’S
1. If the pH and the Bicarb are in the same direction METABOLIC
2. If the pH and the Bicarb are in different directions RESPIRATORY
Examples:
pH 7.25 (v) pH 7.21 (v)
HCO3 20 (v) HCO3 38 (^)
Metabolic Acidosis Respiratory Acidosis
pH 7.50 (^) pH 7.50 (^)
HCO3 30 (^) HCO3 25 (normal)
Metabolic Alkalosis Respiratory Alkalosis (NORMAL)
SIGNS & SYMPTOMS
Know the principles, not the lists.
PRINCIPLE: “As the pH goes, so does my patient, except for potassium”
ALKALOSIS (^) ACIDOSIS (v)
Hyperreflexia Headache
Irritability Hyporeflexia
Tachypnea Bradycardia
Tachycardia Bradypnea
Borborygmi Paralytic/adynamic ileus
Seizures *need suction Coma
Hypokalemia Respiratory arrest *need ambu bag
HYPOkalemia MACkussmau’s (ONLY METABOLIC
ACIDOSIS “MAC”)
Heart block
HYPERkalmia
,CAUSES OF IMBALANCES
1. Is it a LUNG SCENARIO? YES. It is RESPIRATORY.
OVER-VENTILATING UNDER-VENTILATING
RESPIRATORY ALKALOSIS RESPIRATORY ACIDOSIS
Examples: Examples:
- Pregnant woman hyperventilating. - Emphysema
- Ventilator setting is TOO HIGH. - Drowning
- Pneumonia
- PCA pump (toxicity)
- Ventilator setting is TOO LOW.
2. What if it is NOT A LUNG SCENARIO? It is METABOLIC
PROLONGED SUCTIONING ANYTHING ELSE!
OR VOMITING
METABOLIC Alkalosis METABOLIC Acidosis
Examples: Examples:
- Surgery with NG tube suction for - Acute RF
3 days - Infantile diarrhea
- Hyperemesis gravidum - 3rd degree burns over 60% of body
- Hyperemesis gravidum
with dehydration
NOTE: Always pay attention to
MODIFYING PHRASE rather than
original statement.
.
, VENTILATORS AND ALARMS
HIGH PRESSURE ALARM
Ventilator is working too hard to get air into lungs. There is INCREASED RESISTANCE due to
OBSTRUCTIONS.
1. Kinks unkink
2. Water condensing into dependent loops empty
3. Mucus in airway turn, cough and deep breathe, suction PRN.
LOW PRESSURE ALARM
Ventilator finds that it is working too easy to get air into lungs. There is DECREASED
RESISTANCE due to DISCONNECTIONS.
1. Main tubing is disconnected reconnect
2. Oxygen sensor tubing, which senses FiO2, is disconnected. This is the black
coated wire reconnect
Question
MD orders to disconnect ventilator in AM @ 0900hr. At 0600hr, ABC reveals respiratory
acidosis. What do you do?
a. Follow order
b. Call MD and hold order
c. Call RT
d. Begin to decrease settings.
B is the answer because the patient is not able to breathe without the ventilator. The settings
are TOO low. Patient should be in respiratory ALKALOSIS.
, ALCOHOLISM
#1 PROBLEM: DENIAL
Psychological problem in abuse is denial, which is refusal to accept the reality of a problem.
Denial is the #1 problem in all abuse situations.
It is #1 because how can you treat someone who can’t admit that they have a problem?
You treat denial by confronting it by pointing out the difference between what they say and
what they do.
Confrontation attacks the problem. Aggression attacks the person.
You say you’re not an alcohol, but it’s 10AM and you already drank a 6-pack.
You say you’re not a spouse abuser, but she has a restraining order against you.
They deny, you confront.
Denial of loss + grief is different.
Stages of Grief: DABDA: Denial, anger, bargaining, depression, and acceptance
You want to support this type of denial.
Guy lost one hand and wants to play piano. You do not tell him he can’t. You ask him more
about piano.
Pay attention to the question, is it loss or abuse?
With loss you support. With abuse you confront.
#2 PROBLEM: DEPENDENCY VERSUS CODEPENDENCY
Dependency: Abuser gets significant other to do things for them. The abuser is dependent on
others.
Call in sick for me. Go buy me this. Drop me off here.
Codependency: Significant other derives positive self-esteem from making decisions for or
doing things for the abuser.
Aren’t I such a great wife for calling in sick for you?
Abuser: Life without responsibility
Significant Other: Positive self esteem
Treatment:
Set limits and enforce them. Teach significant other to say NO.
Work on self-esteem of the codependent person to solve the issue.
o I’m saying no and I’m a good person because I’m saying no.
May solve the problem but may lose relationship.
