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Acid/ Base Review

Acid/ Base Review. NR-75 D Diana Diaz RN MSN. Objectives. Review the basic mechanisms of acid/base Recall the 4 major types of Acid/base imbalances Analyze a set of blood gas values. pH and Hydrogen Ion. Indirect measure of H+ ion concentration Ratio of base (HCO 3 ) to acid (CO 2 )

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Acid/ Base Review

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  1. Acid/ Base Review NR-75 D Diana Diaz RN MSN

  2. Objectives • Review the basic mechanisms of acid/base • Recall the 4 major types of Acid/base imbalances • Analyze a set of blood gas values

  3. pH and Hydrogen Ion • Indirect measure of H+ ion concentration • Ratio of base (HCO3) to acid (CO2) • Acids give up (donate) H+ ions, while bases pick up H+ ions

  4. pH • Body maintains a slightly alkaline pH of 7.35 - 7.45 • Metabolic and respiratory processes work together to keep hydrogen (H+) levels in a normal range

  5. Regulators of Acid/Base • Buffers • Respiratory system • Renal system

  6. Acid – Base Balance CO2 + H20H2CO3H+ + HCO3- Kidneys Lungs Respiratory Metabolic Fast Slow

  7. ABG Normal Values • pH 7.35 - 7.45 overall state • PaCO2 35 - 45 mm Hg (respiratory component) • HCO3 22 - 26 mEq/L (metabolic component)

  8. ABG Normal Values • PaO2 80 - 100 mmHg partial pressure of oxygen in arterial blood • SaO2 96 - 100% arterial O2 saturation

  9. ABG Normal Values • pH 7.35 - 7.45 overall state • PaCO2 35 - 45 mm Hg (respiratory component) • HCO3 22 - 26 mEq/L (metabolic component)

  10. Acid-Base Imbalances • Alkalemia • Alkalosis • Acidemia • Acidosis

  11. Metabolic Acidosis • Causes • Anaerobic metabolism • Lactic acidosis • Anoxia • Poisoning • Overdose

  12. Metabolic Alkalosis • Causes • Vomiting • Poisoning • Overdose

  13. Respiratory Acidosis • Causes • Hypoventilation • Respiratory failure • - Long-standing respiratory insufficiency, COPD

  14. Respiratory Alkalosis • Causes • Hyperventilation

  15. Interpretation of ABGs • Evaluate pH: this determines acidosis or alkalosis • 7.40 is in the middle of the normal range of 7.35 - 7.45 • Value below 7.40 is moving towards acidosis • Value above 7.40 is moving towards alkalosis

  16. Interpretation of ABGs • Evaluate respiratory component (PaCO2) • If PaCO2 < 35, the value is alkalotic • If PaCO2 > 45, the value is acidotic

  17. Interpretation of ABGs • Evaluate the metabolic component (HCO3) • If HCO3 > 26 mEq/L, the value is alkalotic • If HCO3 < 22 mEq/L, the value is acidotic

  18. Interpretation of ABGs • Determine which component (PaCO2 or HCO3) matches the pH • If pH is decreased or increased is the underlying disorder respiratory or metabolic?

  19. Interpretation of ABGs • Respiratory • ↑ pH, ↓ PaCO2 • ↓ pH, ↑ PaCO2 • Metabolic • ↑ pH, ↑ HCO3 • ↓ pH, ↓ HCO3

  20. Compensation • Determine the degree of compensation Absent: • pH is not within normal range • The component that does not match the pH imbalance is still within its normal range

  21. Compensation • Determine the degree of compensation Complete: • pH is within the normal range and both components are either above or below normal range

  22. Compensation • Determine the degree of compensation Partial: • pH is not within normal range • The component that does not match the pH disorder is above or below the normal range

  23. Acid/Base Mnemonic- ROME • R (respiratory) • O (opposite) • pH PaCO2 alkalosis • pH PaCO2 acidosis • M (metabolic) • E (equivalent) • pH HCO3 acidosis • pH HCO3 alkalosis

  24. More Fun with Acid - Base • Mixed diagnoses • More than one problem • Acute and compensated respiratory acidosis • Respiratory and metabolic acidosis

  25. Lets Practice

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