VA balance of fluids, electrolytes, and acids

and bases is required to maintain good

health.

V This balance is called Homeostasis.

V untracellular fluid (u

 found within the cells of the body
 constitutes 2/3 of total body fluid in adults
 major cation is potassium

V Extracellular fluid (E

 found outside the cells
 accounts of 1/3 of total body fluid
 major cation is sodium
V smosis
 movement of water across cell membranes from
less concentrated to more concentrated

V Solutes
 substances dissolved in a liquid

V smolality
 the concentration within a fluid
V =iffusion
 movement of molecules in liquids from an area of higher
concentration to lower concentration
V
iltration
 fluid and solutes move together across a membrane
from area of higher pressure to one of lower pressure
V Active Transport
 substance moves across cell membranes from less
concentrated solution to more concentrated - requires a
carrier
V ïrine
V unsensible fluid loss
V
eces
 V Sodium
V Potassium V Magnesium
V hloride V alcium
V Phosphate V Bicarbonate

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V Acid-Base balance is:

 the regulation of HY= 
EN ions.

V The acidity or alkalinity of a solution is
measured as pH.
V The more acidic a solution, the lower the
pH.
V The more alkaline a solution , the higher
the pH.
V Water has a pH of 7 and is neutral.
V The pH of arterial blood is normally
between 7.35 and 7.45
V The more Hydrogen ions, the more acidic the
solution and the LWE the pH

V The lower Hydrogen concentration, the more

alkaline the solution and the Hu
HE the pH
V 9now what is normal.
V egulate pH by binding or releasing
Hydrogen

V Most important buffer system:

 Bicarbonate- arbonic Acid Buffer System
(Blood Buffer systems act instantaneously and thus
constitute the body¶s first line of defense against acid-
base imbalance
V 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 2 level
35 to 45 mm Hg
V 9idneys
 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.
V Age
 especially infants and the elderly
V
ender and Body Size
à à

 
V Environmental Temperature
V Lifestyle
 stress
V espiratory Acidosis
V espiratory Alkalosis
V Metabolic Acidosis
V Metabolic Alkalosis
V Mechanism
 Hypoventilation or Excess 2 Production

V Etiology
 P=
 Neuromuscular =isease
 espiratory enter =epression
 Late A =S
 unadequate mechanical ventilation
 Sepsis or Burns
 Excess carbohydrate intake
VSymptoms
 =yspnea, =isorientation or coma
 =ysrhythmias
 pH < 7.35, Pa 2 > 45mm Hg
 Hyperkalemia or Hypoxemia

VTreatment
 Treat underlying cause
 Support ventilation
 orrect electrolyte imbalance
 u Sodium Bicarb
V isk
actors and etiology
 Hyperventilation due to
extreme anxiety, stress, or pain
elevated body temperature
overventilation with ventilator
hypoxia
salicylate overdose
hypoxemia (emphysema or pneumonia
NS trauma or tumor
V Symptoms
 Tachypnea or Hyperpnea
 omplaints of SB, chest pain
 Light-headedness, syncope, coma, seizures
 Numbness and tingling of extremities
 =ifficult concentrating, tremors, blurred vision
 Weakness, paresthesias, tetany
 Lab findings
pH above 7.45
2 less than 35
V Treatment
Monitor S and AB
s
Treat underlying disease
Assist client to breathe more slowly
Help client breathe in a paper bag
or apply rebreather mask
Sedation
V isk
actors/Etiology
 onditions that increase acids in the blood
enal
ailure
=9A
Starvation
Lactic acidosis
 Prolonged diarrhea
 Toxins (antifreeze or aspirin
 arbonic anhydrase inhibitors - =iamox
VSymptoms
 9ussmaul¶s respiration
 Lethargy, confusion, headache, weakness
 Nausea and omiting
 Lab:
pH below 7.35
Bicarb less than 22
VTreatment
 treat underlying cause
 monitor AB
, u, S, L Sodium Bicarb?
V isk
actors/Etiology
 Acid loss due to
vomiting
gastric suction
 Loss of potassium due to
steroids
diuresis
 Antacids (overuse of
VSymptoms
 Hypoventilation (compensatory
 =ysrhythmias, dizziness
 Paresthesia, numbness, tingling of extremities
 Hypertonic muscles, tetany
 Lab: pH above 7.45, Bicarb above 26
2 normal or increased w/comp
Hypokalmia, Hypocalcemia

VTreatment
 u, S, L
 give potassium
 treat underlying cause
V espiratory
V pposite
V Metabolic
V Equal
V1. Look at the pH
is the primary problem acidosis (low or alkalosis (high
V2. heck the 2 (respiratory indicator
is it less than 35 (alkalosis or more than 45 (acidosis
V3. heck the H 3 (metabolic indicator
is it less than 22 (acidosis or more than 26 (alkalosis
V4. Which is primary disorder ( esp. or
Metabolic?
uf the pH is low (acidosis, then look to see if 2 or H 3 is acidosis
(which ever is acidosis will be primary.
uf the pH is high (alkalosis, then look to see if 2 or H 3 is alkalosis
(which ever is alkalosis is the primary.
The one that matches the pH (acidosis or alkalosis, is the primary disorder.
V The espiratory system and enal systems
compensate for each other
 attempt to return the pH to normal
V AB
¶s show that compensation is present when
 the pH returns to normal or near normal
V uf the nonprimary system is in the normal range
( 2 35 to 45 (H 3 22-26, then that system
is not compensating for the primary.
V
or example:
 un respiratory acidosis (pH<7.35, 2>45, if the H 3 is
>26, then the kidneys are compensating by retaining
bicarbonate.
 uf H 3 is normal, then not compensating.