WEST VIRGINIA NORTHERN
COMMUNITY COLLEGE
CLINICAL GROUP WORKSHEET
ACID/BASE BALANCE
The normal pH range of the blood is
.
to
, reflecting a ratio of
to
Ph is a negative logarithm that is a measurement of
The greater the H+ concentration, the more
whereas the lesser the H+ concentration, the more
pH.
in a solution.
the solution and the
the solution and the
the pH,
the
Ways is which the kidneys eliminate acids to maintain an acid/base balance:
1.
2.
3.
How does the respiratory system control acid/base balance?
.
Define & list the normal values of each of the following:
pH (7.35-7.45):
PaO2 (70-100 mmHg):
PaCO2 (35-45 mmHg):
Bicarbonate (HCO3) (19-25 mmHg):
Base Excess (+/- 5 mEq/L):
Carbonic Acid (3% of PaCO2, a 20:1 ratio):
Oxygen Saturation (>90-95%):
Match the acid/base imbalances with their mechanisms:
Increased Bicarbonate (HCO3)
Decreased Carbonic Acid (CO2)
Increased Carbonic Acid
Decreased base Bicarbonate
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Match the acid/base imbalances with their common causes:
Prolonged Vomiting
Renal Failure
Response to Anxiety Fear, and Pain
Respiratory Failure
Baking Soda used as an Antacid
Severe Shock
Diabetic Ketoacidosis
Mechanical over Ventilation
Sedative or Opioid Overdose
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Identify the acid/base imbalance: (pH 7.35-7.45, PaCO2 35-45, HCO3 19-25)
Are the balances uncompensated, compensated or partially compensated?
pH 7.50
PaCO2 30 mmHg
HCO3 24 mEq
pH 7.62
PaCO2 48 mmHg
HCO3 45 mEq
pH 7.20
PaCO2 25 mmHg
HCO3 15 mEq
pH 7.44
PaCO2 54 mmHg
HCO3 36 mEq
pH 7.26
PaCO2 56 mmHg
HCO3 24 mEq
pH 7.35
PaCO2 60 mmHg
HCO3 40 mEq
Acid/Base Differentiation Table
Causes/Risk Factor
Metabolic
Acidosis
a)
b)
c)
d)
e)
f)
g)
h)
i)
Ketoacidosis
Lactic Acidosis
ASA Poison
Alcoholism
Uremia
(increased H &
K)
Renal Failure
Diarrhea
Intestinal fistula
(drains HCO3)
Excess gain of
CL from H-Al’s
Effect
on ABG
Compensation
a-f:
Decreases
pH,
HCO3, &
BE
Decrease CO2 to
increase pH.
Hyperkalemia may
also occur (shift of
K+ out of cells).
----------------pH: normal
pCO2: decreased
pO2: normal
HCO3: decreased
BE: decreased
g-i:
pCO2 &
pO2 are
within
normal
ranges
Clinical
Manifestation











Metabolic
Alkalosis
a)
b)
c)
d)
e)
f)
Overdose on
NaHCO3
Prolonged
vomiting
NG drainage
Hypokalemia
Fever
Pregnancy
Increased
pH
Increased
HCO3
pCO2
normal
Lungs retain CO2
to decrease pH.
pH: normal
pCO2: increased
pO2: normal
HCO3: increased
BE: increased







Headache
CNS
depression
Peripheral
Vasodilation
Cardiac
Dysrhythmia
Increased K+
Decreased
muscle tone
N-V r/t
decreased GI
functioning
Poor tissue
turgor
Hyperventilation
Decreased pH
(to make it
acid)
Kussmal
Respirations
Decreased
LOC
N-V-D
Decreased
respirations
Hypokalemia
Dysrhythmias
Restlessness
& lethargy
Compensatory
hypoventilation
Dx Tests
Nursing
Dx
and
Care
ABG’s
Give HCO3
BMP
(K+)
Monitor K+
LOC
(neuro)
ECG
Hydration
Mgmt.
Neuro.
Assess
CBC
Dialysis if
too severe!
ABG’s
Correct
dehydration
ECG
Replace K+
BMP
CBC
Decrease
suction
Give RL to
assure
adequate
CL so
kidney
binds with
Na to allow
HCO3 to be
excreted
Give
Diamox, a
carbonic
anhydrase
inhibitor to
increase
HCO3
excretion
Causes/Risk Factor
Respiratory
Acidosis
a)
b)
c)
d)
Respiratory
depressant drugs
CNS Trauma
Pulmonary
Disease:
pneumonia &
COPD
Underventilation while
on respirator
Effect
on ABG
Compensation
Decreased
pH
Kidney’s will
retain increased
amounts of HCO3
to increase pH
pH: normal
pCO2: increased
pO2: ?
HCO3: increased
BE: increased
Increased
pCO2
HCO3
normal
Clinical
Manifestation










HypoVentilation
Rapid &
shallow resp.
Increased BP
Dyspnea
Headache
Hyperkalemia
Disorientation
Increased
CO2
Muscle
weakness
Hypoxia
Dx Tests
ABG’s
BMP
ECG
CBC
Nursing
Dx
and
Care
Give
BronchoDilators
Perform
postural
drainage
Antibiotics
if needed
Adequate
hydration
Supplement
al O2 with
caution
Ventilator
Steroids
(solumedrol)
Treatment
of increased
K+
Respiratory
Alkalosis
a)
b)
c)
d)
e)
Hyperventilation
Pain
Stress
Anxiety
Fear
Increased
pH
Decreased
pCO2
Normal
HCO3
Kidney’s will
excrete increased
amounts of HCO3
to decrease the pH
pH: normal
pCO2: decreased
pO2: decreased
HCO3: decreased
BE: decreased








Seizures
Deep and
rapid resp.
Hyper –
ventilation
Confusion
Hypokalemia
Light –
headedness
Tingling of
extremeties
ABG’s
ECG
BMP
Give pain
meds as
ordered
Reduce
anxiety
CBC
Low O2
content
Breathe into
paper bag to
conserve
CO2
Reassess
vent
settings and
have
changed if
need be by
respiratory
therapy