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Acid-Base Balance Interactive Tutorial Emily Phillips MSN 621 Spring 2009 E-mail: emmalemmaRN@hotmail.com All images imported from Microsoft Clipart & Yahoo Image gallery
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How to navigate this tutorial: To advance to the next slide click on the box To return to the previous slide click on the box To return to the Main Menu: click the box Hover over underlined text for a definition/explanationunderlined text To return to the last slide viewed click on the button Click the for additional information
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Objectives: Define acid base balance/imbalance Explain the pathophysiology of organs involved in acid base balance/imbalance Identify normal/abnormal and compensated/uncompensated lab values Explain symptoms related to acid base imbalances and compensated vs. uncompensated Appropriate interventions and expected outcomes
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Main Menu: Acid-Base PretestThe Buffer Systems ABG Interpretation & Case Studies Acid-Base Review test Diagnostic Lab Values Metabolic Distubances Respiratory DisturbancesAcid-Base Compensation
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Acid-Base Pretest: What is the normal range for arterial blood pH? 7.38 – 7.46 7.40 – 7.52 7.35 – 7.45
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Incorrect Close but not quite… try again. Next QuestionPrevious Question
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Incorrect Close, but no cigar… 7.52 would indicate alkalosis. Next QuestionPrevious Question
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Correct! This is the correct parameters for arterial blood pH with the extracellular fluid in the middle at 7.40… well done! Next QuestionPrevious Question
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Acid-Base Pretest: What 2 extracellular substances work together to regulate pH? Sodium bicarbonate & carbonic acid Carbonic acid & bicarbonate Acetic acid & carbonic acid
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Incorrect Sorry, but not exactly… although sodium bicarbonate plays a role as a buffer in acid-base balance it isn’t 1 of the extracellular substances that works to regulate pH Next QuestionPrevious Question
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Correct! Right on! Carbonic acid and bicarbonate are the two primary extracellular regulators of pH. pH is also further regulated by electrolyte composition within the intra & extracellular compartments. Next QuestionPrevious Question
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Incorrect Although carbonic acid is 1 of 2 extracellular substances that work to regulate pH, acetic acid is not; it’s simply a weak acid. Next QuestionPrevious Question
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Acid-Base Pretest: Characterize an acid & a base based on the choices below. Acids release hydrogen (H + ) ions & bases accept H + ions. Acids accept H + ions & bases release H + ions Both acids & bases can release & accept H + ions
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Correct! Acids are molecules that have the ability to release H + ions & bases are molecules that have the ability to accept or bind with H + ions. Next QuestionPrevious Question
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Incorrect Think this through and try again. Acids increase the concentration of H + ions & bases decrease the concentration. Think of an acid like a wet sponge & a base as a dry sponge. What happens when you squeeze a wet sponge? Likewise, what happens to a dry sponge when placed in a bucket of water? Next QuestionPrevious Question
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Incorrect If you think of an acid as wet sponge & a base as a dry sponge; what happens when a wet sponge gets squeezed & a dry sponge gets wet? Next QuestionPrevious Question
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Acid-Base Pretest: Buffering is a normal body mechanism that occurs rapidly in response to acid- base disturbances in order to prevent changes in what? HCO 3 - H 2 CO 3 H+H+
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Incorrect HCO 3 - is its own buffer system which is very important because HCO 3 - can be regulated by the kidneys & CO 2 by the lungs. Nice try, but think again… Next QuestionPrevious Question
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Incorrect The bicarbonate buffer system utilizes carbonic acid & sodium bicarbonate to buffer, but carbonic acid is NOT the major ion involved in acid-base balance. Next QuestionPrevious Question
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Correct! Excellent! H + ion concentration is most important to regulate in order to prevent acid-base balance disturbances. Next QuestionPrevious Question
