Acid-Base-Balance: Presented by

Acid-Base-Balance
presented by
Drger Medical
Contents
Basics of Acid - Base - Balance ( ABB )

arterial blood gas analysis ( BGA )
parameters and standard values
The Bicarbonate Buffer System

chemical equation
Deviations
respiratory / metabolic Acidosis
respiratory / metabolic Alkalosis
Acid-Base-Balance
Basics of Acid - Base - Balance ( ABB )

arterial blood gas analysis ( BGA )
parameters and standard values
Acid-Base-Balance
Basics of Acid-Base-Balance
Purpose of an arterial BGA is to receive current information

about the pulmonary gas exchange and the ABB.
The documentation takes place together with the respirator
settings and the patient`s data.
Acid-Base-Balance
The BGA generally gives information about the following

parameters:
paO2
paCO2
pH-value
HCO3 BE
SaO2
Hb / Hk / electrolytes / Lactic
Acid-Base-Balance
Standard values:
paO2
70 - 105 mmHg
paCO2
35 - 45 mmHg
pH-value
7,35 - 7,44
HCO3-
21 - 25 mmol/l
BE
2 mmol/l
SaO2
95 - 98 %
The Bicarbonate-Buffer-System
The Bicarbonate Buffer System

chemical equation
organ functions linked to a pH-value
metabolic activities affect the pH-value
regulating mechanisms keep the pH-value constantly
responsible for this:

Phosphate-buffer, Protein-buffer, Bicarbonate-buffer
Bicarbonate buffer takes over 75% of the tasks of buffer
deviations of the pH-value is called Acidosis or Alkalosis
Acidosis: leads to myasthenia, coma,BP-decrease, heartbeat disturbances
Alkalosis: leads to confusion, BP-decrease, heartbeat disturbances,

over stimulation of the peripheral nervous system
Chemical equation
H+ + HCO3- H2CO3 H2O + CO2
carbonic anhydrase
Chemical equation
H+ + HCO3-
H2CO3
H2O + CO2
pH-value
7,30
Acidosis
respiratory / metabolic
1
0
7,40
neutral
7,50
Alkalosis
respiratory / metabolic
Deviations
respiratory / metabolic Acidosis
respiratory / metabolic Alkalosis
1
1
Chemical equation
H+ + HCO3-
H2CO3
H2O + CO2
pH-value
7,30
respiratory
Acidosis
1
2
Cause:
e.g. obstruction of the airways , central breath depression, lung

illness, illness thorax wall, incorrect ventilator settings
Consequence:
rise of the paCO2 due the hypo ventilation
Diagnosis:
pH < 7,35 ; paCO2 > 45 mmHg
Compensation: kidney increases H+- ions elimination and bicarbonate formation
Therapy:
eliminate cause, possible mandatory ventilation
Case report:
female, 23-year-old, dilatative cardiomyopathia, ventilated
Ventilator settings:
BIPAP ; FiO2 = 1,0 ; I:E=1:2 ; Bpm=14 ;

pinsp=35 mbar ; PEEP=5mbar
Results of settings:
Bpm=14 ; vt=500 ml ; MV = 6,4 l/min
Blood gas analysis:
pH
7,106
paO2
77,2 mm Hg
paCO2 69,1 mm Hg
SaO2
86,7 %
BE
-2,6
HCO3-
21,8 mmol/l
1
3
Interpretation:
respiratory acidosis
Chemical equation
H+ + HCO3-
H2CO3
H2O + CO2
pH-value
7,30
metabolic
Acidosis
1
4
Cause:
e.g. acute kidney insufficiency, lactic acidosis, ketoacidosis, coma
diabeticum, alcoholic poisoning
Consequence:
HCO3- , BE negative
Diagnosis:
pH < 7,35 ; BE < -2 mmol/l ; Bicarbonate < 21 mmol/l
Compensation: increased CO2-exhalation, pH-reconciliation succeeds nearly never

completely
Therapy:
eliminate cause, ( dialysis, hemofiltration), supply of bicarbonate
in the form of NaHCO3 = neg. BE * kgbw * 0,3
Case report:
male, 58-years-old, gastrointestinal bleeding, breathing spontaneously, 6 l/min

O2, not accessible
Diabetes mellitus, CHD
Further diagnostics:
blood sugar level 633 mg/dl, ketone in the urine positive
Blood gas analysis:
pH
7,26
paO2
160,3 mm Hg
paCO2 31,6 mm Hg
SaO2
100%
BE
-5,9
HCO3-
19,8 mmol/l
1
5
Interpretation:
metabolic Acidosis
Chemical equation
H+ + HCO3-
H2CO3
H2O + CO2
pH-value
7,50
respiratory
Alkalosis
1
6
Cause:
e.g. craniocerebral trauma, fear, pain,excitement, aspirin

intoxication, incorrect adjusted ventilator
Consequence:
decrease of the paCO2 due the hyperventilation
Diagnosis:
pH 7,44 ; paCO2 35 mmHg
Compensation : kidney increases HCO3- - elimination and H+- retention
Therapy:
eliminate cause, leave breathing into a bag, possible mandatory

ventilation
Case report:
female, 23-year-old, dilatative cardiomyopathia, ventilated
Ventilator settings:
BIPAP ; FiO2 = 0,5 ; I:E=1:1 ; bpm=9 ;

