Acid-Base Balance

Carmelo A. Baldovino Jr., RMT

Henderson-Hasselbalch
Equation
1. It is the logarithmic expression of
the ionization constant equation of a
weak acid.
2. Formula: Pka = log (HCO3-)
(H2CO3)

Sample Collection and

Handling
1. Anticoagulant: Sodium Heparinate
(heparin)
2. Must use anaerobic collection for
blood pH and blood gas studies
3. If blood is exposed to air:
a. CO2 and PCO2
b. pH
c. PO2

Sample Collection and

Handling
4. If testing prolonged (>20 minutes),
blood should be kept in cracked ice to
prevent glycolysis, which leads to:
a. CO2 and PCO2
b. pH
c. PO2

Blood Gas Reference

Ranges

PARAMETER DEFINITION
pH
Negative Log
of H+
PCO2
Partial
Pressure or
Tension of
CO2 in Blood
HCO3
Bicarbonate calculated
PO2
Oxygen
Tension
Partial

NORMAL
7.35-7.45
35-45 mm Hg

22-26 mM/L
85-105 mm
Hg

Metabolic Acidosis
1. Primary bicarbonate deficit
a. Diabetic ketoacidosis ( acid
production)
b. Renal disease ( H+ excretion)
c. Prolonged diarrhea (excessive
HCO3- loss)
d. late salicylate poisoning

Metabolic Acidosis
2. Compensatory Mechanisms
a. Primarily respiratory
hyperventilation PCO2
b. Some renal (if kidney function is
normal) - excretion of H+ and
reabsorption og HCO3
3. Laboratory findings:
a. pH, HCO3, CO2 and PCO2
b. acid urine

Metabolic Alkalosis
1. Primary HCO3 excess
2. Seen in :
a. NaHCO3 infusion
b. Citrate (anticoagulant in blood transfusions)
c. Antacids (contains HCO3)
d. Vomiting (HCl loss; prolonged vomiting
leads to alkalosis due to GI loss of HCO3)
e. K+ depletion
f. diuretic therapy
g. Cushings Syndrome ( mineralocorticoids)

Metabolic Alkalosis
3. Compensatory Mechanisms
a. Primarily respiratory
hypoventilation - retention of CO2
b. Some renal - excretion of H+
and reabsoption og HCO3
4. Laboratory findings:
a. pH, HCO3, CO2 and pCO2

Respiratory Acidosis
1. Primary CO2 excess
2. Seen in:
a. Emphysema
b. Pneumonia
c. Rebreathing of air (paper bag)

Respiratory Acidosis
3. Compensatory mechanisms
a. Mainly renal - H+ excretion and
HCO3 reabsorption
b. Some respiratory (if defect is not
in the respiratory center)
4. Laboratory findings - pH and
HCO3, CO2 and PCO2

Respiratory Alkalosis
1. Primary CO2 deficit
2. Seen in:
a. Hyperventilation (blowing off too
much CO2)
b. Early salicylate poisoning

Respiratory Alkalosis
3. Compensatory mechanisms
a. mainly renal - H+ excretion
4. Laboratory findings - pH and
HCO3, PCO2 and CO2

COMPENSATORY MECHANISMS
Respiratory
renal
HCO3
Acidosis
Respiratory
renal
HCO3
Alkalosis
Metabolic
lung
pCO2
Acidosis
Metabolic
lung
pCO2
Alkalosis

Evaluating Acid-Base
Disorders
1. Look at the pH to determine acidosis
or alkalosis.
2. Look at the PCO2 and HCO3 to see
where they fall in relation to their
normal.
a. Is PCO2 opposite with pH?
(respiratory)
b. Is HCO3 equal with pH?
(metabolic)
3. If the pH is normal, full

Evaluating Acid-Base
Disorders
4. If the main compensatory mechanism has
kicked in, but the pH is still out of normal
range, partial compensation has occurred.
5. A primary dysfunction in respiratory function
results in chancge in PCO2 (opposite). The
main compensating factor will be HCO3
(metabolic).
6. A primary dysfunction in metabolic function
results in change in HCO3 (equal). The main
compensating factor will be PCO2 (respiratory).