Major Chemicals involved in A-B Balance?

• bicarb, hydrogen, CO2
• lung chemicals - CO2 - acid
• kidney chemicals - bicarb (base) & H+ (acid)
• chemicals either make you sick or compensate

What is pH?

• tells you ifblood is acidic, alkaline, ro neutral
• normal range 7.35-7.45
• above 7.45 alkalosis (convulsions, death)
• below 7.35 acidosis (coma, death)
• brain doesn't like it - body tries to keep in the pH within normal range 

How do the kidneys compensate?

How do the lungs compensate?

• kidneys remove acid through urine (H+)
• bicarb is either excreted or held on to
• kidneys take hours to days to do their jobs
• lungs get rid of CO2 through exhalation
• hypoventilation retains CO2
• hyperventilation gets rid of CO2
• lungs respond quickly 

Respitory Acidosis:

Pathophysiology 

• lung problem
• CO2 problem- too much
• hypoventilating
• kidneys will compensate by excreting hydrogen and retaining bicarb
• pH is low 

Respitory Acidosis:

Causes (6)

• retaining CO2
• mid abominal incision
• narcotics
• sleeping pills
• pneumothorax
• collapsed lung
• pneumonia

Respitory Acidosis:

S/Sx (3)

• headache, confused, sleepy
• if not corrected, can lead to a coma
• Hypoxic
• give them O2
• earliest signs are restlesseness and tachycardia 

Respitory Acidosis:

Treatment (4)

• Fix the breathing problem
• Treat pneumonia - get rid of secretions by postural drainage, incentive spirometrey, vibration theraby (percussion), deep breathing exercises, fluids, suction, elevate HOB
• Pneumothorax client will need chest tubes
• Encourage post-op turn, cough, deep breathe 

Respitory Alkalosis:

Pathophysiology 

• lungs are sick, kidneys will compensate by excreting bicarba and retaining H+
• Hyperventilating, too little CO2 acid
• pH is high 

Respitory Alkalosis:

Causes (2)

• Hysterical client (hyperventilating)
• Acute aspirin overdose (initially stimulates respiratory center in brain)

Respitory Alkalosis:

S/Sx (4)

• lightheaded
• faint
• peri-oral numbness
• numbnes/tingling in fingers and toes 

Respitory Alkalosis:

Treatment (5)

• do not wait for kidneys to kick in
• breathe into a bag
• may sedate client to decrease RR
• treat the cause
• Monitor ABG's  

Metabolic Acidosis:

Pathophysiology 

• kidneys are sick, lungs will compensate with CO2
• bicarb and hydrogen are problem chemicals, client is retaining H+ and does not have enough bicarb 
• pH is low
• RR will increase (hyperventilate)

Metabolic Acidosis:

Causes (4)

• DKA
• Starvation
• Renal Failure
• Severe diarrhea 

Metabolic Acidosis:

S/Sx (3)

• Depends on the cause
• Hyperkalemia
• muscle twitching, muscle weakness, flaccid paralysis, arrythmias 
• Increased RR 

Metabolic Acidosis:

Treatment (2)

• treat the cause
• IVP sodium bicarbonate - helps acidosis (gives bicarb) 

Metabolic Alkalosis:

Pathophysiology 

• kidneys are sick, lungs will compensate with CO2
• Problem chemical (bicarb and H)
• retaining too much base and excreting H
• pH is high 

Metabolic Alkalosis:

Causes (3)

• loss of upper GI contents
• Too many antacids, too much sodium
• Too much IV bicarb 

Metabolic Alkalosis:

S/Sx (4)

• depends on cause
• observe LOC
• Hypokalemia - monitor for arrythmias, muscle cramps