F. Normal values
p
pCO2
p O2
HCO3
BE
SaO2
7.35 -7.45
35 -45mm g
more than 100 mm Hg
22 - 26 mmol/L
-5 to 5 mmol/L
more than 95%
Definitions :
1. p
defined as negative logarithm of hydrogen activity
2. Acidemia
defined as a condition where the arterial pH is less than 7.35
3. Alkalaemia
defined as a condition where the arterial pH is higher than 7.45
4. Acidosis
defined as an abnormal condition that lowers the arterial pH if
5. Alkalosis
defined as an abnormal condition which tends to raise the
6. Mixed Disorder
two or more primary acid-base disorder occurs.
7. Compensation
refers to normal body processes tending to return arterial pH
Increased
PaCO2
PaCO2
Decreased
Increased
Decreased
Increased
Metabolic
acidosis
Respiratory
acidosis
Respiratory
alkalosis
Metabolic
alkalosis
PaCO2 up
PaCO2 dn
HCO3 dn
HCO3 up
HCO3 up
HCO3 dn
PaCO2 dn
PaCO2 up
A. Respiratory Acidosis
1. Central Nervous System Depression
Drugs
Cerebral Trauma
2. Neuro-muscular Disorders
Neuropathies
Myopathies
3. Airway Obstruction
Tumour
Foreign Body
4. Increased CO2 Production
Malignant Hyperthermia
Burns
B. Metabolic Acidosis
1. Increased production of acids
Renal Failure
Diabetic Ketoacidosis
Starvation
2. Ingestion of Toxins
Salicylates
Methanol
3. Rhabdomyolysis
4. Increased GIT loss
Diarrhoea
Fistula (pancreatic, small bowel)
C. Respiratory Alkalosis
1. Central Nervous System
pain
anxiety
2. Drugs
Salicylates
doxapram
3. Ventilator Induced
4. Peripheral Stimulation
hypoxia
high altitude
D. Metabolic Alkalosis
1. Drugs
diuretics
antacids
2. GIT causes
vomiting
3. Alkaline administration
4. Severe Hypokalemia
2. pCO2
3. pO2
G. Compensatory Mechanisms
Physiological responses to change in Hydrogen ion
concentration are characterized by three phases : 1.
2.
3.
1. Bicarbonate (H2CO3/HCO3)
2. Hemoglobin (HbH/b)
3. Intra-cellular proteins (HPr/Pr)
4. Phosphates (H2PO4/HPO4)
5. Ammonia (NH3/NH4)
2. Metabolic Alkalosis.
acetazolamide
vitamin C
ammonium chloride
3. Respiratory Alkalosis
intra-venous ammonium chloride
intra-venous hydrochloric acid (0.1 mol/L)
4. Respiratory Acidosis
increasing alveolar ventilation (bronchodilation,
respiratory stimulant-doxapram, reversal of
narcosis-naloxone, improving lung compliancediuretics)