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Acid-Base Pretest: What are the two systems in the body that work to regulate pH in acid-base balance & which one works fastest? The Respiratory & Renal systems Renal The Respiratory & Renal systems Respiratory The Renal & GI systems Renal
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Incorrect These two systems do work together to regulate pH in acid-base imbalance, however, the renal system works over a matter of days as opposed to hours… think it over & try again. End PretestPrevious Question
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Correct! Great work! Both the respiratory & renal systems work to regulate pH in acid- base imbalance; the respiratory system works in a matter of minutes & is maximal within 12-24 hours while the renal (kidneys) system continues to function for days to restore pH within normal limits (WNL). End PretestPrevious Question
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Incorrect The renal system does work to regulate pH in acid-base imbalance, but the GI system does not… try again. End PretestPrevious Question
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Acid-Base Balance: Homeostasis of bodily fluids at a normal arterial blood pH Homeostasis pH pH is regulated by extracellular carbonic acid (H 2 CO 3 ) and bicarbonate (HCO 3 - )carbonic acid (H 2 CO 3 ) bicarbonate (HCO 3 - ) Acids are molecules that release hydrogen ions (H + ) A base is a molecule that accepts or combines with H + ionsbase
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Acids and Bases can be strong or weak: A strong acid or base is one that dissociates completely in a solution dissociates - HCl, NaOH, and H 2 SO 4HCl, NaOH, and H 2 SO 4 A weak acid or base is one that dissociates partially in a solution -H 2 CO 3, C 3 H 6 O 3, and CH 2 OH 2 CO 3, C 3 H 6 O 3, and CH 2 O
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The Body and pH: Homeostasis of pH is controlled through extracellular & intracellular buffering systems extracellular intracellular buffering systems Respiratory: eliminate CO 2CO 2 Renal: conserve HCO 3 - and eliminate H + ionsHCO 3 - H + Electrolytes: composition of extracellular (ECF) & intracellular fluids (ICF) - ECF is maintained at 7.40 Protein Buffer system HCO 3 - Buffer system K + - H + Exchange
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Protein Buffer Systems: Largest buffer system in the body Amphoteric: can function as acids or bases Contain several ionizable groups able to bind or release H + Largely located in cells; H + & CO 2 diffuse across cell membranes for buffering by Albumin & plasma globulins Albumin & plasma globulins Previous Slide
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Bicarbonate Buffer System: Uses NaHCO 3 as its weak base & H 2 CO 3 as its weak acidNaHCO 3H 2 CO 3 The HCO 3 - /CO 2 buffer system can readily add or remove components from the body An ample supply of CO 2 provided via metabolism, replaces H 2 CO 3 lost when excess base is added In turn, the kidneys conserve or form new HCO 3 - in the presence of excess acid & excrete HCO 3 - in the presence of excess base Previous Slide
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Plasma Potassium-Hydrogen Exchange: Both positively charged ions move freely between IC & EC compartmentsIC & EC Decreases in plasma K + cause movement of K + from ICF to ECF & movement of H + from ECF to ICFK + With an EC decrease in K +, K + moves out & is replaced by H + As a result, changes in EC K + levels affect acid-base balance & vice versa Previous Slide
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Quick Review: Click the Boxes A donator of H + ionsAn acceptor of H + w/ pH 7.0 Regulated by EC Controlled by EC H 2 CO 3 & HCO 3 - & IC buffer systems Eliminates CO 2 Conserves HCO 3 - Eliminates H + ions An Acid is:A Base is: pH is: Respiratory System: pH is: Renal System:
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Respiratory Control Mechanisms: Works within minutes to control pH; maximal in 12-24 hours Only about 50-75% effective in returning pH to normal Excess CO 2 & H + in the blood act directly on respiratory centers in the brain CO 2 readily crosses blood-brain barrier reacting w/ H 2 O to form H 2 CO 3 H 2 CO 3 splits into H + & HCO 3 - & the H + stimulates an increase or decrease in respirations
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Renal Control Mechanisms: Don’t work as fast as the respiratory system; function for days to restore pH to, or close to, normal Regulate pH through excreting acidic or alkaline urine; excreting excess H + & regenerating or reabsorbing HCO 3 - Excreting acidic urine decreases acid in the EC fluid & excreting alkaline urine removes base H+ elimination & HCO3- conservation
