Acid Base Balance and Fluid

Balance
Dr. Kathleen Ethridge
Northeast Texas Community College
 Homeostasis

• A delicate balance of fluids, electrolytes, and acids

and bases is required to maintain good health.

• This balance is called Homeostasis.

 Body Fluids
• Intracellular fluid (ICF)
– found within the cells of the body
– constitutes 2/3 of total body fluid in adults
– major cation is potassium

• Extracellular fluid (ECF)

– found outside the cells
– accounts of 1/3 of total body fluid
– major cation is sodium
 Terms
• Osmosis
– movement of water across cell membranes from less
concentrated to more concentrated

• Solutes
– substances dissolved in a liquid

• Osmolality
– the concentration within a fluid
 More Terms
• Diffusion
– movement of molecules in liquids from an area of higher
concentration to lower concentration
• Filtration
– fluid and solutes move together across a membrane from
area of higher pressure to one of lower pressure
• Active Transport
– substance moves across cell membranes from less
concentrated solution to more concentrated - requires a
carrier
 Routes of Fluid Loss

• Urine
• Insensible fluid loss
• Feces
 Electrolytes
• Sodium
• Potassium • Magnesium
• Chloride • Calcium
• Phosphate • Bicarbonate

Electrolytes are important for:

. Maintaining fluid balance
. Contributing to acid-base regulation
. Facilitating enzyme reactions
 Acid-Base Balance

• Acid-Base balance is:

– the regulation of HYDROGEN ions.

 pH
• The acidity or alkalinity of a solution is
measured as pH.
• The more acidic a solution, the lower the pH.
• The more alkaline a solution , the higher the pH.
• Water has a pH of 7 and is neutral.
• The pH of arterial blood is normally between
7.35 and 7.45
 Hydrogen ions

• The more Hydrogen ions, the more acidic the solution and
the LOWER the pH

• The lower Hydrogen concentration, the more alkaline the

solution and the HIGHER the pH
 pH
• Know what is normal.
 Buffer Systems
• Regulate pH by binding or releasing Hydrogen

• Most important buffer system:

– Bicarbonate-Carbonic Acid Buffer System
• (Blood Buffer systems act instantaneously and thus constitute
the body’s first line of defense against acid-base imbalance)
Acid Base Balance
Respiratory Component
Renal Component
 Respiratory Regulation
• Lungs
– help regulated acid-base balance by
eliminating or retaining carbon dioxide
– pH may be regulated by altering the rate and depth of
respirations
– changes in pH are rapid,
» occurring within minutes

– normal CO2 level

• 35 to 45 mm Hg
 Renal Regulation
• Kidneys
– the long-term regulator of acid-base balance
– slower to respond
• may take hours or days to correct pH
– kidneys maintain balance by excreting or conserving
bicarbonate and hydrogen ions

– normal bicarbonate level

• 22 to 26 mEq/L.
 Factors Affecting Balance

• Age
– especially infants and the elderly
• Gender and Body Size
– amount of fat
• Environmental Temperature
• Lifestyle
– stress
Acid-Base Imbalances

• Respiratory Acidosis
• Respiratory Alkalosis
• Metabolic Acidosis
• Metabolic Alkalosis
See Chart
 Respiratory Acidosis
• Mechanism
– Hypoventilation or Excess CO2 Production

• Etiology
– COPD
– Neuromuscular Disease
– Respiratory Center Depression
– Late ARDS
– Inadequate mechanical ventilation
– Sepsis or Burns
– Excess carbohydrate intake
 Respiratory Acidosis (cont)
• Symptoms
– Dyspnea, Disorientation or coma
– Dysrhythmias
– pH < 7.35, PaCO2 > 45mm Hg
– Hyperkalemia or Hypoxemia

• Treatment
– Treat underlying cause
– Support ventilation
– Correct electrolyte imbalance
– IV Sodium Bicarb
 Respiratory Alkalosis

• Risk Factors and etiology

– Hyperventilation due to
» extreme anxiety, stress, or pain
» elevated body temperature
» overventilation with ventilator
» hypoxia
» salicylate overdose
» hypoxemia (emphysema or pneumonia)
» CNS trauma or tumor
 Respiratory Alkalosis (cont)
• Symptoms
– Tachypnea or Hyperpnea
– Complaints of SOB, chest pain
– Light-headedness, syncope, coma, seizures
– Numbness and tingling of extremities
– Difficult concentrating, tremors, blurred vision
– Weakness, paresthesias, tetany
– Lab findings
– pH above 7.45
– CO2 less than 35
 Respiratory Alkalosis (cont)
• Treatment
• Monitor VS and ABGs
• Treat underlying disease
• Assist client to breathe more slowly
• Help client breathe in a paper bag
• or apply rebreather mask
• Sedation
 Metabolic Acidosis
• Risk Factors/Etiology
– Conditions that increase acids in the blood
• Renal Failure
• DKA
• Starvation
• Lactic acidosis
– Prolonged diarrhea
– Toxins (antifreeze or aspirin)
– Carbonic anhydrase inhibitors - Diamox
 Metabolic Acidosis (cont)
• Symptoms
– Kussmaul’s respiration
– Lethargy, confusion, headache, weakness
– Nausea and Vomiting
– Lab:
• pH below 7.35
• Bicarb less than 22

• Treatment
– treat underlying cause
– monitor ABG, I&O, VS, LOC Sodium Bicarb?
 Metabolic Alkalosis
• Risk Factors/Etiology
– Acid loss due to
• vomiting
• gastric suction
– Loss of potassium due to
• steroids
• diuresis
– Antacids (overuse of)
 Metabolic Alkalosis (cont)
• Symptoms
– Hypoventilation (compensatory)
– Dysrhythmias, dizziness
– Paresthesia, numbness, tingling of extremities
– Hypertonic muscles, tetany
– Lab: pH above 7.45, Bicarb above 26
– CO2 normal or increased w/comp
– Hypokalmia, Hypocalcemia

• Treatment
– I&O, VS, LOC
– give potassium
– treat underlying cause
 Pneumonic
• Respiratory
• Opposite
• Metabolic
• Equal
 Interpreting ABGs
• 1. Look at the pH
• is the primary problem acidosis (low) or alkalosis (high)

• 2. Check the CO2 (respiratory indicator)

• is it less than 35 (alkalosis) or more than 45 (acidosis)

• 3. Check the HCO3 (metabolic indicator)

• is it less than 22 (acidosis) or more than 26 (alkalosis)

• 4. Which is primary disorder (Resp. or Metabolic)?

• If the pH is low (acidosis), then look to see if CO2 or HCO3 is acidosis
(which ever is acidosis will be primary).
• If the pH is high (alkalosis), then look to see if CO2 or HCO3 is alkalosis
(which ever is alkalosis is the primary).
• The one that matches the pH (acidosis or alkalosis), is the primary disorder.
 Compensation
• The Respiratory system and Renal systems
compensate for each other
– attempt to return the pH to normal
• ABG’s show that compensation is present when
– the pH returns to normal or near normal
• If the nonprimary system is in the normal range
(CO2 35 to 45) (HCO3 22-26), then that system is
not compensating for the primary.
• For example:
– In respiratory acidosis (pH<7.35, CO2>45), if the HCO3 is >26,
then the kidneys are compensating by retaining bicarbonate.
– If HCO3 is normal, then not compensating.