ACID

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ACID BASE BALANCE

• HOMEOSTASIS
• Relative of hydrogen ions
• pH potential hydrogen
• Normal pH 7.35 7.45
• lt7.35 is acidosis
• gt7.45 is alkalosis

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• Deviation of 0.4 in either direction can be fatal

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• ACIDOSIS
• Metabolic Acidosis
• Excessive blood acidity or loss of bicarbonate
• Causes
• ingestion of something that is or can be
  metabolized to an acid
• such as..

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• Wood alcohol
• Antifreeze
• Large doses of ASA
• Abnormal metabolism
• Advanced stages of shock
• Poorly controlled IDDM
• Normal levels of acid if kidneys arent
  functioning normally

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• Symptoms
• Mild metabolic acidosis may have no sx.
• Usually experiences
• nausea
• vomiting
• fatigue
• Breathing becomes deeper and slightly faster
• As acidosis worsens

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• Extremely weak and drowsy
• May feel confused
• Increasingly nauseated
• Eventually b/p can fall leading to shock, coma,
  or death
• Treatment
• Depends primarily on the cause
• insulin
• removing toxic substances

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• RESPIRATORY ACIDOSIS
• Build up of CO2 in the blood from poor lung
  function or slow breathing
• Blood becomes acidic -gt pH drops ? respiratory
  center in the brain stimulates faster and deeper
  breathing
• Develops when.

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• Develops when the lungs do not expel CO2
  adequately.such as
• Emphysema
• Chronic bronchitis
• Severe pneumonia
• Pulmonary edema
• Asthma

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• Diseases of the nerves or muscles of the chest
• If overly sedated from narcotics and strong
  sleeping medications that slow respirations
• Symptoms

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• First symptom may be headache and drowsiness
• Drowsiness may progress to stupor or coma
• ABGs
• Treatment..

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• Aims at improving function of the lungs
• i.e. drugs to improve breathing
• If acidosis is mild, IV fluid may be all that is
  needed
• If severe HCO3- (provides only temporary relief
  and may cause harm by overloading the body with
  Na and H2O

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• Treatment
• Slow down rate
• Pain relief
• Other facts to ponder.

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• J\Class Presentations\BA Acid Base
  Disturbances.doc

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• Life essential functions like K and Na channels
  are inactivated by acidosis
• A habitually acid pH can directly cause immediate
  weight gain
• Fasting and dieting are known acid producing
  conditions
• One way the body compensates is to deposit excess
  acid into tissues and joints

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• Acid producing foods create excess mucus, which
  congests the system and block oxygen from entering

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ALKALOSIS

• Overabundance of bicarbonate in the blood
• Loss of acid from the blood

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• Respiratory Alkalosis
• Low levels of CO2 in the blood that results from
  rapid or deep breathing
• Hyperventilation
• anxiety
• cirrhosis
• low levels of oxygen in the blood
• fever
• ASA overdose

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• METABOLIC ACIDOSIS
• Body looses too much acids
• Gain too much base
• stomach acid is lost during periods of
  prolonged vomiting
• excessive loss of Na or K affects the
  kidneys ability to control the bloods
  acid-base balance
• loss of K - use of diuretics or
  corticosteroids

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• Corticosteroids
• Steroid hormones
• Synthesized from cholesterol
• Involved in stress response, immune response,
  regulation of inflammation, carbohydrate
  metabolism, protein catabolises blood electrolyte
  level and behavior

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• Catabolism breaks down molecules into smaller
  units and releases energy
• Alkalosis may cause
• Irritability
• Muscle twitching
• Muscle cramps
• If severe, prolonged contraction and spasms of
  muscle (tetnaory)

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• Treatment
• Metabolic
• Replacing H2O, Na, and K while treating
  underlying cause
• Next ..

