Electrolytes and Acid-Base Balance
Question Answer
ANSWER
Note/Hint
1. Clinical manifestations of respiratory
alkalosis
1. N/V, tingling of fingers, excitatory
symptoms.
1. Patients likely to get metabolic acidosis.
2. Reasons for metabolic acidosis
1. Kidney patients, C. Diff patients lose
too much bicarb from diarrhea.
2. Kidneys are not escreting enough
hydrogen produced by anaerobic
metabolism; losing too much HCO3 by
GI tract; drug overdose.
1. Physiologic buffers(4)
1. Lungs
2. second line of defense
3. twice as effective as chemical buffers
because can handle twice the amount of
acid and bases.
4. responds quickly but can restore only
temporarily.
1. Respiratory acidosis means the patient is
2. Some of the common causes of the
retention of carbon dioxide (respiratory
acidosis) are
1. retaining CO2
2. Pneumonia, drug overdose, pulmonary
edema, pneumothorax. (Less surface
area, decreased respiratory rate, fluid in
lungs)
1. CO2
1. respiratory alkalosis is not enough
2. Pain, fever, asthma, congestive heart
2. Some of the common causes of respiratory
failure, anxiety/fear, pulmonary
alkalosis (6)
embolus.
3. first sign of pulmonary embolus is
3. tachypnea
1. Respiratory control center is in the__.
2. Long term adjustments of pH are
accomplished by the __. Takes how long to
work?
3. Bicarb can be excreted in
1. medulla
2. kidneys
up to 4 days
3.urine
1. The major diagnostic tool for evaluating
acid-base balance and oxygenation.
2. the purpose of ABG is to show how
1. ABG's
2. effectively the lungs are delivering
oxygen to the blood, how efficiently they
are eliminating carbon dioxide, and how
well the lungs and kidneys are
interacting to maintain normal blood pH
(acid base balance).
1st step to blood gas interpretation
look at pH and determin a/b status
60% of the body's weight is made up of
what? water
Water
A client has been taking extra lasix for
“bloating”. The acid base imbalance is?
Metabolic alkalosis
A pt. is in pain and is anxious from an
accident. The acid base imbalance is?
Respiratory alkalosis
ABG Normal Values:
1. pH
2. PaO2
3. PaCO2
4. HCO35. SaO2
6. critical range of pH
1.
2.
3.
4.
5.
6.
Acid
A substance that can donate H+
Acidosis
•< 7.35
•H+ Excess
•HCO3 Deficit
Alkalosis
•> 7.45
•H+ Deficit
•HCO3 Excess
At an age, a PaO2 lower than 40 is ?
life-threatening and requires immediate
action.
Base
A substance that can accept H+
Bicarb is a product of what body system?
The kidneys
Bicarbonate-Carbonic Acid Buffering system
•Most important ECF buffering system
•HCO3 + H+ => H2CO3 => H20 + CO2
breathe out
Buffering anions
HCO3 major also hemoglobin,
phosphate, and proteins
Carbonic Acid (H2CO3)
Unable to measure directly
Dissolves in plasma to form CO2 +H20
eliminated by lungs
Use co2 to measure acid component
Causes of Metabolic Acidosis
Cardiac Arrest, Shock, Diabetic
Ketoacidosis,
Fasting/starvation/malnutrition,
Ketogenic diet, Aspirin Toxicity, Renal
Failure, Severe Diarrhea, Hyperchloremia
Causes of Metabolic Alkalosis
Excess NaHCO3 intake, prolonged
vomiting/bingeing/purging, GI suction,
Diuretics, Hyperaldosteronism, Renal
Failure
Causes of Metabolic Alkalosis have what in
common?