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H+ Elimination & HCO3- Conservation: Begins with Na + /H + transport systemNa + / H + secreted in tubular fluid & Na + reabsorbed in tubular celltubular fluid tubular cell Secreted H + couples w/ filtered HCO 3 - & CO 2 & H 2 O result H 2 O secreted in urine & CO 2 diffuses into tubular cell combining w/ H 2 O to form HCO 3 - via a carbonic anhydrase-mediated reactioncarbonic anhydrase-mediated reaction HCO 3 - is reabsorbed into the blood along w/ Na +, & newly generated H + is secreted into tubular fluid beginning a new cycle Previous Slide
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Mechanisms of Acid-Base Balance: The ratio of HCO 3 - base to the volatile H 2 CO 3 determines pHvolatile Concentrations of volatile H 2 CO 3 are regulated by changing the rate & depth of respiration Plasma concentration of HCO 3 - is regulated by the kidneys via 2 processes: reabsorption of filtered HCO 3 - & generation of new HCO 3 -, or elimination of H + buffered by tubular systems to maintain a luminal pH of at least 4.5tubular systems luminal pH Phosphate Buffer system Ammonia Buffer system
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The Phosphate Buffer system: Uses HPO 42 - and H 2 PO 4 - present in tubular filtrateHPO 42 - and H 2 PO 4 - Both become concentrated in the fluid due to relatively poor absorption & reabsorption of H 2 O from tubular fluid H + combines w/ HPO 42 - to form H 2 PO 4 - giving the kidneys the ability to increase secretion of H + ions When H + ions in the bloodstream decrease, pH increases & vice versa Subsequently hydrogen phosphate either accepts or releases H + ions to maintain pH within the bloodstream Previous Slide
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The Ammonia Buffer System: This buffer system is the more complex of the two The generation of HCO 3 - & excretion of H + by this system occurs in 3 steps: 1) synthesis of NH 4 + from glutamine, an amino acid in the proximal tubule, thick ascending loop of Henle & distal tubulesNH 4 +proximal tubulethick ascending loop of Henle distal tubules 2) recycling & reabsorption of NH 3 in the kidney’s medulla, &NH 3 3) buffering of H + ions by NH 3 in the collecting tubules. Previous Slide
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Acid-Base Balance Review test: The kidneys regulate pH by excreting HCO 3 - and retaining or regenerating H + TRUE FALSE
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Incorrect Actually the kidneys work to regulate pH through the regeneration or reabsorption of HCO 3 - & excretion of H + Next QuestionPrevious Question
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Correct! You’re absolutely right! The kidneys actually do the opposite in order to regulate pH. Nicely done. Next QuestionPrevious Question
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Acid-Base Review test: H 2 CO 3 splits into HCO 3 - & H + & it is the H + that stimulates either an increase or decrease in the rate & depth of respirations. TRUE FALSE
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Correct! You got it! This is because H +, along with CO 2 in the blood stream, act directly on respiratory centers in the brain. Next QuestionPrevious Question
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Incorrect The correct answer is TRUE. Please review the Respiratory Control Mechanisms slide as needed. Next QuestionPrevious Question
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Acid-Base Review test: Plasma concentration of HCO 3 - is controlled by the kidneys through reabsorption/regeneration of HCO 3 -, or elimination of buffered H + via the tubular systems. TRUE FALSE
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Correct! Yes! Reabsorption of filtered HCO 3 - or generation of new HCO 3 - & or H + ion elimination via phosphate & ammonia buffer systems help the kidneys regulate plasma concentrations of HCO 3 -. Next QuestionPrevious Question
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Incorrect Please review Mechanisms of Acid-Base balance if needed. Next QuestionPrevious Question
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Acid-Base Review test: The ratio of H + to HCO 3 - determines pH. TRUE FALSE
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Incorrect The answer is false. It’s the ratio of HCO 3 - to volatile H 2 CO 3 that determines pH. Next QuestionPrevious Question
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Correct! You’re right, the answer is false. REMEMBER: concentrations of volatile H 2 CO 3 are regulated by changing the rate & depth of respirations. Next QuestionPrevious Question
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Acid-Base Review test: Secreted H + couples with filtered HCO 3 - & CO 2 & H 2 O result. TRUE FALSE
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Correct! Well done! If you look back at the H + Elimination & HCO 3 - Conservation slide, this is part of the Na + /H + transport system. End Post testPrevious Question
