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ACID BASE IMBALANCES

Manal Alatrash, MSN, RN


Analyzing Blood Gas
Normal values
PH
7.35-7.45
PaCO2
35-45
HCO3
22-26 (some institutions 20-24)
PaO2
80-100 (in infants 60-80)
THE RULES
1) Look at pH. Decide if acidosis or alkalosis
2) Look at PaCo2. Is it normal, increased, or decreased?
3) Look at HCO3. Is it normal, increased, or decreased.
4) Look at the PaO2 to determine if there is hypoxia
Respiratory Acidosis
Definition: An acid base disturbance characterized by excess of CO2
in the blood (Hypercapnia). Indicated by PaCO2 greater than 45 mm
Hg
Etiology
Hypoventilation
Obstructive lung disease (Chronic bronchitis, emphysema,
asthma(late stages)
Sedation
Neuromuscular disease (polio, MS, guillian barre syndrome
Respiratory failure
Respiratory Acidosis

Low pH <7.35
PaCO2 >45 mm Hg
Always due to a respiratory problem with inadequate excretion of
CO2
The signs and symptoms of respiratory acidosis are centered within
the pulmonary, nervous, and cardiovascular systems
With chronic respiratory acidosis, the body may compensate and
may be asymptomatic; symptoms may include a suddenly increased
pulse, respiratory rate, and BP; mental changes; feeling of fullness in
the head
Potential increased intracranial pressure
Respiratory Acidosis
Treatment is aimed at improving ventilation
Monitor blood pH level, hydration status, electrolytes, vital signs
Respiratory Alkalosis
Definition: Characterized by a deficiency of CO2

in the blood (hypocapnia) as indicated by a decreased in


PaCo2less than 35 mm Hg
Etiology
Hyperventilation
Hypoxia (CHF, PE, Pulmonary fibrosis)
Pneumonia
Acute Asthma
Pregnancy
Severe anemia, pain, fever
Meds such as respiratory stimulants
Hyperventilation with mechanical ventilation
Respiratory Alkalosis
High pH >7.45
PaCO2 <35 mm Hg
Always due to hyperventilation
S&S are associated with the nervous and cardiovascular systems
Manifestations: lightheadedness, inability to concentrate, numbness
and tingling, sometimes loss of consciousness, dysrhythmias, and
palpitations
Correct cause of hyperventilation
Acid-Base Cont.
See supplemental notes:
Remember:
Metabolic Acidosis

Low pH <7.35
Low HCO3 <22 mEq/L
Most commonly due to renal failure, diarrhea
Manifestations: headache, confusion, drowsiness, increased
respiratory rate and depth, decreased blood pressure, decreased
cardiac output, dysrhythmias, shock; if decrease is slow, patient may
be asymptomatic until bicarbonate is 15 mEq/L or less
Correct the underlying problem and correct the imbalance;
bicarbonate may be administered
Metabolic Acidosis
With acidosis, hyperkalemia may occur as potassium shifts out of the
cell
As acidosis is corrected, potassium shifts back into the cell and
potassium levels decrease
Monitor potassium levels
Metabolic Acidosis
See supplemental notes:
Remember:

Metabolic Alkalosis

High pH >7.45
High bicarbonate >26 mEq/L
Most commonly due to vomiting or gastric suction; may also be
caused by medications, especially long-term diuretic use
Hypokalemia will produce alkalosis
Manifestations: Tingling of fingers and toes
Dizziness, lethargy, seizures, and coma
Muscle weakness, twitching, and tetany
Dizziness
Depressed respirations (compensatory)
Ventricular disturbances
Correct underlying disorder, supply chloride to allow excretion of
excess bicarbonate, and restore fluid volume with sodium chloride
solutions
Question
Which of the following clinical manifestations is most characteristic
of hypocalcemia and hypomagnesemia?

Tetany
Constipation
Facial flushing

Diplopia
Answer

Tetany
Rationale: Tetany is the most characteristic manifestation of
hypocalcemia and hypomagnesemia. Tetany refers to the entire
symptom complex induced by increased neural excitability.
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