they increase the bicarb or volume
concentration of bicarb is high (too much
bicarb), it causes pH level to rise making
it alkalotic/losis
Causes of Respiratory Acidosis
HYPOVENTILATION:
COPD, Drug overdose, Head injury,
respiratory muscle disorders
Causes of Respiratory Acidosis
(3)
1. CNS depression from drugs, injury, or
disease
2. Asphyxia (airway obstruction)
3. Hypoventilation related to a disease
7.35-7.45
80-100 mmHg
35-45 mmHg
22-26 mEq/L
97-100% (also known as SAT)
below 7.20 or above 7.55
Causes of Respiratory Alkalosis
HYPERVENTILATION:
Panic attacks, hypoxia, Fever, Saliclate
Toxicity, Mechanical Ventilation
Clinical Manifestations of metabolic acidosis
(5)
1. hyperkalemia; shift of acid to ICF and
K+ to the ECF
2. anorexia, n/v
3. warm, flushed skin
4. cardiac dysrhythmias & CNS
dysfunction (somnolence, decreased
LOC)
5. h/a, diarrhea, tremors
Clinical manifestations of metabolic alkalosis
(5)
cardia dysrhythmias
seizures
confusion
muscle twitching
agitation
Clinical manifestations of respiratory acidosis
(6)
vasodilation
cardiac dysrhythmias, tachycardia,
somnolence
decreased ventilation, decreased level of
consciousness.
Clinical manifestations or signs of respiratory
acidosis
Drowsiness, unconsciousness,
disorientation, rapid, shallow
respirations, tachycardia, dizziness,
decreased BP, headache, Tachycardia,
seizures
clinical manisfestations of Metabolic acidosis
drowsiness, coma, dehydration, n/v,
diarrhea, headache,MOST COMMON is
muscular twitching and deep rapid
respirations (Kussmaul's breathing)
clinical manisfestations of metabolic alkalosis
belligerence, irritable, disorientated,
lethargy, shallow slow respirations,
periods of apnea, tachycardia,
dysrhythmias, n/v, hypertonic muscles,
tingling of fingers and toes, seizures
Clinical manisfestations or signs of
respiratory acidosis
Drowsiness, unconsciousness,
disorientation, rapid, shallow
respirations, tachycardia, dizziness,
decreased BP, headache, Tachycardia,
seizures
increased neuromuscular irritability,
hyperreflexia, muscular twitching,
clinical manisfestations or signs of respiratory
seizures, lightheadedness,numbness and
alkalosis are
tingling in toes and fingers, tachycardia,
dysrhythmias.
CO2
used to express Carbonic acid
Although CO2 is not an acid (has no H+
to donate), but because of its
relationship with H2CO3, it is referred to
as an acid
common cause of Respiratory acidosis
*abnormalities in pulmonary ventilation
leading to CO2 retention.
*Halted or hindered gas exchange
*Obstructions preventing exhalation of
CO2
*Impaired neuromuscular function or
integerity of chest wall
*Depressed Respiratory center in
medullat
common cause of Respiratory acidosis
*abnormalities in pulmonary ventilation
leading to CO2 retention.
*Halted or hindered gas exchange
*Obsructions preventing exhalation of
CO2
*Impaired neuromuscular function or
integerity of chest wall
*Depressed Respiratory center in
medullat
Common Causes
Increased acid loss or excretion vomiting, gastric suction, hypokalemia
Common Causes
Increased acid production - lactic
acidosis, ketoacidosis
Common causes of metabolic alkalosis
excessive loss of hydrogen ions from
body through vomiting and gastric
suction w/o replacement of alkali
Compensatory mechanisms of metabolic
alkalosis
hypoventilation (to keep some of the
CO2), hydrogen ions are conserved and
large amounts of sodium and potassium
are excreted by the kidneys
Compensatory Mechanisms of Respiratory
alkalosis
*Respirations decrease or even cease
until CO2 levels rise enough to stimulate
increase in respirations.
*Kidneys slow absorption of HCO3 and
increase release of hydrogen ions
causing alkaline urine
Compensatory mechanisms that take place
within 24 hours of Respiratory Acidosis
Kidneys conserve HCO3 and excrete
more hydrogen ions into urine
Urine becomes more acidotic
Compensatory mechanisms that take place
within 24 hours of Respiratory Acidosis
Kidneys conserve HCO3 and excrete
more hydrogen ions into urine
Urine becomes more acidotic
condition in which acid accumulates in the
body
Acidosis
condition in which base substances
accumulate in the body
Alkalosis
Definitions:
1. Acidosis (or acidemia)
2. Alkalosis (or alkalemia)
3. A primary RESPIRATORY problem is
determined if
4. A primary metabolic problem is when
1. occurs when pH drops below 7.35
(causing CNS depression)
2. occurs when the pH rises above 7.45
(causing CNS excitation).