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Incorrect Sorry, but the correct answer is true. End Post testPrevious Question
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Metabolic Disturbances: Alkalosis: elevated HCO 3 - (>26 mEq/L) Causes include: Cl - depletion (vomiting, prolonged nasogastric suctioning), Cushing’s syndrome, K + deficiency, massive blood transfusions, ingestion of antacids, etc. Acidosis: decreased HCO 3 - (<22 mEq/L) Causes include: DKA, shock, sepsis, renal failure, diarrhea, salicylates (aspirin), etc.DKA Compensation is respiratory-related
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Metabolic Alkalosis: Caused by an increase in pH (>7.45) related to an excess in plasma HCO 3 - Caused by a loss of H + ions, net gain in HCO 3 -, or loss of Cl - ions in excess of HCO 3 - Most HCO 3 - comes from CO 2 produced during metabolic processes, reabsorption of filtered HCO 3 -, or generation of new HCO 3 - by the kidneys Proximal tubule reabsorbs 99.9% of filtered HCO 3 - ; excess is excreted in urine
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Metabolic Alkalosis Manifestations: Signs & symptoms (s/sx) of volume depletion or hypokalemiahypokalemia Compensatory hypoventilation, hypoxemia & respiratory acidosis Neurological s/sx may include mental confusion, hyperactive reflexes, tetany and carpopedal spasm Severe alkalosis (>7.55) causes respiratory failure, dysrhthmias, seizures & coma
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Treatment of Metabolic Alkalosis: Correct the cause of the imbalance May include KCl supplementation for K + /Cl - deficits Fluid replacement with 0.9 normal saline or 0.45 normal saline for s/sx of volume depletion Intubation & mechanical ventilation may be required in the presence of respiratory failure
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Metabolic Acidosis: Primary deficit in base HCO 3 - (<22 mEq/L) and pH (<7.35) Caused by 1 of 4 mechanisms Increase in nonvolatile metabolic acids, decreased acid secretion by kidneys, excessive loss of HCO 3 -, or an increase in Cl - Metabolic acids increase w/ an accumulation of lactic acid, overproduction of ketoacids, or drug/chemical anion ingestion
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Metabolic Acidosis Manifestations: Hyperventialtion (to reduce CO 2 levels), & dyspneadyspnea Complaints of weakness, fatigue, general malaise, or a dull headache Pt’s may also have anorexia, N/V, & abdominal painN/V If the acidosis progresses, stupor, coma & LOC may declineLOC Skin is often warm & flush related to sympathetic stimulation
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Treatment of Metabolic Acidosis: Treat the condition that first caused the imbalance NaHCO 3 infusion for HCO 3 - <22mEq/L Restoration of fluids and treatment of electrolyte imbalances Administration of supplemental O 2 or mechanical ventilation should the respiratory system begin to fail
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Quick Metabolic Review: Metabolic disturbances indicate an excess/deficit in HCO 3 - ( 26mEq/L Reabsorption of filtered HCO 3 - & generation of new HCO 3 - occurs in the kidneys Respiratory system is the compensatory mechanism ALWAYS treat the primary disturbance
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Respiratory Disturbances: Alkalosis: low PaCO 2 (<35 mmHg) Caused by HYPERventilation of any etiology (hypoxemia, anxiety, PE, pulmonary edema, pregnancy, excessive ventilation w/ mechanical ventilator, etc.)PE Acidosis: elevated PaCO 2 (>45 mmHg) Caused by HYPOventilation of any etiology (sleep apnea, oversedation, head trauma, drug overdose, pneumothorax, etc.) Compensation is metabolic-related
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Respiratory Alkalosis: Characterized by an initial decrease in plasma PaCO 2 (<35 mmHg) or hypocapnia Produces elevation of pH (>7.45) w/ a subsequent decrease in HCO 3 - (<22 mEq/L) Caused by hyperventilation or RR in excess of what is necessary to maintain normal PaCO 2 levelsRR
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Respiratory Alkalosis Manifestations: S/sx are associated w/ hyperexcitiability of the nervous system & decreases in cerebral blood flow Increases protein binding of EC Ca +, reducing ionized Ca + levels causing neuromuscular excitabilityEC Ca + Lightheadedness, dizziness, tingling, numbness of fingers & toes, dyspnea, air hunger, palpitations & panic may result
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Treatment of Respiratory Alkalosis: Always treat the underlying/initial cause Supplemental O 2 or mechanical ventilation may be required Pt’s may require reassurance, rebreathing into a paper bag (for hyperventilation) during symptomatic attacks, & attention/treatment of psychological stresses.
