1.

) A cell and its surrounding environment in any part of the

body is primary composed of fluid.
2.) Body fluids are mainly made up of H
2
O & solutes
3.) Humans can only survive if there is balance within and
between fluid compartments.
4.) Homeostasis is the term used to mean
BALANCE (EQULBRUM)
5.) Homeostasis is important to continue life.
BASIC CONCEPT OF F & E
BODY FLUIDS
I. FUNCTIONS OF BODY FLUIDS
1.) Body fIuids
a.) Facilitate the transport of nutrients, hormones,
CHONS other molecules into the cells.
b.) and in the removal of cellular metabolic waste product.
c.) Regulate body temperature (hypothalamus regulator)
d.) Provide Lubrication of musculoskeletal joint.
e.) Act as a component in many body cavities
eg. pericardial fluid, pleural fluid, peritoneal fluid.
2.)

O is the principaI component of body fIuids and is

vitaI to Iife.
- 60% of body wt. n kg. For normal adult is H
2
O.
- 70-80% of BW infants
- 40-55% of BW older adult /elderly
- muscle contains more water than fats.
FLUIDS AND ELECTROLYTES
PYSIOLOGY
A.) Basic concepts of body fIuid
1.) H
2
O is a primary body fluid. t is used to transport
nutrients as well as to remove waste products.
a.) nfant 70 to 80 % of body wt. is H
2
O.
b.) Adult 50 to 60% of body wt. is H
2
O.
c.) Elderly Adult 45 to 55% of body wt. is H
2
O.
2.) EIectroIytes - eIectricaIIy changed particIes
a.) Anion carries a negative charge (-)
b.) Cation carries a positive charge (+)
c.) Electrolytes found in intracellular fluid & extracellular
fluid are essentially the same; however the
concentrations differ.
.
DISTRIBUTION OF BODY FLUIDS
Major Compartments of Body FIuids
3. ntracellular fluid provides the cell w/ internal fluid
necessary for cellular fnx.
a.) Approximately 40% to 50% to total body fluid
b.) Electrolytes (1.) K
+
(Primary)
(2.) Mg
(3.) PO
4
c.) Total fluid found inside the cells.
d.) Comprises 2/3 of body fluids (more fluid present in the ECF.)
4.) ExtraceIIuIar fIuids (EFC) transport system for cellular
waste, 02, electrolytes & nutrients, assists to regulate
body temp., lubricates & cushion joints.
a.) Approximately 30% to 40% of total body H
2
O
b.) An infant maintains a larger percentage of Extra
cellular fluids than does an older child or adult.
c.) IntravascuIar Fluid in blood vessels.
Circulating plasma volume
d.) InterstitiaI fluid surrounding tissue cells.
e.) EIectroIytes (1) Na+ (Primary)
(2) Chloride
(3) Calcium
f.) Fluid found outside the cells.
g.) 1/3 of body fluids (less fluid present than fluid found
in spaces between cells in CF.
NON - ELECTOLYTES AND ELECTROLYTES
1.) Non- electrolytes and electrolytes are solutes or particles
present in body fluids.
2.) Non- electrolytes are substance that do not break-up or
dissociate in solution or H
2
O.
Ex. - Glucose, O
2,
CO
2,
urea, organic acids, CHONS, lipids
- Atons & glucose play roles in fluid balance.
3.) Electrolytes are substances w/c break up to form ions
in solution / H
2
O.
a.) cation positively charged electrolytes/ion
ex Na
+
, K
+
, Mg
+
, Ca
+
, H
+
b.) anion negatively charged
ex cl-, PO
4
- , HCO
3
-
4.) The types of solutes and their number vary between 2 fluid
compartments.
More Na
+
and Cl- is found in the ECF.
10x more than in the ECF.
More K
+
and PO
4
(-)
in the CF
5.) Culef cation ECF Na
+
CF K
+
6.) Culef anion EFC - C
(-)
CF PO
4
(-)
7.) n each fluid compartment; the No. of cations and
anions ie. equal (Electrical neutrality)
8.) Electrolytes concentration is expressed in
milliequivalents/Liter (mEa/L) or millimoles /Liter (mmoL/L)
unit of expression for an electrolyte.
9.) Total solute concentration is expressed in
milli osmoles (mosm) per liter. t measures the # of
osmotically capable parties in a green solution.
10.) OSMOLALTY - # of solute in milliosmoles per kg.
of Kg. of H
2
O.
11.) OSMOLARTY now concentrated or diluted fluids are
(usually pertaining to serum/ blood as basis.)
12.) The higher the # of solutes, the higher is the concentration
of the serum, the higher the osmolality / osmolarity
(hyperosmolar)
13.) As serum is diluted with H
2
O or there is severe less of
solutes, osmolarity falls (hypo osmolar)
14.) Osmolarity & Osmolality are used interchangeably.