3. the PaCO2 is less than 35 mmHg
(alkalosis) or greater than 45 mmHg
(acidosis)
4. the HCO3 is less than 22mEq/L
(acidosis) or greater than 26mEq/L
(alkalosis)
Diabetic/starvation/alcoholicKetoacidosis,
Poisoning, lactic acidosis, renal failure, and
diarrhea are causes of?
Metabolic Acidosis
Drainage of pancreatic juice,
ureterosigmoidoscopy, obstructed ileal loop,
acetazolamide(diamox), ammonium chloride,
renal tubular acidosis are causes of?
Metabolic Acidosis
Edema
Excess fluid in the interstitial space and/or body
cavities
Elevated osmolarity is indicative
of what?
Increased solute (sodium) and decreased fluid
(water)
Etiology of Respiratory acidosis
ARDS, Pneumonia, Atelectasis, COPD, emphysema,
asthma, bronchial burns, chest trauma, GuillainBarre, MS, Mysathenia gravi, Drug overdoses,
anesthesia, acute alcoholism.
Etiology of Respiratory acidosis
ARDS, Pneumonia, Atelectasis, COPD, emphysema,
asthma, bronchial burns, chest trauma, GuillainBarre, MS, Mysathenia gravi, Drug overdoses,
anesthesia, acute alcoholism.
Exchange between H+ & K+
Buffering System
•Acidosis => H+ moves into ICF K+ moves into ECF
•Alkalosis => H+ moves into ECF K+ moves into ICF
HCO3- Bicarbonate (4)
1. normal is 22-26 mEq/L
2. Major Base
3. Reflects the activity of the kidneys in retaining or
excreting bicarb.
4. Accomplished by kidneys conserving or excreting
Hydrogen and hydrogen bicarbonate.
How can we improve respiratory
function?
antibiotics for infection, postural drainage,
bronchodilators, inhalation therapy, breathing
exercises, mechanical ventilation, oxygen therapy.
How can we improve respiratory
function?
antibiotics for infection, postural drainage,
bronchodilators, inhalation therapy, breathing
exercises, mechanical ventilation, oxygen therapy.
How is fluid balance regulated?
By regulating intake (thirst) and output (kidneys)
How is PaO2 for an elderly person
calculated?
Starting at 60 years, begin at 80mmHg, then for
each year over 60, add 1mmHg
Hyperventilation can be caused by
1._____________
anxiety, aftermath of severe exercise and hypoxia at
2.____________
high altitudes
3.____________
Imbalances are classified as being
respiratory or metabolic
____________ or ____________.
Imbalances are classified as being
respiratory or metabolic
____________ or ____________.
Increased osmolarity of the
plasma activates what?
Neural pathways that result in the conscious
perception of thirst.
Interpret the ABG: ph 7.25, pCo2
54, HCO3 24, pO2 84
Respiratory acidosis
Interpret the ABG: ph 7.50, pCo2
28, HCO3 24, pO2 70
Respiratory Alkalosis
Interventions for Respiratory
acidosis
Improve respiratory function, correct acidosis,
assess for iatrogenic complications of interventions
Kidney Regulation of pH
Retain or excrete HCO3 or H+ as needed
Kidneys compensate slowly but provide complete
compensation
Acidosis (↓ pH)
•Retain HCO3 or Excrete H+
Alkalosis (↑ pH)
•Excrete HCO3 or Retain H+
Metabolic Acidosis
pH &lt; 7.35
Metabolic Acidosis
↓Bicarbonate (HCO3) <21 mEq/L
↓pH
Resp. Comp: Hyperventalation to ↓ PCO2
Renal Comp: if no renal disease, ↑ H+ excretion and
↑ HCO3 Reabsorption
-BE
Metabolic Acidosis
pH < 7.35
HCO3 <22 mEq/L
Metabolic Acidosis
Bicarbonate or HCO3 loss with acid retention
Metabolic Acidosis
Common Causes
Increased acid production - lactic acidosis,
ketoacidosis
Decreased acid excretion - renal failure
Increased Bicarb loss - Diarrhea, ileosomy drainage,
intestinal biliary or pancreatic fistulas
Increased Chloride - sodium chloride IV solutions,
renal tubular acidosis, carbonic anhydrase inhibitors
Metabolic acidosis cause
excess acids
Metabolic acidosis cause
excess acids
bicarb deficiency
Metabolic acidosis compensation
rate and depth of respirations increase, eliminating