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Respiratory Acidosis: Occurs w/ impairment in alveolar ventilation causing increased PaCO 2 (>45 mmHg), or hypercapnia, along w/ decreased pH (<7.35) Associated w/ rapid rise in arterial PaCO 2 w/ minimal increase in HCO 3 - & large decreases in pH Causes include decreased respiratory drive, lung disease, or disorders of CW/respiratory muscles CW
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Respiratory Acidosis Manifestations: Elevated CO 2 levels cause cerebral vasodilation resulting in HA, blurred vision, irritability, muscle twitching & psychological disturbancesHA If acidosis is prolonged & severe, increased CSF pressure & papilledema may resultCSF Impaired LOC, lethargy/coma, paralysis of extremities, warm/flushed skin, weakness & tachycardia may also result
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Treatment of Respiratory Acidosis: Treatment is directed toward improving ventilation; mechanical ventilation may be necessary Treat the underlying cause Drug OD, lung disease, chest trauma/injury, weakness of respiratory muscles, airway obstruction, etc. Eliminate excess CO 2
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Quick Respiratory Review: Caused by either low or elevated PaCO 2 levels ( 45mmHg) Watch for HYPOventilation or HYPERventilation; mechanical ventilation may be required Kidneys will compensate by conserving HCO 3 - & H + REMEMBER to treat the primary disturbance/underlying cause of the imbalance
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Compensatory Mechanisms: Adjust the pH toward a more normal level w/ out correcting the underlying cause Respiratory compensation by increasing/decreasing ventilation is rapid, but the stimulus is lost as pH returns toward normal Kidney compensation by conservation of HCO 3 - & H + is more efficient, but takes longer to recruit
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Metabolic Compensation: Results in pulmonary compensation beginning rapidly but taking time to become maximal Compensation for Metabolic Alkalosis: HYPOventilation (limited by degree of rise in PaCO 2 ) Compensation for Metabolic Acidosis: HYPERventilation to decrease PaCO 2 Begins in 1-2hrs, maximal in 12-24 hrs
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Respiratory Compensation: Results in renal compensation which takes days to become maximal Compensation for Respiratory Alkalosis: Kidneys excrete HCO 3 - Compensation for Respiratory Acidosis: Kidneys excrete more acid Kidneys increase HCO 3 - reabsorption
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DIAGNOSTIC LAB VALUES & INTERPRETATION
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Normal Arterial Blood Gas (ABG) Lab Values: Arterial pH: 7.35 – 7.45 HCO 3 - : 22 – 26 mEq/LmEq/L PaCO 2 : 35 – 45 mmHg TCO 2 : 23 – 27 mmol/Lmmol/L PaO 2 : 80 – 100 mmHg SaO 2 : 95% or greater (pulse ox) SaO 2 Base Excess: -2 to +2 Anion Gap: 7 – 14
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Acid-Base pH and HCO 3 - Arterial pH of ECF is 7.40 Acidemia: blood pH < 7.35 (increase in H + ) Alkalemia: blood pH >7.45 (decrease in H + ) If HCO 3 - levels are the primary disturbance, the problem is metabolic Acidosis: loss of nonvolatile acid & gain of HCO 3 - Alkalosis: excess H + (kidneys unable to excrete) & HCO 3 - loss exceeds capacity of kidneys to regenerate
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Acid-Base PCO 2, TCO 2 & PO 2 If PCO 2 is the primary disturbance, the problem is respiratory; it’s a reflection of alveolar ventilation (lungs)PCO 2 PCO 2 increase: hypoventilation present PCO 2 decrease: hyperventilation present TCO 2 refers to total CO 2 content in the blood, including CO 2 present in HCO 3 - TCO 2 >70% of CO 2 in the blood is in the form of HCO 3 - PO 2 also important in assessing respiratory function PO 2
