Fluid, Electrolyte and Acid-

base Balance Block

ACID-BASE BALANCE

By Harliansyah, PhD
2012
 HYDROGEN IONS, ACIDS,
AND BASES
HYDROGEN IONS (H+)

ACIDS

BASES

PH
Normal arterial pH is 7.35 7.45
ACID-BASE BALANCES
Acidosis pH < 7.35

Alkalosis pH > 7.45

Buffers
PRIMARY BUFFER SYSTEMS
IN EXTRACELLULAR FLUID
 REGULATION OF ACIDS
AND BASES
THE BIG THREE ACID-BASE
REGULATORS

Chemical regulation
Biological regulation
Physiological regulation
 PHYSIOLOGICAL
REGULATION

Alkalosis

Acidosis
ACID BASE IMBALANCES
RESPIRATORY ACIDOSIS
RESPIRATORY

ALKALOSIS
METABOLIC ACIDOSIS

METABOLIC ALKALOSIS
ARTERIAL BLOOD GASES
NORMAL BLOOD GAS
VALUES
pH 7.35-7.45
PCO 35-45 mmHg
2
HCO 22-27 mEq/L
3
PO 80-100 mmHg
2
ARTERIAL BLOOD GASES
RESPIRATORY IMBALANCES
Respiratory function indicator is PCO
2
Opposite response between the pH

and PCO2
pH is down in an acidotic condition

and is elevated in an alkalotic

condition
pH and PCO determines if the

condition is a respiratory problem

ARTERIAL BLOOD GASES
METABOLIC IMBALANCES
HCO3 is indicator for metabolic

function
A corresponding response between the

pH and the HCO3

pH is down in an acidotic condition and

is elevated in an alkalotic condition

The pH and the HCO determines if the
3
condition is a metabolic problem
ANALYZING ARTERIAL
BLOOD GAS RESULTS
PYRAMID STEPS
Look at the blood gas report
PYRAMID STEP 1
Look at the pH. Is it up or down? If it is up, it
reflects alkalosis. If it is down, it reflects acidosis.
PYRAMID STEP 2
Look at the PCO2. Is it up or down? If it reflects
an opposite response as the pH then you know
that the condition is a respiratory imbalance. If it
does not reflect an opposite response as the pH,
then move on to Pyramid Step 3.
ANALYZING ARTERIAL
BLOOD GAS RESULTS
PYRAMID STEP 3
Look at the HCO3. Does the HCO3 reflect a
corresponding response with the pH? If it does,
then the condition is a metabolic imbalance.
PYRAMID STEP 4
Remember, compensation has occurred if the
pH is in a normal range of 7.35-7.45.
If the pH is not within normal range, look at the
respiratory or metabolic function indicators.
FLUID, ELECTROLYTE &
ACID -BASE
REMEMBER~~~~

NORMAL CHEMISTRY LABORATORY VALUES

Serum electrolyte levels

CBC (changes in Hct related to FVD & FVE)
BUN & Blood Creatinine Levels (kidney functions)
Urine Specific gravity (normal 1.003 1.023)
ABGs
F
OVERALL GOALS/EVALUATION

LUID,
NORMALELECTROLYTE

BALANCE
&
FLUID, ELECTROLYTE AND ACID BASE

ACID -BASE
CAUSES OF IMBALANCES IDENTIFIED OR CORRECTED

NO COMPLICATIONS FROM THERAPIES NEEDED TO

RESTORE BALANCE

INCLUDE FAMILY IN PROCESS