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Acid-Base Balance KNH 413
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Acid-Base Balance Acids Donate or give up H+ ions
Nonvolatile acids or fixed acids Inorganic acids that occur through metabolism of CHO, protein, lipid Average amount mmol/day Proteins contribute the most Lungs cannot eliminate
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Acid-Base Balance Bases Can accept or receive H+ ions Bicarbonate HCO3
Kidneys provide primary regulation
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Acid-Base Balance pH Acidosis Acidemia Alkalosis Alkalemia
Accumulation of acid or loss of base Acidemia pH < 7.35 Alkalosis Accumulation of base or loss of acid Alkalemia pH > 7.45
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Regulation of Acid-Base Balance
Chemical buffers Respiratory regulation Kidney regulation
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Regulation of Acid-Base Balance
Respiratory regulatory control Change in respiration rate Depth of breathing Release or retention of CO2
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Regulation of Acid-Base Balance
Renal regulatory control Control of HCO3 by the kidneys Increased or decreased based on need Formation of dibasic phosphate and sulfur in the urine Accepts H+
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Regulation of Acid-Base Balance
Electrolyte Balance Hydrogen and bicarbonate both electrolytes Other electrolytes affected to maintain electroneutrality Potassium, chloride, sodium
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Acid-Base Disorders 4 major types Respiratory acidosis
Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
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Acid-Base Disorders Respiratory acidosis
Excess acid in blood secondary to carbon dioxide retention Hypercapnia Common causes d/t respiratory dysfunction – renal regulatory systems compensate
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Acid-Base Disorders Respiratory acidosis Labs Hypoxemia
Decreased pH, elevated pCO3 Slightly elevated bicarbonate Increase in serum Ca, K, Cl Hypoxemia Restlessness, apprehension, lethargy, muscle twitching, tremors, convulsions, coma
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Acid-Base Disorders Respiratory acidosis Treatment
Correct underlying condition Increase oxygenation Mechanical ventilation
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Acid-Base Disorders Respiratory alkalosis
Relative excess amount of base d/t reduction of CO2 Hyperventilation Common causes - see Table 9.6 Shift of acid from ICF to ECF Bicarbonate moved into cells in exchange for chloride – renal compensation
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Acid-Base Disorders Respiratory alkalosis pH > 7.45
Plasma HCO3 low in chronic, PaCO3 low in acute Cardiac, CNS, respiratory symptoms Treat underlying cause Correction of hypoxia
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Acid-Base Disorders Metabolic Acidosis
All types not caused by excessive CO2 Common causes Diarrhea most common cause d/t excessive loss of bicarbonate – bicarbonate- carbonic acid buffer system is stimulated
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© 2007 Thomson - Wadsworth
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Acid-Base Disorders Metabolic Acidosis Kussmaul breathing
Cardiac and neurological Treat underlying cause Raise pH to safe level – not too quickly
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Acid-Base Disorders Metabolic Alkalosis Excess amount of base
Fluid imbalance – with volume decrease Without fluid imbalance – without volume decrease Common causes Underlying event determines pathophysiology
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Assessment of Acid-Base Disorders
© 2007 Thomson - Wadsworth
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