ABI

Acid base imbalance
Acid-Base Balance
• Acid–base disorders are caused by disturbances in
hydrogen ion (H) homeostasis
– maintained by extracellular buffering
– renal regulation of hydrogen ion and bicarbonate
– ventilatory regulation of carbon dioxide (CO2) elimination
• Buffering refers to the ability of a solution to resist change in

pH after the addition of a strong acid or base.
• The body’s principal buffer system is the carbonic

acid/bicarbonate (H2CO3/HCO3–) system.
3
Reference ranges and points
Parameter Reference range Reference point

pH 7.35-7.45 7.40
PCO2 33-44 mm Hg 40 mm Hg
PO2 75-105 mm Hg
HCO3- 22-28 mEq/L 24mEq/L
Anion gap 8-16 mEq/L 12 mEq/L
Types of Acids in the Body
-Volatile acids:
– Pco2 is most important factor in pH of body tissues.
-Fixed Acids.
– Catabolism of amino acids, nucleic acids, and
phospholipids
-Organic Acids:
– Byproducts of aerobic metabolism, anaerobic
metabolism , during starvation, and diabetes.
– Lactic acid, ketones
Compensation=Buffer Systems
– Attempt to return the pH to normal or near
normal
• Provide or remove H+ and stabilize the pH.
• Include weak acids that can donate H+ and
weak bases that can absorb H+.
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Acid-base Terminology
Acidemia: blood pH < 7.35
Acidosis: a primary physiologic process that, occurring alone,

tends to cause acidemia.
Examples: metabolic acidosis from decreased perfusion (lactic acidosis);
respiratory acidosis from hypoventilation.
Alkalemia: blood pH > 7.45
Alkalosis: a primary physiologic process that, occurring

alone, tends to cause alkalemia.
Examples: metabolic alkalosis from excessive diuretic therapy; respiratory
alkalosis from acute hyperventilation.
Primary Acid-base Disorders
• Respiratory Acidosis
• Respiratory Alkalosis
• Metabolic Acidosis
• Metabolic Alkalosis
Primary Acid-base Disorders:
Respiratory Acidosis
Respiratory acidosis - A primary disorder where the first change is an

elevation of PaCO2, resulting in decreased pH.
Compensation (bringing pH back up toward normal) is a secondary

retention of HCO3 by the kidneys; this elevation of HCO3- is not
metabolic alkalosis since it is not a primary process.
Primary Event Compensatory Event
HCO3- ↑HCO3-
↓ pH ~ --------- ↓ pH ~ ---------
↑PaCO2 ↑ PaCO2
Respiratory Acidosis
• Mechanism
– Hypoventilation or Excess CO2 Production
• Etiology
– Pnumonia,Pneumothorax
– Respiratory Center Depression
– Inadequate mechanical ventilation
– Sepsis or Burns
– Neuromuscular Disease
Respiratory Acidosis (cont)
• Symptoms
• Breathlessness,Restlessness
• Lethargy and disorientation
• Tremors, convulsions, coma
• Skin warm and flushed due to vasodilation caused by
excess CO2
• Treatment
– Treat underlying cause
– Support ventilation
– Correct electrolyte imbalance .
Metabolic Acidosis
Metabolic acidosis - A primary acid-base disorder where

the first change is a lowering of HCO3-, resulting in
decreased pH.
Compensation (bringing pH back up toward normal) is a
secondary hyperventilation; this lowering of PaCO2,
Renal excretion of hydrogen ions & K+ exchanges
↓ HCO3- ↓HCO3-
↓ pH ~ ------------ ↓ pH ~ ------------
PaCO2 ↓ PaCO2
Metabolic Acidosis
• Etiology
– Conditions that increase acids (lactic acid or ketones)
• Renal Failure
• DKA
• Starvation
• Lactic acidosis
– Loss of bicarbonate through diarrhea or renal dysfunction
– Accumulation of acids, Failure of kidneys to excrete H+
Metabolic Alkalosis
Metabolic alkalosis - A primary acid-base disorder where the

first change is an elevation of HCO3-, resulting in increased
pH.
Compensation is a secondary hypoventilation (increased

