PARAMETERS OF INTEREST: pH pCO2 pO2 HCO3

NORMAL VALUES: 7.35-7.45 35-45mmHg 81-100mmHg 21-28 mEq/L

I. Role of the Lungs II. Role of the Kidneys III. Role of Buffer System IV. Abnormal States of Acid-Base Balance a. Respiratory Acidosis b. Respiratory Alkalosis c. Metabolic Acidosis d. Metabolic Alkalosis

release carbon dioxide. The blood carries carbon dioxide to the lungs, where it is exhaled. As carbon dioxide accumulates in the blood, the pH of the blood decreases (acidity increases). The brain regulates the amount of carbon dioxide that is exhaled by controlling the speed and depth of breathing. The amount of carbon dioxide exhaled, and consequently the pH of the blood, increases as breathing becomes faster and deeper.

excrete excess acids or bases. The kidneys have some ability to alter the amount of acid or base that is excreted, but because the kidneys make these adjustments more slowly than the lungs do, this compensation generally takes several days.

guard against sudden shifts in acidity and alkalinity. The pH buffer systems are combinations of the body's own naturally occurring weak acids and weak bases. These weak acids and bases exist in balance under normal pH conditions.

work chemically to minimize changes in the pH of a solution by adjusting the proportion of acid and base.

Acidosis: The blood has too much acid (or too little base), resulting in a decrease in blood pH. Alkalosis: The blood has too much base (or too little acid), resulting in an increase in blood pH.

Respiratory acidosis the lungs do not expel carbon dioxide adequately

is an excess carbonic acid that is caused by conditions resulting in hypoventilation and CO2 retention. In respiratory acidosis, the arterial pH is less than 7.35, the pC02 is greater than 45 torr, and the HC03- is normal or elevated (depending on the degree of renal compensation).

Major Causes of Respiratory Acidosis

Lung disorders, such as emphysema,

chronic bronchitis, severe asthma, pneumonia, or pulmonary edema Sleep-disordered breathing Diseases of the nerves or muscles of the chest that impair breathing, such as Guillain-Barr syndrome or amyotrophic lateral sclerosis Overdose of drugs such as alcohol, opioids, and strong sedatives

pCO2

pH

Respiratory Alkalosis a low level of carbon dioxide in the blood that results from rapid or deep breathing.

develops when rapid, deep breathing (hyperventilation) causes too much carbon dioxide to be expelled from the bloodstream.

In respiratory alkalosis, the arterial pH is greater than 7.45, the PC02 is less than 35 torr, and the HC03- is normal or decreased

Major Causes of Respiratory alkalosis

Anxiety Aspirin overdose (early stages) Fever Low levels of oxygen in the blood Pain

pH

pCO2

Metabolic Acidosis deficit of bicarbonate caused by conditions that result in a loss of bicarbonate or an increase in fixed acids.

In metabolic acidosis, the arterial pH is less than 7.35, the PC02 is decreased (a normal or elevated PC02 would indicate failing respiratory compensation and the development of respiratory acidosis), and HC03- is less than 21 mEq/L.

Major Causes of Metabolic Acidosis

Diabetic ketoacidosis (buildup of ketones) Drugs and substances such

as acetazolamide, alcohol, aspirin, and iron Lactic acidosis Loss of bases, such as bicarbonate, through the digestive tract from diarrhea, an ileostomy, or a colostomy Kidney failure Poisons such as carbon monoxide, cyanide, ethylene glycol, and methanol Renal tubular acidosis

Metabolic Alkalosis excessive blood alkalinity caused by an overabundance of bicarbonate in the blood or a loss of acid from the blood

excess of HC03- is caused by conditions resulting in excess base, because of loss of H+, reabsorption of HC03-, or loss of other ions (i.e.,chloride,sodium).

Major Causes of Metabolic Alkalosis

Loss of acid from vomiting or drainage of the

stomach Overactive adrenal gland (Cushing's syndrome) Use of diuretics (thiazides, furosemide,ethacrynic acid)

Respiratory Opposite (pCO2, pH) Metabolic Equal (HCO3,pH)

Compensatory Mechanisms
Metabolic Acidosis
Uncompensatory Organ Uncompensatory Mechanism Compensatory Organ Compensatory Mechanism Kidney

Metabolic Alkalosis
Kidney

Respiratory Respiratory Acidosis Alkalosis

Lungs Lungs

Bicarbonate deficiency Lungs

Bicarbonate excess Lungs

Increase pCO2 Kidney

Decrease pCO2 Kidney

Decrease pCO2

Increase pCO2

Bicarbonate excess

Bicarbonate deficiency

pH: 7.24 pCO2: 44 HCO3: 18

pH: 7.26 pCO2: 56 HCO3: 47

Metabolic Acidosis

Respiratory Acidosis

pH: 7.48 pCO2: 53 HCO3: 30

pH: 7.50 pCO2: 28 HCO3: 19

Metabolic Alkalosis

Respiratory Alkalosis