15.) N
o
serum osmolarity is 270-300mOsm/L
TONICITY
1.) Pertains to the concentration of particles in a solution.
2.) Normally, body fluids are iso-osmolar to achieve
nomeo stasis, w/c means they are of thesame solute
Concentration as the serum, sucu fluids are isotonic.
3.) Fluids that are of a higher solute concentration compared
to the serum are hypertonic.
4.) Hypotonic fluids contains a lesser solute concentration
than the serum.
SOURCE OF FLUIDS:
1.Normally total daily intake of H
2
O is approximately 2,500ml
i. ingested fluid is 1,500ml
ii. H
2
O from solid foods is 700 ml
iii. H
2
O from food oxidation is 300 ml.
2. N
o
daily fluid loss is also approximately 2,500ml to maintain
balance.
3. H
2
O is excited /loss from the body thru the
i. kidneys
ii. skin
iii. lungs
iv. G tract
4. H
2
O loss maybe sensible or insensible.
5. Sensible H
2
O loss is visible or measurable and occurs in the
form of urine and in special cases profuse sweating.
vii. Urine fv. Kidneys is 11500ml.
6. nsensible H
2
O loss is not visible and not measurable w/c
losses from the
ix. Skin thru evaporation 400ml
x. Lungs thru respirations 400ml
xi. G tract in the leces 200ml
7. The best index for fluid balance is the daily wt.
2
F. ACID - BASE BALANCE
1.) ACD substance that gives off /donates hydrogen ion
in body fluids.
* High H concentration in body fluids means more, acids
2.) Base/Alkali substance that accepts hydrogen ion;
they're present as bicarbonate ion (HCO
3
)
* High HCO
3
concentration means more alkalis formed.
3.) Acid base balance refers to stable ratio of H ions to
HCO
3
ions in body fluid.
4.) Acids and bases must be balanced at a ratio of
1H
2
CO
3
(acid); 20 HCO
3
(base)
5.) H
2
CO
3
(carbonic acid) is measured by Carbon dioxide
level (CO
2
)
6.) The blood pH tells the concentration of hydrogen in the
blood. t reflects as a measurement for acid-base balance.
7.) The lower the pH, the higher is the H ion concentration the
serum is acidic.
8.) The higher the pH, the lower is the H ion concentration, the
blood is alkaline
9. N
o
value for arterial blood pH = 7.357.45; urine pH is 4-8
* pH < 7.35 acidic
* pH > 7.35 alkaline
10.) f H ion are abnormally high or HCO
3
concentration is very
low, blood pH falls resulting in ACDOSS.
11.) ALKALOSS occurs when HCO
3
levels or there's deficit in
H ions and the pH rises.
12.) BUFFER Subs. that reacts w/ an acid or base to maintain
a normal H ion condition & normal pH.
Buffer sys. a.) H
2
CO3 HCO
3
system most plenty
b.) Phosphate
c.) CHON
d.) Cell
BODY FLUID MOVEMENT / FLUID TRANSPORT
Fluids move from one compartment to another to maintain
balance
The primary barrier to fluid movement is the semi-
permeable cell membrane (not all subs. Can pass freely)
H
2
O can move freely in and out of cell
For solutes, the cell membrane is selective.
MAJOR FLUIDS TRANSPORT METODS
A. Passive Transport
Fluids move w/out the use or need for energy.
B. Active Transport
Fluid movement that requires energy for ATP mitochondrion
release by cells
eq. Na- K pump most imp't.
active transport mechanism
PASSIVE TRANSPORT
A.DFFUSON solves move from an area of higher solute
concentration to one of a lower concentration
until the cocentration is equal on the components
eq. O
2
& CO
2
exchange
* Facilitated diffusion need help from some CHON carrier
B. OSMOSS Diffusion of H
2
O from an area of high H
2
O
content to lower H
2
O content.
- Also means H
2
O moves from lower solute
concentration to higher solute concentration.
STARLINGS LAW OF CAPILLARIES
(Fluid movement between ntravascular & interstitial space.)
Capillaries are the connection between VS & SS.
Fluid moves at the arterial & venous ends of the
capillary.
Movement is influenced by 2 opposing pressures.
W W
W W
W
W W W
W
W
W
W
ACTIVE TRANSPORT
1)HYDROSTATC PRESSURE (BHP)
Pressure exerted by fluid on blood vessel wall.
"Pushing out force.
Generated be e pumping of the heart.
Higher in the arterial end than in the venous end.