additional CO2
Metabolic acidosis compensation
rate and depth of respirations increase, eliminating
additional CO2
Metabolic acidosis effect on ABGs
decrease pH
decrease HCO3
decrease PaCO2
Metabolic Alkalosis
pH > 7.45
HCO3 > 26 mEq/L
Metabolic Alkalosis
↑HCO3 >28 mEq/L
↑pH
Resp. Comp: Hypoventalation to ↑PCO2
Renal Comp: If no renal disease ↓H+ excretion and ↓
HCO3 reabsorption
+ BE
Metabolic Alkalosis
HCO3 retention and acid loss
Metabolic Alkalosis
Common Causes
Increased acid loss or excretion - vomiting, gastric
suction, hypokalemia
Increased Bicarb - Alkali ingestion (bicarbonate of
soda), excess bicarb administration
Metabolic alkalosis cause
bicarb excess
Metabolic Alkalosis common
causes (2)
1. Gain of base: increased ingestion of antacids or an
excessive administration of sodium bicarb
2. Loss of metabolic acids: vomiting, nasogastric
suctioning diuretics (loss of hydrogen)
Metabolic alkalosis compensation
rate and depth of respirations decrease, retaining
CO2
Metabolic alkalosis effect on ABGs
increase pH
increase HCO3
increase PaCO2
Metabolic imbalances affet the
base ____________.
bicarbonate
Metabolic imbalances affet the
base ____________.
bicarbonate
mild hypoxemia
60-80 mm Hg PO2
Mod. Hypoxemia
PO2: 45-60 mm Hg
Most common cause of metabolic
acidosis?
overproduction of metabolically produced acids found
in diabetes mellitus,
Infections with high fever,
trauma, and major surgery.
Noncompensation
pH is abnormal
PCO2 or HCO3 OR Abnormal
Normal Acid-base balance is
1:20
Normal Acid-base balance is
1:20
Normal adult PaO2 is? and for an
infant?
80-100; 40-70
Normal range for pH
7.35 - 7.45
Normal valuses for HCO3
20-30mmHg
Normal valuses for HCO3
20-30mmHg
Normal valuses for O2 saturation
is
96-100%
Normal valuses for O2 saturation
is
96-100%
Normal valuses for pCO2
35-45 mmHg
Normal valuses for pCO2
35-45 mmHg
Normal valuses for pH
7.35-7.45
Normal valuses for pH
7.35-7.45
Normal valuses for pO2
80-100 mmHg
Normal valuses for pO2
80-100 mmHg
Nursing intervention for
metabolic alkalosis
treat primary condition, correct alkalosis, correct
water sodium, chloride and potassium deficits.
Nursing interventions for
metabolic acidosis
restore blood volume and osmolarity
Correct HCO3 deficit
assess for and prevent electrolyte imbalances
(Hyperkalemia) and protect from injury.
Osmolarity
Total solute concentration in a solution- osmoles/liter
Osmosis
Net movement of water through a selectively
permeable membrane that seperates two solutions
with different solute concentrations.
other causes of Metabolic
acidosis
excessive ingestion of acid (aspirin, ferrous sulfate),
Renal diseases( kidneys lose ability to secrete acids),
abnormal loses of alkali (acute vomiting, loss of
pancreatic, biliary and lower intestinal fluids
PaCo2 (3)
4. Normal CO2 is
1. refers to the partial pressure of CO2 in arterial
blood.
2.Indicates the effectiveness of ventilation (how well
the lungs are blowing off caronic acid)
3. Provides the info about the respiratory component
of acid-base balance
4. 35-45mmHG
PaO2 (Anearobic Metabolism)(4)
1. Gives information about patient's oxygenation
level.
2. Used to identify hypoxemia.
3. Anaerobic Metabolism
4. Normal PaO2 is 80-100 mmHg
PaO2 measures?
the partial pressure of oxygen dissolved in arterial
plasma.
Partial Compensation
pH is abnormal
both PCO2 AND HCO3 are abnormal
PCO2
In acid-base terminology, CO2 is expressed as PCO2
P = Partial Pressure
Refers to the pressure / tension exerted by this gas in
blood
Partial Pressure = because CO2 is only one of several
gases contributing to the total pressure (Oxygen,
Nitrogen & Other Gases
pH down
acidosis
pH indicates the number of
Hydrogen Ions H+
pH ratio and what is it
determined by?