pinsp=35 mbar ; PEEP=15mbar
Results of settings:
Bpm=9 ; vt=900 ml ; MV = 8,1 l/min
Blood gas analysis:
pH
7,510
paO2
154,4 mm Hg
paCO2 31,1 mm Hg
SaO2
99,6 %
BE
+2,2
HCO3-
24,7 mmol/l
1
7
Interpretation:
respiratory alkalosis
Chemical equation
H+ + HCO3-
H2CO3
H2O + CO2
pH-value
7,50
metabolic
Alkalosis
1
8
Cause:
e.g. loss of H+-ions in case of vomiting or diarrhea, to strong

buffering, diuretics
Consequence:
HCO3- , BE positive
Diagnosis:
pH 7,44 ; BE 2 mmol/l ; Bicarbonate 25 mmol/l
Compensation: hypoventilation, no complete reconciliation
Therapy:
eliminate cause ,only very heavy alkalosis must be corrected,

supply of hydrochloric acid= pos. BE * kgbw * 0,2
Case report:
female, 82-years-old, in need of permanent nursing, status after resuscitation

200 ml NaHCO3 i.v. from emergency physician
Anamnesis:
gastrointestinale infection since 7 days
1
9
exsiccosis
Blood gas analysis:
pH
7, 58
paO2
83,2 mm Hg
paCO2 41,2 mm Hg
SaO2
96,3%
BE
+9,2
HCO3-
30,4 mmol/l
Interpretation:
metabolic alkalosis
Acid-Base-Balance
No.
pH
paCO2
p aO 2
S aO 2
HCO3-
BE
Comment
no deviation
1.
7,4
39
50
89
21
-2
2.
7,26
65
151
98
25
-0,2
resp.acidosis
resp. alkalosis
3.
7,5
29,5
68
93
24
4.
7,2
42
71
95
14
-12
5.
7,56
39
110
99
35
11
met. acidosis
met. alkalosis
met. acidosis
6.
7,2
55
55
70
12
-8
7.
7,6
33
104
98
32
15
met.alkalosis
resp. acidosis
8.
7,32
52
66
93
24
resp. acidosis
9.
7,36
53
61
90
30
resp.alkalosis
10.
7,48
28
90
98
20
-3
resp. alkalosis
11.
7,45
28
82
97
12
-5
met.acidosis
12.
7,28
42
69
94
14
-10
met. acidosis
13.
7,37
29
68
95
14
-11
met. alkalosis
2
0
14.
7,47
47
88
98
30
resp. acidosis
15.
7,08
60
32
34
41
12

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Acid-Base-Balance

Basics of Acid - Base - Balance ( ABB )

The Bicarbonate Buffer System

Basics of Acid - Base - Balance ( ABB )

Purpose of an arterial BGA is to receive current information

The BGA generally gives information about the following

The Bicarbonate Buffer System

organ functions linked to a pH-value

metabolic activities affect the pH-value

regulating mechanisms keep the pH-value constantly

responsible for this:

Bicarbonate buffer takes over 75% of the tasks of buffer

deviations of the pH-value is called Acidosis or Alkalosis

Acidosis: leads to myasthenia, coma,BP-decrease, heartbeat disturbances

Alkalosis: leads to confusion, BP-decrease, heartbeat disturbances,

e.g. obstruction of the airways , central breath depression, lung

rise of the paCO2 due the hypo ventilation

pH < 7,35 ; paCO2 > 45 mmHg

Compensation: kidney increases H+- ions elimination and bicarbonate formation

eliminate cause, possible mandatory ventilation

female, 23-year-old, dilatative cardiomyopathia, ventilated

BIPAP ; FiO2 = 1,0 ; I:E=1:2 ; Bpm=14 ;

Bpm=14 ; vt=500 ml ; MV = 6,4 l/min

Blood gas analysis:

pH < 7,35 ; BE < -2 mmol/l ; Bicarbonate < 21 mmol/l

Compensation: increased CO2-exhalation, pH-reconciliation succeeds nearly never

male, 58-years-old, gastrointestinal bleeding, breathing spontaneously, 6 l/min

blood sugar level 633 mg/dl, ketone in the urine positive

Blood gas analysis:

e.g. craniocerebral trauma, fear, pain,excitement, aspirin

decrease of the paCO2 due the hyperventilation

pH 7,44 ; paCO2 35 mmHg

Compensation : kidney increases HCO3- - elimination and H+- retention

eliminate cause, leave breathing into a bag, possible mandatory

female, 23-year-old, dilatative cardiomyopathia, ventilated

BIPAP ; FiO2 = 0,5 ; I:E=1:1 ; bpm=9 ;

Bpm=9 ; vt=900 ml ; MV = 8,1 l/min

Blood gas analysis:

e.g. loss of H+-ions in case of vomiting or diarrhea, to strong

pH 7,44 ; BE 2 mmol/l ; Bicarbonate 25 mmol/l

Compensation: hypoventilation, no complete reconciliation

eliminate cause ,only very heavy alkalosis must be corrected,

female, 82-years-old, in need of permanent nursing, status after resuscitation

gastrointestinale infection since 7 days

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