2.) COLLOD OSMOTC PRESSURE (COP) /ONCOTC PRESSURE
Exerted by plasma CHONS esp. albumin
- exerted colloid osmotic pressure
"Pulling in or "holding back force
Keeps fluid in e VS, prevents the exit of NF.
Stable in both ends.
Fluids, CHONS, other solutes that escape from VS. to
SS are returned to the circulation via the Lymphatic sys.
Dynamic transport of fIuid and eIectroIytes:
1.) Passive transport movement of body fluids caused by
the concentration and the molecular
weight of the fluid.
a.) Diffusion movement of molecules from an area of
concentration to an area of concentration.
W W W
W W
W
W
W
W
b.) Osmosis movement of H
2
O thru a semi permeable
membrane from an area of low electrolyte
concentration to an are of concentration;
OSMOTC pressure is term used to describe
OSMOSS (water goes where the salt is)
c.) Filtration the movement of H
2
O and electrolytes thru a
semipermeable membrane from an area of high
pressure to an area of low pressure; Hydrostatic
pressure is term used to describe the force of
filtration.
W W W
W
W
W
W
W
W
2.) Active Transport movement of substances from an area of
low concentration to an area of high concentration
w/ the expenditure of energy.
3.) Oncotic Pressure The Osmotic pressure created by
plasma CHONS.
4.) Hydrostatic Pressure The pressure created by the volume
in the vascular bed.
5.) Filtration Occurs in the arterial end of the capillaries vec. the
hydrostatic pressure is higher than the Oncotic
pressure. Fluid then moves out of the vascular
bed into the tissue (Arterial Hydrostatic
pressure )
6.) @ the venous end of e capillaries, the oncotic pressure
is greater and the fluid moves back into the vascular
volume.
(Venus Oncotic Pressure )
7.) Osmolarity refers to the concentration of the dissolved
particles in a solution; Osmolarity controls the movement
of fluid in each of the compartments.
The N
o
Osmolality of plasma is 280 to 294 mOsm/kg.
or 270 to 300 mOsm/L.
2a. Hyper-Osmolar ncreased concentration of particles or
solutes in a solution; fluid will move into
this space to dilute the concentration.
Hypo Osmolar decreased concentration of particles;
more H
2
O and less solutes; fluid will move out
of this space to increase the concentration of
solute.
SO Osmolav (isotonic) N
o
distribution e solutes and H
2
O
in body fluid.
FLUID SIFTS
1.) Plasma to interstitial shift.
a.) Edema accumulation of fluid in insterstitial spaces.
1.) in hydrostatic pressure (pushing out force), as in a
client w/ fluid overload (congestive c1 failure)
2.) n Oncotic (Pulling in) pressure; as in a client w/ excessive
CHON loss (Renal dse)
3.) Break in the inleavity of vessel walls, as in a client
experiencing burns.
b.) Hypovolemid may occur as a result of excessive fluid
shift into the interstitial spacer, resulting in circulatory
collapse (burn client)
2.) nterstitial to plasma fluid shift movement of edema back
into the circulatory, volume as in client w/ mobilization of
burn edema; or in the excessive administration of hypertonic
solution causing the interstitial H
2
O to be returned to
plasma; client may demonstrate symptoms of circulatory
overload.
3.) Fluid Spacing 3
RD
spacing occurs in tissue injury from
an increase in capillary permeable and
from an increase in vascular fluid volume.
1.) ascites
2.) Burn edema
3.) Sequestration of fluid in the bowel.
D. OME OSTATIC Mechanisms.
1.) EnDocrine System.
a.) Hypo thalamus secretes antidiuretic hormone (ADH)
w/c regulates the H
2
O reabsorption by the kidneys.
b.) Adrenal cortex secretes cholesterone, w/c promotes
Na
+
retention and K
+
excretion thereby causing an
increase in plasma vol.
2.) Lymphatic System
- Assists to return excessive protein and fluid that
escapes into the tissue back to the plasma vol.
3.) Cardio Vascular system maintains blood pressure to insure
adequate renal perfusion.
4.) Kidney maintains fluid volume and concentration of urine
via the glomeruli filtration rate.
Nsq Priority Na
+
is the major electrolyte that affects fluid
balance. ("Where goes e Na
+
, so goes e H
2
O)
FLUID IMBALANCES (ECF)
A.) FIuid Deficit extracellular fluid vol. Defecit (dehydration,
EFC VD); hypovolemia result from vascular
fluid volume loss.
1.) Sensible fluid loss- fluid loss w/c an individual is aware;
such as urine.