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Base Excess or Deficit: Measures the level of all buffering systems in the body – hemoglobin, protein, phosphate & HCO 3 - The amount of fixed acid or base that must be added to a blood sample to reach a pH of 7.40 It’s a measurement of HCO 3 - excess or deficit
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Anion Gap: The difference between plasma concentration of Na + & the sum of measured anions (Cl - & HCO 3 - ) Representative of the concentration of unmeasured anions (phosphates, sulfates, organic acids & proteins) Anion gap of urine can also be measured via the cations Na + & K +, & the anion Cl - to give an estimate of NH 4 + excretion
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Anion Gap The anion gap is increased in conditions such as lactic acidosis, and DKA that result from elevated levels of metabolic acids (metabolic acidosis) A low anion gap occurs in conditions that cause a fall in unmeasured anions (primarily albumin) OR a rise in unmeasured cationsanionsalbumincations A rise in unmeasured cations is seen in hyperkalemia, hypercalcemia, hyper- magnesemia, lithium intoxication or multiple myeloma hyperkalemia, hypercalcemia, hyper- magnesemia
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Sodium Chloride-Bicarbonate Exchange System and pH: The reabsorption of Na + by the kidneys requires an accompanying anion - 2 major anions in ECF are Cl - and HCO 3 -Cl One way the kidneys regulate pH of ECF is by conserving or eliminating HCO 3 - ions in which a shuffle of anions is often necessary Cl - is the most abundant in the ECF & can substitute for HCO 3 - when such a shift is needed.
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Acid-Base Interpretation Practice: Please use the following key to interpret the following ABG readings.ABG Click on the blue boxes to reveal the answers Use the button to return to the key at any time Or use the “Back to Key” button at the bottom left of the screen
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Acid-Base w/o Compensation: Parameters: pH PaCO 2 HCO 3 - Metabolic Alkalosis Normal Metabolic Acidosis Normal Respiratory Alkalosis Normal Respiratory Acidosis Normal
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Interpretation Practice: pH: 7.31 Right! PaCO 2 : 48 Try Again HCO 3 - : 24 Try Again pH: 7.47 Try Again PaCO 2 : 45 Right! HCO 3 - : 33 Try Again Back to Key Resp. Acidosis Resp. Alkalosis Metabolic Acidosis Resp. Alkalosis Metabolic Alkalosis Metabolic Acidosis
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Interpretation Practice: pH: 7.20Try Again PaCO 2 : 36Try Again HCO 3 - : 14 Right! pH: 7.50 Try Again PaCO 2 : 29 Right! HCO 3 - -: 22 Try Again Metabolic Alkalosis Resp. Acidosis Metabolic Acidosis Metabolic Alkalosis Resp. Alkalosis Resp. Acidosis Back to Key
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Acid-Base Fully Compensated: Parameters: pH PaCO 2 HCO 3 - Metabolic Alkalosis Normal >7.40 Metabolic Acidosis Normal <7.40 Respiratory Alkalosis Normal >7.40 Respiratory Acidosis Normal <7.40
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Interpretation Practice: pH: 7.36Try Again PaCO 2 : 56Try Again HCO 3 - : 31.4 Right! pH: 7.43 Right! PaCO 2 : 32Try Again HCO 3 : 21Try Again Compensated Resp. Alkalosis Compensated Metabolic Acidosis Compensated Resp. Acidosis Compensated Resp. Alkalosis Compensated Metabolic Alkalosis Compensated Metabolic Acidosis Back to Key
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Acid-Base Partially Compensated: Parameters: pH PaCO 2 HCO 3 - Metabolic Alkalosis Metabolic Acidosis Respiratory Alkalosis Respiratory Acidosis
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Interpretation Practice: pH: 7.47 Right! PaCO 2 : 49Try Again HCO 3 - : 33.1Try Again pH: 7.33Try Again PaCO 2 : 31Try Again HCO 3 - : 16 Right! Partially Compensated Metabolic Alkalosis Partially Compensated Resp. Alkalosis Partially Compensated Metabolic Acidosis Partially Compensated Metabolic Alkalosis Partially Compensated Resp. Acidosis Partially Compensated Metabolic Acidosis Back to Key
