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Notes on Acid-Base Balance/ fluids and electrolytes need to be added later

pH of fluid

refers to the hydrogen ion concentration of that fluid


Body fluids are maintained at a slightly ___________ level.

Chemical buffer system

act like sponges and combine with acid or alkali to prevent excessive changes in the hydrogen ion concentration.

Respiratory system

The lungs effectively regulate the blood levels of CO₂. CO₂ combines with H₂O to form carbonic acid. Increased levels of CO₂ decrease the pH level. Receptors in the brain identify ph changes and vary the rate and depth of breathing to compensate. Faster, deeper respirations reduce the CO₂ level in the lungs. The decrease in CO₂ increases the pH level. Respiratory response is rapid but short lived.

Renal system

The kidneys reabsorb or excrete acids and bases into the urine. They can produce bicarbonate to refill lost stores. The kidneys have a slower response, but long-term effects result.


Neutralize excess acids or bases, preventing marked changes in hydrogen ion concentration.


Body's first line of defense against acid-base balance changes in they body.


Help regulate acid-base balance by elminating or retaing carbon dioxide, a potential acid.

carbonic acid

This is formed when carbon dioxide combines with water

carbonic acid

This breaks down into carbon dioxide and water.

rate and depth of respirations

The lungs regulate acid-base balance and pH by altering these.


The response of the respiratory system to changes in pH is rapid, and occuring within _______.

carbonic acid and carbon dioxide

When blood levels of these rise, respiratory center stimulation causes the rate and depth of respirations to increase.

bicarbonate levels

When these levels are excessive, the rate and depth of respirations are reduced in order to retain carbon dioxide.


provide primary long-term regulation of acid-base balance and is more permanant and selective.

excess hydrogen ions

When ___________________ are present and the pH falls (acidosis), the kidneys reabsorb and regenerate bicarbonate and excrete hydrogen ions.

raise and reduce

During acidosis, the kidneys reabsorb and regenerate bicarbonate and excrete hydrogen ions, helping to _____ pH and _____ the amount of available acid.

excess bicarbonate

When there is excess bicarbonate and a high pH (alkalosis), the kidneys excrete bicarbonate and retain hydrogen ions.

lower pH and make more acid available

The kidneys excrete bicarbonate and retain hydrogen ions in order to ________ and ___________ to offset the bicarbonate.

regulation of hydrogen ion concentration

The key to acid-base balance is ____________ of body fluids.

respiratory acidosis and alkalosis

One type of acid-base imblances which is a carbonic acid deficit and excess.

Metabolic acidosis and alkalosis

One type of acid-base imblances which is a base bicarbonate deficit and excess.

fully compensated

pH normal with abnormal CO₂ and HCO₂

partially compensated

All values abnormal


Two abnormal values and one normal value


CO₂measured in arterial blood


In (R)espiratory imbalances, the ph and CO₂ (O)pposite (ph ↓ and CO₂ ↑ = acidosis) (ph ↑ and CO₂ ↓ = alkalosis)


In (M)etabolic imbalances, the pH and HCO₃ are "(E)qual" (ph ↓ and HCO₃↓= acidosis)(ph ↑ and HCO₃↑ = alkalosis)

Respiratory acidosis

As carbon dioxide is retained, it creates carbonic acid that builds up in the blood; the pH drops and creates this. A drop in blood pH from carbonic acid buildup.

Respiratory Alkalosis

A client is in a lot of pain and breathing rapidly. The nurse recognizes this will cause CO₂ to be exhaled and the client may develop wich acid-base imbalance?

Metabolic acidosis

A client is admitted with diabetic ketoacidosis (DKA). Due to the ketone bodies formed, the client is most likely experiencing what type acid-base imbalance?

dizziness, tingling of fingers and toes, decreased respirations, and cardiac dysrhythmias

Signs and symptoms that would indicate metabolic alkalosis (bicarbonate excess)

Kussmaul respirations

deep and rapid respirations (hyperventalations) that accompany metabolic acidosis

Metabolic acidosis etiology

diarrhea, diabetic ketoacidosis, renal failure, acid ingestion, fistulas

metabolic alkalosis etiology

gastric suctioning, vomiting, hypokalemia, potassium-losing diuretics, excessive alkali ingestion

respiratory acidosis etiology

aspiration, cardiac arrest, severe pneumonia, emphysema, pulmonary edema, pneumothorax

respiratory alkalosis etilogy

jyperventilation, anxiety, hypoxemia, high fever, pulmonary emboli

metabolic acidosis manifestations

nausea/vomiting, Kussmaul breathing, headache, drowsiness, increades breathing

metabolic acidosis treatment

reverse underlying cause, administer sodium bicarbonate per physician order

metabolic alkalosis manifestations

dizziness, tingling of the fingers, carpopedal spasm, depressed respirations, circumoral paresthesis

metabolic alkalosis treatment

reverse underlying cause, administer chloride for the kidneys to excrete bicarbonate, restore normal fluid volume

respiratory acidosis manifestations

dizziness, palpitations, convulsions, weakness, mental changes, ventricular fibrillation

respiratory acidosis treatment

improve ventilation, use bronchodilators, administer oxygen and fluids.

respiratory alkalosis manifestations

light-headedness, numbness and tingling of extremities, tinnitus, palpitations, blurred vision, chest tightness

respiratory alkalosis treatment

treat source of anxiety, ask client to breathe slowly into a paper bag, administer sedatives as ordered.

Respiratory alkalosis

May develop when hyperventilation occurs. An elevated pH due to a decrease in CO₂(PaCO₂)

Metabolic acidosis

Occurs when bicarbonate is lost or acid is increased within the plasma. Greater than normal acid within the plasma.

Metabolic alkalosis

Occurs when the plasma loses hydrogen ions (acid) and gains bicarbonate. Less than normal acid within the plasma.

Respiratory acidosis mode of compensation

Kidneys will retain increased amounts of HCO₃to increase pH

Respiratory alkalosis mode of compensation

Kidneys will excrete increased amounts of HCO₃to lower pH

Metabolic acidosis mode of compensation

Lungs "blow off" CO₂to raise pH

Metabolic alkalosis mode of compensation

Lungs retain CO₂to lower pH

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