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Part 2 - 1
ACID/BASE BALANCE
Objectives
Describe the meaning of anion gap and explain the significance of an abnormal anion gap in metabolic acidosis.
Electrolyte = a substance which develops an electrical charge in the presence of water
Anion = (-) Cl
Acid = Electrolyte that forms a hydrogen cation and an anion in the presence of water
Strong base Binds well with hydrogen OH- (Hydroxide); KOH (Potassium hydroxide)
pH = Expression of the hydrogen ion concentration
Ranges from 0 - 14
Neutral = pH of 7
Physiological pH = 7.4
Varies depending on body fluid: ABG = 7.35-7.45, Urine = 5-6, Pancreatic fluid = 7.8-8.0
Volatile Acid = CAN be eliminated as CO2 gas via the lungs
FUNCTIONS:
o Control pH respond to changes in acid-base balance
o Converts a strong acid/base into a weak one by absorbing excess hydrogen ions or excess hydroxide to
minimize fluctuations in pH
REGULATION OF PH
Renal system (produce more acidic or alkaline urine) = Several days (SLOW)
BUFFER SYSTEMS act to keep pH normal
Patho Wk 5: Ch. 3
Part 2 - 2
75% is reabsorbed
o
NH4+
BOTH types of renal buffering use the bicarbonate buffering system as well
o CO2 H2CO3
o H2CO3 H+ + HCO3o H+ is secreted from renal tubular cells and is buffered by HPO4-- and NH3
o Hydrogen is secreted
o HCO3- is retained
RESPIRATORY Control of pH
Carbonic anhydrase
o Carbonic acid dissociates to CO2 and H2O
Acidosis RR s, CO2 s d pH
Alkalosis RR s, CO2 s d pH
Response time = 20-30 minutes
RENAL Control of pH
H2CO3 H+ + HCO3
Na+ is reabsorbed from the tubular fluid
H+ is excreted
Patho Wk 5: Ch. 3
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ACID-BASE DISORDERS
RESPIRATORY ACIDOSIS pH < 7.35 with PaCO2 > 45mmHg
TREATMENT:
o Need to breathe!
TREATMENT:
o Treat underlying cause!
o Watch for respiratory fatigue, may need intubation
o Sedate the patient
o Adjust ventilator
CAUSES:
Patho Wk 5: Ch. 3
o
o
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DECd Base
Starvation ketosis
Poisoning
ASA
TREATMENT:
o Treat underlying cause
CAUSES:
o INCd Base (base excess)
Antacids
Dialysis
o DECd Acid (loss of acid)
Diuretics
Adrenal disorder
TREATMENT:
o Treat underlying cause
Diamox
Slow resolution
POTASSIUM IMBALANCES
In ACIDOSIS = HYPERkalemia
o Kidney
In ALKALOSIS = HYPOkalemia
o Kidney
Patho Wk 5: Ch. 3
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Cellular
CALCIUM IMBALANCES
COMPENSATION
Gentle balance between the lungs and kidneys (act as each others compensatory mechanism)
Patho Wk 5: Ch. 3
o
o
o
Part 2 - 6
Intrapulmonary shunting
MUDPILES methanol, uremia, DKA, paraldehyde, isoniazid, lactic acidosis, ethylene glycol, salicylates
INTERPRETATION OF ABGs
Look at the pH
o Is it normal? 7.35-7.45
o Is it abnormal?
Acidosis = <7.35
Alkalosis = >7.45
Patho Wk 5: Ch. 3
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