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FLUIDS AND ELECTROLYTYES

• Water
• 60 total body weight
• Distributed into various compartments, separated
  by cell membranes
• Largest compartment is intracellular environment
• ICF
• All the fluid found inside body cells
• 75 of all water is found within this
  compartment

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• Extracellular compartment
• 2 divisions
• Intravascular fluid
• Outside the cells and within the circulatory
  system. Essentially the same as the blood plasma

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• Interstitial fluid
• Outside the cell membranes, not within the
  circulatory system
• TBW
• Infants 75-80
• Infants have less fat. Fat does not absorb
  water. Less fat, more water

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• Water is essential for high rates of metabolism
  necessary to promote growth
• With age
• Loss of muscle mass inc. of fat
• Bodys decreasing ability to regulate fluid
  levels lower TBW to 45-55
• Elderly and very young are at high risk for
  dehydration and disorders related to to
  electrolyte imbalances

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ELECTROLYTES

• Dissociate in electronically charged particles
  when placed into water
• ions
• Cations charge
• Anions - charge

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• Cations
• Na
• Most prevalent in extracellular fluid
• Plays major role in distribution of water
• Important in the transmission of nervous impulses

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• K
• Intracellular fluid
• Transmission of electrical impulses
• Ca
• Major role in muscle contraction
• Nervous impulse transmission

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• Mg
• Necessary for several biochemical processes (over
  300)
• Prevents over excitability of muscles
• ½ found in bone
• ½ found predominantly inside cells of tissues and
  organs
• Helps maintain normal nerve and muscle function

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• Regulates heart rhythm
• Supports healthy immune system
• Keeps bones strong
• Helps regulate blood sugar levels
• Promotes normal blood pressure
• Known to be involved in protein synthesis and
  metabolism

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• ANIONS
• Cl-
• Plays a major role in fluid balance and renal
  function
• HCO3-
• Principal buffer

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• Phosphate
• HPO4-
• Body energy stores
• Closely associated with Mg in renal function
• Acts as a buffer primarily in the intracellular
  space

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• OSMOSIS AND DIFFUSION
• Isotonic
• When solutions on opposite sides of a
  semipermiable membrane are equal in
• gt on one side hypertonic
• lt on one side hypotonic
• Difference in osmotic gradient

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• Homeostasis
• The tendency to keep the balance of water
• electrolytes are on both sides of the
  membrane.
• Diffusion
• Movement from an area of higher to lower
  and does not require energy

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• Osmosis
• The passage of any solvent usually water through
  a membrane
• Active Transport
• Movement of a substance across the cell membrane
  against the osmotic gradient or toward the side
  that already has more of the substance requires
  an expenditure of energy

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• Facilitated diffusion
• Diffusion of a substance such as glucose that
  requires the assistance of a helper or carrier
  protein

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• FLUIDS
• COLLOIDS
• Contain large proteins
• Cannot pass through a capillary membrane
• Remains in the circulatory system
• Increases volume of blood and fluid contained
  within the blood vessels

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• CRYSTALLOID
• Contain electrolytes and water
• Tonicity number of particles per unit volume
• Isotonic
• Tonicity equal to blood plasma
• Will not cause a significant fluid or electrolyte
  shift

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• HYPERTONIC
• Higher solute that the cells
• Causes fluid shift out of intracellular
  compartment into extracellualar compartment

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• HYPOTONIC
• Lower solute than the cells
• Movement extracellular ? intracellular

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• ABGs
• Determine pH but also to differentiate
  respiratory / metabolic acidosis / alkalosis
• Norms
• pH 7.35 - 7.45
• PaCO2 35 - 45
• PaO2 greater than 80
• HCO3- 22 - 28

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• PaCO2
• Amount of CO2 dissolved in arterial blood
• PaO2 amount of oxygen dissolved in arterial blood
• HCO3 amount of bicarbonate

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• Interpretation
• (R)espirtory (O)pposite, (M)etabolic (E)qual
• If the pH is opposite the PaCO2 (high or low)
  then its respiratory if the pH is equal to the
  HCO3, it is metabolic

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• Problem 1
• pH 7.30
• PaCO2 50
• HCO3 26
• PaO2 60
• Acidosis or Alkalosis?
• Metabolic or Respiratory?
• Answer

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• Respiratory Acidosis
• Why?
• pH is high indicating Acidosis
• pH is low PaCO2 is high opposite indicating
  this is respiratory
• Problem 2

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• pH 7.50
• PaCO2 43
• HCO3 45
• PaO2 80
• Acidosis or Alkalosis?
• Metabolic or Respiratory?
• Answer

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• Metabolic Alkalosis
• Why?
• pH is high indicating alkalosis
• pH high HCO3- high equal
• Indicating this is metabolic
• METABOLIC ACIDOSIS