1. Acid Base Balance and Fluid Balance disorder
Dr ; Niazy B Hussam
PhD candidate

2. Homeostasis
A delicate balance of fluids, electrolytes, and acids and bases is required to maintain good health.
This balance is called Homeostasis.

3. Body Fluids Intracellular fluid (ICF) Extracellular fluid (ECF)
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

4. Terms Osmosis Solutes Osmolality
movement of water across cell membranes from less concentrated to more concentrated
Solutes
substances dissolved in a liquid
Osmolality
the concentration within a fluid

5. More Terms Diffusion Filtration Active Transport
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

6. Routes of Fluid Loss
Urine
Insensible fluid loss
Feces

7. Electrolytes Electrolytes are important for:
Sodium
Potassium
Chloride
Phosphate
Magnesium
Calcium
Bicarbonate
Electrolytes are important for:
. Maintaining fluid balance
. Contributing to acid-base regulation
. Facilitating enzyme reactions
. Transmitting neuromuscular reactions

8. Acid-Base Balance Acid-Base balance is:
the regulation of HYDROGEN ions.

9. 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

10. 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

11. 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)

12. 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

13. 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.

14. Factors Affecting Balance
Age
especially infants and the elderly
Gender and Body Size
Environmental Temperature
Lifestyle
Stress
Amount of fat

15. Henderson-Hasselbach Equation
Demonstrates interrelationship between
Carbonic acid
Bicarbonate pH
pH = pK + log [HCO3-] /[H2CO3]

16. Acid-Base Imbalances Respiratory Acidosis Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

17. Respiratory Acidosis Mechanism Etiology
Hypoventilation or Excess CO2 Production
Etiology
COPD
Neuromuscular Disease
Respiratory Center Depression
Late ARDS
Inadequate mechanical ventilation
Sepsis or Burns
Excess carbohydrate intake

18. 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

19. 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

20. 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

21. 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 re breather mask
Sedation

22. 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

23. 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, I&O, VS, LOC Sodium Bicarb?
ABG

24. Metabolic Alkalosis Risk Factors/Etiology Acid loss due to
vomiting
gastric suction
Loss of potassium due to
steroids
diuresis
Antacids (overuse of)

25. 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

27. 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.

28. 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) (HCO ), 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.