•Determined by ratio of bicarb & carbonic acid
•pH maintained by a ratio of 20:1 (bicarb:CA)
pH Up
Alkalosis
Possible causes of Metabolic
Acidosis
(3)
1. Bicarbonate depletion from diarrhea
2. Excess production of organic acids from hepatic
disease, endocrine disorders, shock, or drug
intoxication
3. Inadequate excretion of acids from renal disease
Possible causes of Metabolic
Alkalosis
(3)
1. Loss of hydrochloric acid from prolonged vomiting
or gastric suctioning
2. Loss of potassium from increased renal excretion
(as in diuretic therapy) or steroids
3. Excessive alkali ingestion
Possible causes of Respiratory
Alkalosis
(3)
1. Hyperventilation from anxiety, pain, or improper
ventilator settings
2. Respiratory stimulation due to drugs, disease,
hypoxia, or fever
3. Gram negative bacteremia
Primary Disturbance
match between pH and PCO2
Respiratory system causing primary disturbance
Primary Disturbance:
Match between pH and HCO3
Metabolic system causing primary disturbance
Respiratory Acidosis
* Excess carbon dioxide retention
* patient is <7.35pH
* increase in carbonic acid
Respiratory Acidosis
pH &lt; 7.35
Respiratory Acidosis
↑ PCO2 (>45mm Hg)
↓pH
Renal Comp:↑H+ excretion and ↑HCO3 reabsorption
Respiratory Acidosis
pH < 7.35
PaCO2 > 45 mmHg
Respiratory Acidosis
Common Causes
Acute respiratory conditions (pulmonary edema,
pneumonia, acute asthma), opiate OD, foreign body
aspiratio0n, chest trauma
Chronic respiratory acidosis, COPD, cystic fibrosis,
MS, Stroke
Respiratory acidosis cause
retained CO2
excess carbonic acid
Respiratory acidosis
compensation
Kidneys conserve bicarb to resore carbonic
acid:bicarb ration of 1:20
Respiratory acidosis effect on
ABGs
decrease pH
Increase PaCO2
Increase HCO3
Respiratory Alkalosis
pH 7.45
PaCO2 < 35 mmHg
Respiratory Alkalosis
↓PCO2 (<35mm Hg)
↑pH
Renal Comp: ↓H+ excretion and ↓ HCO3 reabsorption
Respiratory Alkalosis
excess CO2 excretion
Respiratory Alkalosis
Common Causes
Anxiety induced hyperventilation, fever, early
salicylate intoxication, hperventilation with
mechanical ventilator
Respiratory alkalosis cause
loss of CO2
deficient carbonic acid
Respiratory alkalosis
compensation
Kidneys excrete bicarb and conserve H+ to restore
carbonic acid: bicarb ratio
Respiratory alkalosis effect on
ABGs
increase pH
decrease PaCO2
decrease HCO3
Respiratory alkalosis is almost
always a result of _________?
hyperventilation
Respiratory imbalances affect
_________ _________
concentrations.
carbonic acid
Respiratory imbalances affect
_________ _________
concentrations.
carbonic acid
Respiratory Regulation of pH
Lungs regulate carbonic acid (H2CO3) by ↑ ↓
Respirations
Lungs compensate quickly but incompletely
Acidosis (↓ pH)
•↑ RR => Blow off CO2 + H20
Alkalosis (↑ pH)
•↓ RR => Retain CO2 + H2O
Salicylates, fever, gram neg
septicemia, hepatic insufficiency,
chf, asthma, severe anemia- all
causes of?
Respiratory Alkalosis
SaO2 values give a measurement the amount of oxygen bound to hgb compared to the
of ?
total hgb.
Severe Hypoxemia
PO2: < 45 mm Hg
Symptoms of Metabolic Acidosis
(9)
1.
2.
3.
4.
Headache and lethargy
Kussmaul's respirations
Hypotension
Stupor, possibly leading to coma and death
5.
6.
7.
8.
9.
Anorexia
N/V/D
Dehydration
Warm, flushed skin
Fruity-smelling breath
Symptoms of Metabolic Alkalosis
(6)
1. Picking at bedclothes
2. Twitching
3. Confusion
4. N/V/D
5.Trousseau's sign
6. Slow, shallow respirations
Symptoms of Respiratory
Acidosis
(8)
1.
