Fluid, Electrolyte and Acidbase Balance Block

ACID-BASE BALANCE
By Harliansyah, PhD
2012

HYDROGEN IONS, ACIDS,

AND BASES

HYDROGEN IONS (H+)

ACIDS

BASES

PH
Normal arterial pH is 7.35 7.45

ACID-BASE BALANCES

Acidosis pH < 7.35

Alkalosis pH > 7.45

Buffers

PRIMARY BUFFER SYSTEMS

IN EXTRACELLULAR FLUID

REGULATION OF ACIDS
AND BASES

THE BIG THREE ACID-BASE

REGULATORS

Chemical regulation
Biological regulation
Physiological regulation

PHYSIOLOGICAL
REGULATION

Alkalosis

Acidosis

ACID BASE IMBALANCES

RESPIRATORY ACIDOSIS
RESPIRATORY
ALKALOSIS
METABOLIC ACIDOSIS
METABOLIC ALKALOSIS

ARTERIAL BLOOD GASES

NORMAL
VALUES
pH
PCO
2
HCO
3
PO
2

BLOOD GAS

7.35-7.45
35-45 mmHg
22-27 mEq/L
80-100 mmHg

ARTERIAL BLOOD GASES

RESPIRATORY IMBALANCES
Respiratory function indicator is PCO
2
Opposite response between the pH
and PCO2
pH is down in an acidotic condition
and is elevated in an alkalotic
condition
pH and PCO determines if the
condition is a respiratory problem

ARTERIAL BLOOD GASES

METABOLIC IMBALANCES
HCO3 is indicator for metabolic
function
A corresponding response between the
pH and the HCO3
pH is down in an acidotic condition and
is elevated in an alkalotic condition
The pH and the HCO determines if the
3
condition is a metabolic problem

ANALYZING ARTERIAL
BLOOD GAS RESULTS

PYRAMID STEPS

PYRAMID STEP 1

Look at the blood gas report

Look at the pH. Is it up or down? If it is up, it
reflects alkalosis. If it is down, it reflects acidosis.

PYRAMID STEP 2

Look at the PCO2. Is it up or down? If it reflects

an opposite response as the pH then you know
that the condition is a respiratory imbalance. If it
does not reflect an opposite response as the pH,
then move on to Pyramid Step 3.

ANALYZING ARTERIAL
BLOOD GAS RESULTS

PYRAMID STEP 3

Look at the HCO3. Does the HCO3 reflect a

corresponding response with the pH? If it does,
then the condition is a metabolic imbalance.

PYRAMID STEP 4

Remember, compensation has occurred if the

pH is in a normal range of 7.35-7.45.
If the pH is not within normal range, look at the
respiratory or metabolic function indicators.

FLUID, ELECTROLYTE &

ACID -BASE

REMEMBER~~~~

NORMAL CHEMISTRY LABORATORY VALUES

Serum electrolyte levels

CBC (changes in Hct related to FVD & FVE)
BUN & Blood Creatinine Levels (kidney functions)
Urine Specific gravity (normal 1.003 1.023)
ABGs

OVERALL GOALS/EVALUATION

NORMALELECTROLYTE
FLUID, ELECTROLYTE AND ACID
BASE
LUID,
&
BALANCE
ACID
-BASE
CAUSES OF IMBALANCES IDENTIFIED OR CORRECTED

NO COMPLICATIONS FROM THERAPIES NEEDED TO

RESTORE BALANCE

INCLUDE FAMILY IN PROCESS