#3 PROBLEM: MANIPULATION
RULE OF THE B’S
1. If the pH and the Bicarb are in the same direction METABOLIC
2. If the pH and the Bicarb are in different directions RESPIRATORY
Examples:
pH 7.25 (v) pH 7.21 (v)
HCO3 20 (v) HCO3 38 (^)
Metabolic Acidosis Respiratory Acidosis
pH 7.50 (^) pH 7.50 (^)
HCO3 30 (^) HCO3 25 (normal)
Metabolic Alkalosis Respiratory Alkalosis (NORMAL)
SIGNS & SYMPTOMS
Know the principles, not the lists.
PRINCIPLE: “As the pH goes, so does my patient, except for potassium”
ALKALOSIS (^) ACIDOSIS (v)
Hyperreflexia Headache
Irritability Hyporeflexia
Tachypnea Bradycardia
Tachycardia Bradypnea
Borborygmi Paralytic/adynamic ileus
Seizures *need suction Coma
Hypokalemia Respiratory arrest *need ambu bag
HYPOkalemia MACkussmau’s (ONLY METABOLIC
ACIDOSIS “MAC”)
Heart block
HYPERkalmia
,CAUSES OF IMBALANCES
1. Is it a LUNG SCENARIO? YES. It is RESPIRATORY.
OVER-VENTILATING UNDER-VENTILATING
RESPIRATORY ALKALOSIS RESPIRATORY ACIDOSIS
Examples: Examples:
- Pregnant woman hyperventilating. - Emphysema
- Ventilator setting is TOO HIGH. - Drowning
- Pneumonia
- PCA pump (toxicity)
- Ventilator setting is TOO LOW.
2. What if it is NOT A LUNG SCENARIO? It is METABOLIC
PROLONGED SUCTIONING ANYTHING ELSE!
OR VOMITING
METABOLIC Alkalosis METABOLIC Acidosis
Examples: Examples:
- Surgery with NG tube suction for - Acute RF
3 days - Infantile diarrhea
- Hyperemesis gravidum - 3rd degree burns over 60% of body
- Hyperemesis gravidum
with dehydration
NOTE: Always pay attention to
MODIFYING PHRASE rather than
original statement.
.
, VENTILATORS AND ALARMS
HIGH PRESSURE ALARM
Ventilator is working too hard to get air into lungs. There is INCREASED RESISTANCE due to
OBSTRUCTIONS.
1. Kinks unkink
2. Water condensing into dependent loops empty
3. Mucus in airway turn, cough and deep breathe, suction PRN.
LOW PRESSURE ALARM
Ventilator finds that it is working too easy to get air into lungs. There is DECREASED
RESISTANCE due to DISCONNECTIONS.
1. Main tubing is disconnected reconnect
2. Oxygen sensor tubing, which senses FiO2, is disconnected. This is the black
coated wire reconnect
Question
MD orders to disconnect ventilator in AM @ 0900hr. At 0600hr, ABC reveals respiratory
acidosis. What do you do?
a. Follow order
b. Call MD and hold order
c. Call RT
d. Begin to decrease settings.
B is the answer because the patient is not able to breathe without the ventilator. The settings
are TOO low. Patient should be in respiratory ALKALOSIS.
, ALCOHOLISM
#1 PROBLEM: DENIAL
Psychological problem in abuse is denial, which is refusal to accept the reality of a problem.
Denial is the #1 problem in all abuse situations.
It is #1 because how can you treat someone who can’t admit that they have a problem?
You treat denial by confronting it by pointing out the difference between what they say and
what they do.
Confrontation attacks the problem. Aggression attacks the person.
You say you’re not an alcohol, but it’s 10AM and you already drank a 6-pack.
You say you’re not a spouse abuser, but she has a restraining order against you.
They deny, you confront.
Denial of loss + grief is different.
Stages of Grief: DABDA: Denial, anger, bargaining, depression, and acceptance
You want to support this type of denial.
Guy lost one hand and wants to play piano. You do not tell him he can’t. You ask him more
about piano.
Pay attention to the question, is it loss or abuse?
With loss you support. With abuse you confront.
#2 PROBLEM: DEPENDENCY VERSUS CODEPENDENCY
Dependency: Abuser gets significant other to do things for them. The abuser is dependent on
others.
Call in sick for me. Go buy me this. Drop me off here.
Codependency: Significant other derives positive self-esteem from making decisions for or
doing things for the abuser.
Aren’t I such a great wife for calling in sick for you?
Abuser: Life without responsibility
Significant Other: Positive self esteem
Treatment:
Set limits and enforce them. Teach significant other to say NO.
Work on self-esteem of the codependent person to solve the issue.
o I’m saying no and I’m a good person because I’m saying no.
May solve the problem but may lose relationship.
#3 PROBLEM: MANIPULATION