2.
3.
4.
5.
6.
7.
8.
Restlessness
Confusion
Coma
Headaches
SOB and tachypnea
Decreased reflexes
Hypoxemia
Tachycardia and arrhythmias
Symptoms of Respiratory Alkalosis
(5)
1. Deep and rapid respirations
2. Dizziness
3. Agitation
4. Circumoral and peripheral paresthesia
5. Carpopedal spasms, twitching, and muscle
weakness
The acid base imbalance of a client
with diabetic ketoacidosis is
called?
Metabolic acidosis
The causes of Metabolic Acidosis
have what in common?
Volume concentration of bicarb is too low (not
enough), it causes the pH level to fall making it
acidosis/dotic
The goal of the body is to maintain
what kind of osmolarity?
Neutral
Treatment of Metabolic Acidosis
(4)
1. Mechanical ventilation is usually first line of
therapy
2. Treat DKA
3. Administer sodium bicarbonate
4. Dialysis
Treatment of Metabolic Alkalosis
(3)
1. D/C thiazide diuretics and NG suctioning
2. Give an antimetic for N/V
3. Meds to excrete bicarb
Treatment of Respiratory Acidosis
(6)
1.
2.
3.
4.
5.
6.
Treatment of Respiratory Alkalosis
1. Treat underlying cause: sepsis, salicylate overdos
2. Hypoxia: give O2
Bronchodilator
Oxygen
Treat hyperkalemia
Treat infection
Treat underlying causes
Chest CPT
3. Anxiety: gove a sedative
4. Hyperventilation: breathe into a paper bag
5. Adjust ventilator settings
Ventilatory failure occurs when the
PaCO2 level reaches? Acute
ventilatory failure is indicated by?
>50; PaCO2 >50 AND pH <7.30
What are the three compartments The intracellular, the extracellular and as a
that water is stored in in the body? component of blood
What are the two components of
extracelluar fluid?
Plasma and interstitial fluid
What are the two most important
extracellular solutes?
Sodium and protein
What are the two most important
intracellular solutes?
Potassium and protein
What cells monitor the osmolarity
of the plasma?
Osmoreceptors
What does isosmotic mean?
Equal osmolarity
What is interstitial fluid responsible A medium for exchange between the cell and the
for?
outside, how things enter and exit cells
What is the 2nd intervention in
correcting respiratory acidosis?
and how do we correct that?
Correct Acidosis
through treating hyperkalemia if present and IV
sodium bicarbonate
What is the 2nd intervention in
correcting respiratory acidosis?
and how do we correct that?
Correct Acidosis
through treating hyperkalemia if present and IV
sodium bicarbonate
What is the 3rd intervention in
correcting respiratory acidosis?
and what are some of them?
assess for iatrogenic complications of interventions--tetany, CO2 narcosis, rebound respiratory
alkalosis, metabolic acidosis.
What is the principal regulator of
water intake?
Thirst
What is thirst regulated by?
The osmolarity of the plasma
What is water directly regulated
by?
Antidiuretic hormone (ADH)
What is water indirectly regulated
by and how is it regulated?
Aldosterone- because it regulates sodium and
wherever sodium goes water follows
What organs regulate water
balance?
Kidneys, GI tract, lungs, and to a lesser extent skin
What results from excreting too
much CO2?
respiratory alkalosis
What should the nurse do for a
respiratory alkalosis pt.?
Eliminate cause of hyperventilation, help person
breathe more slowly and deeply (paper bag), if
neurological problems is the cause, treat the
primary problem.
What type of conditions can cause
Respiratory Acidosis?
any condition that would keep Co2(an acid) in the
lungs; hypoventilation, obstructive lung disease,
oversedation
Whay type of condition can cause
Respiratory alkalosis?
Conditions due to LACK of Co2 (either by loss or
inability to intake);hypoxia, anxiety, pulm embolus,
hyperventilation
Where does all the exchange
between plasma and interstitial
space occur?
The capillary level
Which is more dilute a solution
with an osmolarity of 100 or a
100
solution with an osmolarity of 200?
Why are diabetics always thirsty?
Because there is an increased plasma osmolarity
because of the increased glucose so the regulators
are always being stimulated
Your COPD patient has an acute
exacerbation of the disease-- the
acid base imbalance is?
Respiratory acidosis