Acid Base
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Created by:
benmarler123 on June 3, 2011
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Acid base
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English | Photos |
|---|---|
 Normal pH = 7.4 (range 7.35-7.45) | For physiologic processes to occur at a normal rate, body pH must remain within a narrow range |
| PC02 | Respiratory paramater of acid-base in body Normal PC02 = 35-45 mm Hg Measured by ABG Regulated by lungs |
| HCO3 | Metabolic parameter of acid-base in body Normal HCO3 = 22-26 mEq/L Estimated from CO2 content on Basic Metabolic Panel (Chem 7) or calculated using H-H equation Regulated by kidneys |
| Buffers | Regulation of Acid-Base Homeostasis FIRST LINE OF DEFENSE Bicarbonate-carbonic acid system Phosphate Intracellular and extracellular proteins |
| Bicarbonate-Carbonic Acid System | H+ + HCO3- (base) <=> H2CO3 <=> H2O + CO2 (acid) Kidneys and lungs affect this system pH = pKcarbonic acid + log [base/acid] |
| Respiratory mechanism | CO2 + H2O is excreted by the lungs |
| Kidneys mechanism | Buffer blood pH by excreting H+ in the urine and reabsorbing filtered HCO3- |
| Mechanism of Kidney buffer system |  |
| Respiratory Acidosis | Low pH Increased pCO2 Normal HCO3 |
| Etiology Respiratory Acidosis | Pulmonary disorders Nonpulmonary disorders Narcotic overdose Mechanical underventilation |
| Compensatory Mechanism of Respiratory Acidosis | Buffering system (acute) After 6-12 hrs, evokes renal compensatory response to generate more HCO3; usually takes several days to complete Acute: 0.1 mEq increased HCO3 per 1 mm Hg increased pCO2 Chronic: 0.4 mEq increased HCO3 per 1 mm Hg increased pCO2 |
| Acute (6-12 hrs) Respiratory Acidosis | If pCO2 ↑ from 40 to 60 mm (↑ 20) mm Hg, would expect HCO3 to ↑ from 24 to 26 (↑ 2) mEq/L 20 x 0.1= 2 |
| Chronic (48-72 hrs) Respiratory Acidosis | If pCO2 ↑ from 40 to 60 (↑ 20) mm Hg, would expect HCO3 to ↑ from 24 to 32 (↑ 8) mEq/L 20 x 0.4= 8 |
| Treatment of Respiratory Acidosis | Treat underlying pulmonary disorder (Drug overdose, COPD, Asthma and infection), which may include antibiotics, bronchodilators, steroids, respiratory support Naloxone to reverse narcotic overdose Hyperventilate or increase rate on vent Administration of HCO3 not recommended in most cases |
| Balance of Respiratory Alkalosis | High pH High pCO2 Normal HCO3 |
| Etiology of Respiratory Alkalosis | Hyperventilatory syndrome Hypoxia CNS-mediated disorders—sepsis Pulmonary disease—pneumonia, PE Mechanical overventilation |
| Compensation of Respiratory Alkalosis | Buffering system (acute) Kidneys Acute: 0.1-0.3 mEq/L decrease HCO3 per 1 mm Hg decrease PCO2 Chronic: 0.2-0.5 mEq/L decrease HCO3 per 1 mm Hg decrease PCO2 |
| Acute Respiratory Alkalosis | If PCO2 ↓ from 40 to 20 (↓ 20) mm Hg, HCO3 will ↓ from 24 to 18-22 (↓ 2-6) mEq/L 20 x 0.1-0.3= 2-6 |
| Chronic Respiratory Alkalosis | If PCO2 ↓ from 40 to 20 (↓ 20) mm Hg, HCO3 will ↓ from 24 to 14-20 (↓ 4-10) mEq/L 20 x 0.2-0.5= 4-10 |
| Treatment of Respiratory Alkalosis | TREAT UNDERLYING CAUSE Rebreathing into a paper bag will increase pCO2 Decrease rate of vent |
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