acid base balance

• ph-7.35-7.45
• pco2=35-45
• HCO3=21-28

• <6.8 death
• 7.35-7.45
• >7.8

• heart rate will stop
• hypothermia(heart shuts down)
• hyper(brain shuts down)

• hydrogen ion concentration 
• -measured by ph scale
• --log{H+}
• -1-14
• acidity(ph<7) lower #
• alkalinity(ph>7) higher #
•  more free h more acid
• a free h will change ph
• strong acid=fall apart easy H falls off

• acid ingestion
• -ASA(asprin)
• -FeSO4(iron sulfate) 
• -paraldehyde(antibuse-trying to break addictions)
• *base ingestion(alkaline)-bicarbonate ph increase=alkolosis
• -antacids-TUMS ca+ carbonate
• -citrate(blood preservative)-blood transfusions ph will increase 
• -lactate(counteract acidity)

• CO2 build up
• -co2 converted to carbonic acid (stop breathing stays in body and converts acid) 
• *Metabolic waste products 
• -lactic acid (carbs, protein ..anaerobic metabolism)
• -keto acids (fats ) 

resp arrest-lactic acids builds up(anaerobic) and co2..gives bicarbonate

• acid loss : gastric suction, gastric vomiting 
• alkali loss :  diarrhea(huge amounts of base)why it burns skin , intestinal vomiting

• buffers 
• -1st line of defense 
• -temporary
• -chemically inactivates H+
• -always there..temporary grabs free h and binds it to something

• phosphate*** can buffer carbonic acid
• proteins(hemoglobin)-buffers carbonic acid

• carbonic acid/bicarbonate system(can't buffer own components ..can do ASA, citrate can't buffer co2) 
• -can't buffer carbonic acid
• -important because of large amounts of co2 produced daily

• must maintain 
• 20 parts HCO3 to one part H2CO3 ratio for homeostasis
• (change ratio change ph) 
• lungs: regulate h2CO3 (acid regulation)
• kidneys: regulate hco3- (bicarb base regulator)

• most rapid 
• only minutes from co2 production to co2 elimination 
• controlled by respiratory center in medulla 

• speed up rr to get rid of acid(exhaling more) 
• save acid--breath slower RR , limited in how much lungs can do because of the need of 02

• exercise increase in acid production (lactic acid increases RR) 
• medulla sense increase in acid(monitor co2 levels) 
• tells lungs to speed up 
• lungs blow off co2
• acid levels drop 

what kills people, because brain is sedated..the brain can't tell the lungs what to do , acidic..lungs are also under voluntary control

• alkolosis -- you lose acid 
• dizzy

• Regulate HCO3 (base) side of the equation
• may take several days 
• very powerful
• act by: reabsorb HCO3, secrete h+ in urine(ammonia) (decreases acid)

• CO2 retention 
• -pneumonia(gas exhange) -alveoli lined with mucous ..barrel chest
• -emphysema, burns(obstruction)
• -chest trauma, polia(NM function) 
• -drug overdose, etoh(medulla fx) ..medulla is sedated 

ribs goes horizontal due to co2 levels (trapping air) -expand  to support structure of lungs ..change and ribs try to accommodate

• symptoms: CNS DEPRESSION(result of ph change) 
• -disorientation, coma 
• dyspnea
• -tachycardia
• -arrhythmias
• -co2 narcosis(excessive co2) birhgt red 
• cause resp problem 

• respiratory drive becomes insensitive to long term co2 elevation 
• medulla uses hypoxia as respiratory trigger
• meed to maintain some degree of hypoxia to keep breathing 
• breath runs on co2 levels co2 driver RR 
• emphayzeema increases co2 brain then learns to respond to 02 changes ..if you give 02 the resp rate decreases ..limit amounts of 02"keep air hungry"

• ph- decrease 
• co2-increase 
• hco3-ultamilty it will save base ..increase ..kidney

• improve respiratory function
• correct acidosis(NaHCO3-high risk of rebound alkalosis.....(overdose of base causes tetny-muscle rigidity ..begins with twitching hyper reflex ...) then give Ca+ to correct ) 
• IV ringers lactate or NaLactate 
• NG suction(sucking acid out of stomach) 

Correct other electrolyte imbalance (hyperkalemia(causes arrhythmia problems) or chloride deficit 

take a deep breath and relax 

• hyperventilation 
• overstimulation of respiratory center 
• -pain, trauma, hyperstimulus of brain(drugs), panic 
• -exhaling too often and too deep 

• cns-irritable 
• hyperreflexia- jittery, reflexes are super active 
• paresthesia-tingling, numbness, circumoral, extremities, fingertips 

Potassium will be low... 

• treat underlying disorder
• -sedatives
• -breath into paper bag(not if hypnotic, used for anxiety induced hyperventilation) 
• -pain management
• -oxygen therapy
• -change ventilator settings(may be too high)

k goes inside cells so H ions can come out to solve the acid deficit 

• overproduction of acids( DM, hyperthyroid...too much metabolic..lactic acid and keto acids--breath will smell sweet) 
• excessive ingestion( salicylate(aspirin), paraldehyde, antibus) 
• renal disease
• loss of alkali(base...diarrhea) 
• tissue anoxia(anaerobic--lactic acid = shock)

• CNS is depressed
• fruity breath=ketones..DM...can be mistaken for drunks 
• nausea/diarrhea=causing the problem 
• Potassium level is high=h+ going int0 cell K+ going out
• 02 level=normal most likely 
• co2=low-->high resp rate 

• Kussmaul respirations- is a result and hyperventilation to blow of co2
• flushed, warm, dry skin=blood vessels dilate in presence of acidosis(more blood to the lungs to exhale more) 
• stupor.coma=dehydrated, dumps sugar into urine ..pulls water with. 

• restore blood volume 
• correct bicarbonate deficit(NaHCO3) (beware of rebound alkalosis) 
• NG suction 
• treat electrolyte problems= increase K+, low HC03, 
• protect from injury=dehydrated, unstable, confused 
• dialysis-esp if renal induced problem 
• insule/saline=used temporary fix for hyperkalemia( grabs sugar and gets into cell with a K+, temporarily lowering potassium..

if tenty(from rebound alkalosis) give CA iv 

• vommiting 
• ng suction 
• diuretics(losing acid from kidney) 
• hypokalemia( decrease K , cause or result 
• ingestion of bicarb(baking soda) 
• massive blood transfusion(citrate-preservative in blood) 

• CNS- irritability , tingling in fingers 
• polyuria-if caused by diuretics ..may add to hypokalemia 
• dysrhythmias-low K, heart doesn't like any changes in K ..heart will increase or decrease 
• tetany=muscle rigidity , stiff muscles, hyper reflexes, ALWAYS ON EKG 

• ph=high 
• pco2=high(lungs slow down to save acid immediately) 
• hco3=hight 
• o2=may be low 

SLOW resp 

• treat primary problem
• -ingestion
• -volume depletion(diuretics) 
• control alkalosis 
• ringers solution(chloride ) 
• ammonium chloride(beware rbc hemolysis)=last effort..acid to treat base prob
• treat other deficits(K, NA, cl)