ACID-BASE

balance
Acids and Bases
Arrhenius’s definition:
An acid is a substance that increases the
concentrationof hydrogen ion (H+) when
dissolved in water, and a base is a
substancethat increases the concentration
of hydroxyl ion (OH−) when dissolve in
water.
Acids and Bases
Bronsted and Lowry’s definition:
An acid is a substance that donates a proton in
a reaction, and a base is a substance that
accepts a proton in a reaction.
Lewis’s definition:
An acid is a molecule or ion that accepts a pair
of electrons to form a covalent bond, and a
base is a molecule that donates a pair of
electrons for a covalent bond.
Definitions
 Respiration – process to supply cells with
oxygen (metabolic process) and remove
carbon dioxide (metabolism)
 Partial Pressure : amount of pressure each
gas contributes to the total pressure
exerted by the mixture
 Acidemia – arterial blood pH < 7.35
 Alkalemia – arterial blood pH > 7.45
Definitions
 Hypercapnia – increased blood PCO2
 Hypocapnia – decreased blood PCO2
 Partial Pressure of Carbon dioxide (PCO2) :
Measured in blood as mmHg
 Concentration of dissolved carbond dioxide
(cdCO2) : undissociated carbonic acid (H2CO3)
and Carbon dioxide in blood (represented by PCO2)
 Concentration of total carbon dioxide (ct CO2) :
includes bicarbonate (primary component),
carbamino-bound CO2, carbonic acid and
dissolved carbon dioxide
 Power of Hydrogen (pH) of
Plasma
 PartialPressure of Carbon dioxide (Lungs)
and concentration of Bicarbonate
(HCO3-) concentration (kidneys)
 Carbon dioxide transported as
bicarbonate, carbamino compound
(CO2 bound to serum Proteins and
Hemoglobin) and dissolved carbon
dioxide. Even though these forms
transport the carbon dioxide they also
serve as buffers to maintain blood pH.
 Henderson-Hasselbach
equation
 Indicates that pH depends on the ratio of
HCO3 - /PCO2
 When kidneys and lungs are functioning
properly , there is a 20:1 ration of HCO3 –
to H2CO3
 Henderson-Hasselbach
equation
 Carbon dioxide, pH and PCO2 are related

pH = pka + log conjugate base

weak acid

Where in
pk = 6.1
Conjugate base = bicarbonate
Weak acid = carbonic acid

CO2 + H2O <-> H2CO3 <-> H+ + HCO3-

Reference Range for ABG
analysis
 pH : 7.35 – 7.45
 ctCO2 : 22-26 mmol/L
 PCO2 : 35-45 mm Hg
 Blood pH : 7.35-45
Factors maintaing Acids and
Bases in the body
 Kidneys
 Lungs
 Buffers (Weak acids and bases)
 Lungs
 to control blood pH the lungs is responsible for
releasing CO2 in the body
 As carbon dioxide accumulates in the body , pH
blood decreases (acidic)
 The brain regulates the amount of carbon dioxide
that is exhaled , and consequently the pH of the
blood , increases as breathing becomes faster and
deeper.
 By adjusting the speed and depth of breathing , the
brain and lungs are able to regulate the blood pH
minute by minute
Kidneys
 Kidneys are able to affect blood pH
excreting excess acids and bases.
 Adjustments in pH through kidneys are
slow , generally takes several days.
Buffer systems
 pH buffers are combination of the body’s
weak acids and base
 Bicarbonate-carbonic acid system (most
important)
 Protein buffer system
 Phosphate buffer system
 Hemoglobin buffer system
 Normal Values

Acid 7.35 pH 7.45 Alkaline

Alkaline 35 PCO2 45 Acid
Acid 22 HCO3 26 Alkaline
 Four step Guide to ABG
analysis
1. Evaluation of pH
 Is it normal,acidotic or alkalotic?

2. Evaluate the PCO2 or HCO3

 Is it Abnormal?
 Which on appears to be abnormal?
 If both, the one that deviates the most from the norm
is most likely causing an abnormal pH
Four step Guide to ABG
analysis
3. Evaluate Compensation
An ACUTE (abnormal pH) is differentiated
from COMPENSATED (normal pH) based on
the value of pH.
COMPENSATION occurs when the pCO2
and HCO3 rise together to maintain a
normal pH. PART COMPENSATION occurs
when the pCO2 and HCO3 rise together
but the pH remains abnormal.
Four step Guide to ABG
analysis
 Check the pO2.
>Is the patient hypoxic?
Problem Solving
Patient 1:

pH = 7.21
pCO2 = 42 mm Hg
HCO3- = 19 mEq/L
Problem Solving
pH : 7.29
pCO2 = 33 mm Hg
HCO3 = 19 mEq/L
Problem Solving
Acidosis
Alkalosis