Nursing 113-exam 2
Acid-Base Balance
ØRefers to the homeostasis of the hydrogen ion (H-) concentration in the plasma
high amount of hydrogen ions is considered
an acid
low amount of hydrogen ions is considered an
alkaline or base
Buffer Systems:
Hydrogen ion concentration is determined by the ratio of
carbonic acid to bicarbonate
For homeostasis, we need the ratio to be
1 part carbonic acid to 20 parts bicarbonate
10=
basic
Normal pH is between
7.35-7.45
pH <7.35
is acid
pH >7.45
alkaline/base
By hyperventilation we remove carbon dioxide from the blood which lowers the
carbonic acid levels and raises pH which makes the body more alkaline
If there is too much alkaline in the blood, the body hypoventilation and we retain
carbon dioxide
which results in lower pH and makes the body more acidic
Kidneys can
can return the pH back to normal
Blood buffers are immediate and continuous
Respiratory works in minutes
Kidneys works in hours/days
However all of them can increase/decrease pH
Respiratory Acidosis Symptoms
Tachycardia, elevated BP, confusion, decreased LOC
respiratory alkalosis causes:
by hyperventilation;
anxiety, adult respiratory distress syndrome, CHF, head trauma, severe blood loss
respiratory alkalosis treatment:
sedation and reassurance; breathing into a paper bag will cause rebreathing of the
exhaled carbon dioxide
Respiratory Alkalosis symptoms
Lightheadedness, inability to concentrate, numbness and tingling, tachycardia,
ventricular and atrial arrhythmias.
Metabolic Acidosis
retaining too many acids or losing too many bases
Metabolic Acidosis Effect:
, hyperventilation, as the lungs attempt to compensate by blowing off carbon dioxide to
lower the Pco2 level
Metabolic Acidosis Treatment
is the administration of sodium bicarbonate
Metabolic Acidosis symptoms:
Headache, decreased LOC, lethargy
Kussmaul respirations (deep/rapid)
Abd pain, anorexia, diarrhea, N/V
Metabolic alkalosis
•significant amount of acid is lost from the body or an increase in the bicarbonate level
occurs;
•The most common cause is vomiting gastric content, normally high in acid;
•Renal acid loss
Metabolic Alkalosis Symptoms
slow, shallow RR with periods of apnea
anorexia, N/V, atrial tachycardia
hypertonicity of muscles, tetany, tremors
•PaCO2 normal range:
35-45
HCO3- range
22-26
HCO3-, is a measure of
renal metabolic component of acid-base balance
HCO3- increases, the pH
increases
HCO3- decreases, the pH
decreases
Acute renal failure is a
reversible syndrome that results in decreased GFR and oliguria low urine output
Chronic renal failure (ESRD) is a
progressive, irreversible deterioration of renal function that results in azotemia elevation
of serum BUN & Creatinine
Creatinine
waste product of muscle metabolism;
Normal serum level - 0.7 to 1.4 mg/dL
BUN
Normal level - 10 to 20 mg/dL;
Breakdown of protein
complications of AKI; Acute kidney injury
´Metabolic acidosis
´Fluid & Electrolyte imbalances
Acute kidney injury treatment
aimed at replacing the renal function
´Minimize potential lethal complications
´Reduce potentially increased kidney injury
Phases of AKI
Acid-Base Balance
ØRefers to the homeostasis of the hydrogen ion (H-) concentration in the plasma
high amount of hydrogen ions is considered
an acid
low amount of hydrogen ions is considered an
alkaline or base
Buffer Systems:
Hydrogen ion concentration is determined by the ratio of
carbonic acid to bicarbonate
For homeostasis, we need the ratio to be
1 part carbonic acid to 20 parts bicarbonate
10=
basic
Normal pH is between
7.35-7.45
pH <7.35
is acid
pH >7.45
alkaline/base
By hyperventilation we remove carbon dioxide from the blood which lowers the
carbonic acid levels and raises pH which makes the body more alkaline
If there is too much alkaline in the blood, the body hypoventilation and we retain
carbon dioxide
which results in lower pH and makes the body more acidic
Kidneys can
can return the pH back to normal
Blood buffers are immediate and continuous
Respiratory works in minutes
Kidneys works in hours/days
However all of them can increase/decrease pH
Respiratory Acidosis Symptoms
Tachycardia, elevated BP, confusion, decreased LOC
respiratory alkalosis causes:
by hyperventilation;
anxiety, adult respiratory distress syndrome, CHF, head trauma, severe blood loss
respiratory alkalosis treatment:
sedation and reassurance; breathing into a paper bag will cause rebreathing of the
exhaled carbon dioxide
Respiratory Alkalosis symptoms
Lightheadedness, inability to concentrate, numbness and tingling, tachycardia,
ventricular and atrial arrhythmias.
Metabolic Acidosis
retaining too many acids or losing too many bases
Metabolic Acidosis Effect:
, hyperventilation, as the lungs attempt to compensate by blowing off carbon dioxide to
lower the Pco2 level
Metabolic Acidosis Treatment
is the administration of sodium bicarbonate
Metabolic Acidosis symptoms:
Headache, decreased LOC, lethargy
Kussmaul respirations (deep/rapid)
Abd pain, anorexia, diarrhea, N/V
Metabolic alkalosis
•significant amount of acid is lost from the body or an increase in the bicarbonate level
occurs;
•The most common cause is vomiting gastric content, normally high in acid;
•Renal acid loss
Metabolic Alkalosis Symptoms
slow, shallow RR with periods of apnea
anorexia, N/V, atrial tachycardia
hypertonicity of muscles, tetany, tremors
•PaCO2 normal range:
35-45
HCO3- range
22-26
HCO3-, is a measure of
renal metabolic component of acid-base balance
HCO3- increases, the pH
increases
HCO3- decreases, the pH
decreases
Acute renal failure is a
reversible syndrome that results in decreased GFR and oliguria low urine output
Chronic renal failure (ESRD) is a
progressive, irreversible deterioration of renal function that results in azotemia elevation
of serum BUN & Creatinine
Creatinine
waste product of muscle metabolism;
Normal serum level - 0.7 to 1.4 mg/dL
BUN
Normal level - 10 to 20 mg/dL;
Breakdown of protein
complications of AKI; Acute kidney injury
´Metabolic acidosis
´Fluid & Electrolyte imbalances
Acute kidney injury treatment
aimed at replacing the renal function
´Minimize potential lethal complications
´Reduce potentially increased kidney injury
Phases of AKI