PaCO2), Compensation for metabolic alkalosis is less predictable than for
the other three acid-base disorders.
↑ HCO3- ↑HCO3-
↑ pH ~ ------------ ↑ pH ~ ---------
PaCO2 ↑PaCO2
Metabolic Alkalosis
• Risk Factors/Etiology
– Acid loss due to
• vomiting
• gastric suction
– Loss of potassium due to
• steroids
• diuresis
– Antacids (overuse of)
Metabolic Alkalosis (cont)
• Symptoms
– Hypoventilation (compensatory)
– Dysrhythmias, dizziness
– Paresthesia, numbness, tingling of extremities
– Hypertonic muscles, tetany
– Lab: pH above 7.45, Bicarb above 26
– CO2 normal or increased w/comp
– Hypokalmia, Hypocalcemia
• Treatment
– treat underlying cause
– give potassium
Metabolic alkalosis
Plasma HCO3- greater than expected

Loss of strong acid or gain of base
Causes (2 ways to organize)
 loss of H+ from ECF via kidneys (diuretics) or gut (vomiting)
 gain of alkali in ECF from exogenous source (IV NaHCO3
infusion) or endogenous source (metabolism of ketoanions)
or
 addition of base to ECF (milk-alkali syndrome)
 Cl- depletion (loss of acid gastric juice)
 K+ depletion (primary/secondary hyperaldosteronism)
 Other disorders (laxative abuse, severe hypoalbuminaemia)
Respiratory Alkalosis
Respiratory alkalosis - A primary disorder where the first change is

a lowering of PaCO2, resulting in an elevated pH.
Compensation is a secondary lowering(excreting)HCO3 by the

kidneys.
HCO3- ↓HCO3-
↑ pH ~ ------- ↑ pH ~ --------
↓ PaCO2 ↓ PaCO2
Respiratory Alkalosis
Etiology
– Hyperventilation due to Conditions that stimulate
respiratory center
» extreme anxiety, stress, or pain
» Fever
» overventilation with ventilator
» hypoxia
» salicylate overdose
» hypoxemia (emphysema or pneumonia)
» CNS trauma or tumor
Respiratory Alkalosis (cont)
• Symptoms
– Tachypnea or Hyperpnea
– Complaints of SOB, chest pain
– Light-headedness, syncope, coma, seizures
– Numbness and tingling of extremities
– Difficult concentrating, tremors, blurred vision
– Weakness, paresthesias, tetany
– Lab findings
– pH above 7.45
– CO2 less than 35
Respiratory Alkalosis (cont)
• Treatment
• Treat underlying disease
• Assist patient to breathe more slowly
• breathe in a paper bag or apply rebreather mask
• Sedation

ABI

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Acid base imbalance

– renal regulation of hydrogen ion and bicarbonate

– ventilatory regulation of carbon dioxide (CO2) elimination

• Buffering refers to the ability of a solution to resist change in

• The body’s principal buffer system is the carbonic

Parameter Reference range Reference point

Acidemia: blood pH < 7.35

Acidosis: a primary physiologic process that, occurring alone,

Alkalemia: blood pH > 7.45

Alkalosis: a primary physiologic process that, occurring

Respiratory acidosis - A primary disorder where the first change is an

Compensation (bringing pH back up toward normal) is a secondary

Metabolic acidosis - A primary acid-base disorder where

Metabolic alkalosis - A primary acid-base disorder where the

Compensation is a secondary hypoventilation (increased

Primary Event Compensatory Event

Plasma HCO3- greater than expected

Respiratory alkalosis - A primary disorder where the first change is

Compensation is a secondary lowering(excreting)HCO3 by the

Primary Event Compensatory Event

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