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Fluid, Electrolyte and Acid-base Balance BlockACID-BASE BALANCE
By Harliansyah, PhD2012
HYDROGEN IONS, ACIDS, AND BASES
HYDROGEN IONS (H+)
ACIDS
BASES
PHNormal arterial pH is 7.35 7.45
ACID-BASE BALANCESAcidosis pH < 7.35
Alkalosis pH > 7.45
Buffers
PRIMARY BUFFER SYSTEMS IN EXTRACELLULAR FLUID
REGULATION OF ACIDS AND BASESTHE BIG THREE ACID-BASE REGULATORS
Chemical regulationBiological regulationPhysiological regulation
PHYSIOLOGICAL REGULATION
Alkalosis
Acidosis
ACID BASE IMBALANCESRESPIRATORY ACIDOSISRESPIRATORY ALKALOSISMETABOLIC ACIDOSISMETABOLIC ALKALOSIS
ARTERIAL BLOOD GASES
NORMAL BLOOD GAS VALUESpH 7.35-7.45PCO2 35-45 mmHgHCO3 22-27 mEq/LPO2 80-100 mmHg
ARTERIAL BLOOD GASESRESPIRATORY IMBALANCESRespiratory function indicator is PCO2Opposite response between the pH and PCO2pH is down in an acidotic condition and is elevated in an alkalotic conditionpH and PCO determines if the condition is a respiratory problem
ARTERIAL BLOOD GASESMETABOLIC IMBALANCESHCO3 is indicator for metabolic function A corresponding response between the pH and the HCO3 pH is down in an acidotic condition and is elevated in an alkalotic condition The pH and the HCO3 determines if the condition is a metabolic problem
ANALYZING ARTERIAL BLOOD GAS RESULTSPYRAMID STEPSLook at the blood gas reportPYRAMID STEP 1Look at the pH. Is it up or down? If it is up, it reflects alkalosis. If it is down, it reflects acidosis.PYRAMID STEP 2Look at the PCO2. Is it up or down? If it reflects an opposite response as the pH then you know that the condition is a respiratory imbalance. If it does not reflect an opposite response as the pH, then move on to Pyramid Step 3.
ANALYZING ARTERIAL BLOOD GAS RESULTSPYRAMID STEP 3Look at the HCO3. Does the HCO3 reflect a corresponding response with the pH? If it does, then the condition is a metabolic imbalance.PYRAMID STEP 4Remember, compensation has occurred if the pH is in a normal range of 7.35-7.45.If the pH is not within normal range, look at the respiratory or metabolic function indicators.
FLUID, ELECTROLYTE & ACID -BASEREMEMBER~~~~
NORMAL CHEMISTRY LABORATORY VALUES
Serum electrolyte levelsCBC (changes in Hct related to FVD & FVE)BUN & Blood Creatinine Levels (kidney functions)Urine Specific gravity (normal 1.003 1.023)ABGs
F
LUID, ELECTROLYTE & ACID -BASEOVERALL GOALS/EVALUATION
NORMAL FLUID, ELECTROLYTE AND ACID BASE BALANCE
CAUSES OF IMBALANCES IDENTIFIED OR CORRECTED
NO COMPLICATIONS FROM THERAPIES NEEDED TO RESTORE BALANCE
INCLUDE FAMILY IN PROCESS
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