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Case Study 1: Mrs. D is admitted to the ICU. She has missed her last 3 dialysis treatments. Her ABG reveals the following: pH: 7.32Low, WNL = 7.35-7.45 PaCO 2 : 32Low, WNL = 35-45mmHg HCO 3 - : 18Low, WNL = 22-26mEq/L Assess the pH, PaCO 2 & HCO 3 -. Are the values high, low or WNL?WNL The pH is: The PaCO 2 is: The HCO 3 - is:
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Case Study 1 Continued: What is Mrs. D’s acid-base imbalance? Right! Try Again Remember the difference between full & partial compensation. Go back & use the appropriate key if necessary. Partially Compensated Metabolic Acidosis Fully Compensated Resp. Acidosis
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Case Study 2: Mr. M is a pt w/ chronic COPD. He is admitted to your unit pre-operatively. His admission lab work is as follows: pH: 7.35WNL = 7.35-7.45 PaCO 2 : 52High, WNL = 35-45mmHg HCO 3 - : 50High, WNL = 22-26mEq/L Assess the above labs. Are they abnormal or WNL? The pH is: The PaCO 2 is: The HCO 3 - is:
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Case Study 2 Continued: What is Mr. M’s acid-base disturbance? Try Again Right! Think about appropriate interventions- if the problem is metabolic, the respiratory system compensates & vice versa Fully Compensated Metabolic Acidosis Fully Compensated Resp. Acidosis
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Case Study 3: Miss L is a 32 year old female admitted w/ decreased LOC after c/o the “worst HA of her life.” She is lethargic, but arouseable; diagnosed w/ a SAH.c/oSAH. Her ABG reads: pH: 7.48High; WNL = 7.35-7.45 PaCO 2 : 32Low; WNL = 35-45mmHg HCO 3 - : 25High; WNL = 22-26mEq/L What is the significance of her ABG values? The pH is: The PaCO 2 is: The HCO 3 - is:
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Case Study 3 Continued: What is Miss L’s imbalance? Right! Try Again Great Job! You’ve reached the end of the tutorial & I hope you found it helpful. Thank you! Resp. Alkalosis Metabolic Alkalosis
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REFERENCES: http://www.healthline.com/galecontent/acid-base- balance?utm_medium=ask&utm_source=smart&utm_campaign=article &utm_term=Acid+Base+Equilibrium&ask_return=Acid-Base+Balancehttp://www.healthline.com/galecontent/acid-base- balance?utm_medium=ask&utm_source=smart&utm_campaign=article &utm_term=Acid+Base+Equilibrium&ask_return=Acid-Base+Balance. Retrieved 3/5/09. Porth, C.M. (2005). Pathophysiology Concepts of Altered Health States (7 th ed.). Philadelphia: Lippincott Williams & Wilkins. http://en.wikipedia.org/wiki/Dissociation_(chemistryhttp://en.wikipedia.org/wiki/Dissociation_(chemistry). Retrieved 3/6/09. http://www.clt.astate.edu/mgilmore/pathophysiology/Acid and Base.ppt#1http://www.clt.astate.edu/mgilmore/pathophysiology/Acid and Base.ppt#1. Retrieved 3/6/09. http://www.uhmc.sunysb.edu/internalmed/nephro/webpages/Part_E.htmhttp://www.uhmc.sunysb.edu/internalmed/nephro/webpages/Part_E.htm. Retrieved 3/6/09. http://medical-dictionary.thefreedictionary.com/Volatile+acidhttp://medical-dictionary.thefreedictionary.com/Volatile+acid. Retrieved 3/6/09.
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REFERENCES http://wiki.answers.com/Q/How_does_the_phosphate_buffer_system_help_ in_maintaining_the_ph_of_our_bodyhttp://wiki.answers.com/Q/How_does_the_phosphate_buffer_system_help_ in_maintaining_the_ph_of_our_body. Retrieved 3/10/09. Alspach, J.G. (1998). American Association of Critical-Care Nurses Core Curriculum for Critical Care Nursing (5 th ed.). Philadelphia: Saunders. http://medical-dictionary.thefreedictionary.comhttp://medical-dictionary.thefreedictionary.com. Retrieved 4/14/09. Acid-Base Balance & Oxygenation Power Point. (2007). Milwaukee: Froedtert Lutheran Memorial Hospital Critical Care Class.
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