pH is the result of Acid-Base Balance

in the body

Normal ABG Values

pH: 7.35 --- 7.45
Pco2: 35 --- 45 mmHg
HCO3: 24-26 mEq/L

ACID-Base
Disorders

Acidosis

Respiratory

Metabolic

Alkalosis

Respiratory

Metabolic

Causes of Respiratory Acidosis

Respiratory center depression. E.g.: CVS, Drugs
(narcotics).
Respiratory tract obstruction. E.g.: Foreign body,
OSA syndrome, laryngeal spasm.
Peripheral nerves affection i.e.: lower motor
neuron lesions, GB syndrome or spinal cord
lesions.
Respiratory Muscle weakness as myasthenia
gravis.
Lung Pathology as COPD, Asthma, Pneumonia,
Pneumothorax, pulmonary edema.

ACID-Base
Disorders

Acidosis

Respiratory

Metabolic

Alkalosis

Respiratory

Metabolic

Causes of Respiratory Alkalosis

Increased CNS respiratory drive:
1. Anxiety and pain.
2. Voluntary hyperventilation.
3. CNS diseases: Tumors, infection, CVS.
4. Fever and sepsis.
5. Drugs as salicylate poisoning
6. Hyperthyroidism
7. Hepatic encephalopathy.
8. Excessive exercise.

Causes of Respiratory Alkalosis

Mechanical Ventilation: Over ventilation
Hypoxia: High attitude, pulmonary disease,
profound edema.
Pulmonary diseases:
1. Pulmonary embolism
2. Pulmonary edema
3. Pneumonia
4. Restrictive lung diseases

ACID-Base
Disorders

Acidosis

Respiratory

Metabolic

Alkalosis

Respiratory

Metabolic

Causes of Metabolic Acidosis

Caused by wide variety of causes.
So, Metabolic acidosis is divided into 2
categories according to anion gap (AG):
High anion gap Metabolic acidosis.
Normal anion gap Metabolic acidosis.
According to the equation:

AG= Na - Cl - HCO3
Values more than 12 4 mEq/L is a high AG

Anion Gap
AG is an estimate of the relative abundance of
unmeasured anions, and is used to determine if
a metabolic acidosis is due to an accumulation
of non-volatile acids (e.g., lactic acid) or a net
loss of HCO3 (e.g., diarrhea)

Anion Gap
To achieve electrochemical balance, the
concentration of negatively-charged anions
must equal the concentration of positivelycharged cations.
All ions participate in this balance, including
those that are routinely measured, such as
sodium (Na), chloride (CL), and bicarbonate
(HCO3), and those that are not measured

Anion Gap
The unmeasured cations (UC) and unmeasured
anions (UA) are included in the electrochemical
balance equation:
Na + UC= (Cl + HCO3) + UA
Na - (Cl+ HCO3) = UA- UC
The difference (UA - UC) is a measure of the
relative abundance of unmeasured anions and
is called the anion gap (AG)

Anion Gap
The difference between the two groups reveals
an anion excess (anion gap) of 12 mEq/L, and
much of this difference is due to the Albumin
concentration.
Albumin is major source of unmeasured anions,
and a 50% reduction in the albumin
concentration will result in a 75% reduction in
the anion gap.
Since hypoalbuminemia is common in ICU
patients, the influence of albumin on the AG
must be considered in all ICU patients.

HAGMA
M
U
D
P
I
L
E
S

Methanol
Uremia
DKA
Paraldehyde
Isopropyl alcohol
Lactate
Ethylene glycol
Salicylate

NAGMA
U
S
E
D
C
A
R
P
A
R
T
S

Urinary Fistula
Saline
Early Renal Failure
Diarrhea

Carbonic Anhydrase Inhibitors

Post Hypocapnic
Acidifying Agents: NH4Cl, HCL, MgCl2
Renal Tubular Acidosis
Triamterene
Spironolactone

ACID-Base
Disorders

Acidosis

Respiratory

Metabolic

Alkalosis

Respiratory

Metabolic

Causes of Metabolic Alkalosis

Chloride Responsive:
1. Loss of H+ ions:
Kidney losses: diuretic therapy, post-hypercpnic,
penicillin and ampicillin.
GIT losses: vomiting, NG suction, villous adenoma.
2. Alkali Administration: HCO3, citrate, acetate.
Chloride Resistant:
1. Primary hyperaldosteronism
2. Cushings Syndrome.
3. Drugs with mineralocortcoid activity.
4. Parathyroid disease.
5. Hypokalemia, Hypercalcemia.
6. Refeeding.

ACID-Base
Disorders

Acidosis

Respiratory

Metabolic

Alkalosis

Respiratory

Metabolic

pH

Decreased
<7.35

Acidosis

Increased
Normal

>7.45

Alkalosis

pH
Decreased
<7.35
(Acidosis)
PCO2
Increased

Decreased or normal

>45

35

Respiratory
Acidosis

Go to HCO3

If Decreased
< 22

Metabolic acidosis

pH

Decreased
<7.35

Acidosis

Increased
Normal

>7.45

Alkalosis

pH
Increased
>7.45
(Alkalosis)
PCO2
Decreased

Increased or normal

<35

45

Respiratory
Alkalosis

Go to HCO3

If increased
> 26

Metabolic Alkalosis

Expected Changes In Acid- Base Disorders

Primary Disorder

Expected Changes

Metabolic Acidosis

PaCO2= 1.5* HCO3+(82)

Metabolic Alkalosis

PaCO2= 0.7* HCO3+(212)

Acute Respiratory Acidosis

pH= 0.008 * (PaCO2-40)

Chronic Respiratory Acidosis

pH= 0.003 * (PaCO2-40)

Acute Respiratory Alkalosis

pH= 0.008 * (40- PaCO2)

Chronic Respiratory Alkalosis

pH= 0.017 * (40- PaCO2)

pH= 7.22
PCO2= 68 mmHg
HCO3= 24 mEq/L

pH= 7.25
PCO2= 28 mmHg
HCO3= 12 mEq/L

pH= 7.58
PCO2= 24 mmHg
HCO3= 26 mEq/L

pH= 7.55
PCO2= 50 mmHg
HCO3= 33 mEq/L

pH= 7.39
PCO2= 52 mmHg
HCO3= 34 mEq/L

pH= 7.44
PCO2= 30 mmHg
HCO3= 18 mEq/L

pH= 7.28
PCO2= 82 mmHg
HCO3= 36 mEq/L

pH= 7.61
PCO2= 30 mmHg
HCO3= 36 mEq/L

pH= 7.02
PCO2= 60 mmHg
HCO3= 15 mEq/L

pH= 7.59
PCO2= 30 mmHg
HCO3= 30 mEq/L