2.) nsensible fluid loss fluid loss w/c an individual is not
aware (approximately 1,000 cc of fluid is lost
every 24 hrs. through skin & lungs in a N
o
and Ng)
3.) Causes of fluid deficit (all result from loss both H
2
O & Ng)
a.) fluid intake
b.) Failure to absorb or reabsorb H
2
O; as in diarrhea
and internal disorders.
c.) loss of fluid thru the GT, as in vomiting, nasogastic
suctioning.
d.) Excessive renal excretion due to renal dse and in
appropriate ADH secretion.
e.) atrogenic loss due to overuse of diuretics or
inadequate replacement of fluid loss.
f.) Excessive fluid less thru skin & lungs due to febrile state.
g.) mpaired integrity of the skin as in burns, wounds &
hemorrhage.
4.) CIinicaI Manifestations
a.) Thirst, longitudinal tongue furrows.
b.) Dry skin & dry mucous membranes.
c.) Poor skin turgor (assess skin on the abdomen/the inner
thigh in children; skin turgor is a poor indication on elderly
clients.)
d.) Weight loss
e.) Oligurid
f.) Decrease blood pressure.
g.) Decrease central venous pressure.
h.) Postural hypotension.
i.) motted skin color changes in infant and children.
j.) weakness, confusion, speech difficulty in elderly.
5.) Laboratory Findings.
a.) specific gravity
b.) BUN (Blood urea ultrogen > 25 mg/dl) in creatinine
c.) ncreased Hct. (The normal ratio of Hct to hgb is 3 to 1
for example 12 grams hgb to 36% Hct.
d.) Hyper glycemid (>120mg/dl)
B. Extra cellular fluid volume excess (circulatory overload,
ECFVE) the retention of sodium and H
2
O in the interstitial
spaces.
. Causes of fIuid excess
a.) excessive oral fluid intake.
b.) failure to excrete fluids, as in rental disease and cardiac
failure
c.) ntrogenic fluid increase due to excessive infusion of
hypotonic fluids.
d.) Excess intake of sodium.
2.) CIinicaI manifestation
a.) Pitting edema; sacral edema
b.) Pulmonary edema (dyspnea)
c.) bounaind pulse; Brady cardiac
d.) wt. Gain
e.) Lethargy
f.) Variable urine volume.
g.) Changes in Loc.
h.) central venous pressure.
i.) JVD (Jugular Vein distention)
j.) BP.
3.) Laboratory findings depends on the area of the body the
shift occurs
a.) specific gravity of urine (<1.010).
b.) Hct
c.) Serum Na
C. Extra ceIIuIar FIuid voIume shift (third spacing)
- shift in location of extracellular fluid bet. the
intravascular & interstitial spaces.
a.) Vascular to interstitial space shift due to tissue damage
such as blister, sprains.
b.) Large fluid shift occurs in severe injuries, burns, intestinal
perforations and obstructions & lymphatic obstruction.
2.) Clinical manifestation
a.) Decreased circulating vol. resulting in symptoms of
hypovolemia.
Nsq. Priority Daily wt. s the most releiable indicator of fluid
loss/gain in all clients regardless of age.
b.) Localized symptoms when fluid is obstructing an organ,
as in the intestirial tract.
D.) Nsq. Management of client w/ fluid imbalances.
1.) Assessment
a.) Evaluate clients' hv & predisposing factors
contributing to the problem.
b.) Assess for direction of fluid problem fluid
excess/deficit.
c.) Evaluate appropriate lab data.
d.) Evaluate clients' ability to tolerate & correct problem.
e.) Elderly clients are more likely to develop ECFVE due to
chronic diseases (renal cardiac)
2.) Nsg. Intervention.
a.) Maintain accurate & O records.
b.) Obtain accurate daily wt.
c.) Evaluate for pressure of edema.
d.) Maintain V replacement fluids at prescribed flow rate.
e.) Monitor Central Venous Pressure.
f.) Monitor v/s (BP is a reliable indicator of problems of fluid
balance in young children.)
g.) maintain good skin care prevent breakdown.
h.) Assess lab data for changes in e problem.
i.) Carefully monitor elderly, cardiac & pediatric clients
for tolerance of fluid replacement.
Intravenous FIuid RepIacement Therapy
Isotonic SoIution
Solution contain H
2
O, CHO for calorieneeds, and basic
electrolytes.
Types of solutions a.) 45% or normal saline & D5W.
ypertonic SoIutions
1.) .3% Nacl or 5% Nacl both are hypertonic & only used
to treat situations hyponatremia.
2.) Administered slowly, can cause intravascular volume
overload, carefully monitor serum sodium.
NUTRITIONAL SOLUTIONS
1.) Contain very high percentage of dextrose.
2.) Contain mixture of essential and non-essential amino
acids.
3.) Concentrated solutions are used in TPN and must be
administered via a central line.
4.) Types of nutritional Solutions.
a. 10% Dextrose solution.
b.) Protein solutions (Aminosyn, Freamine)
c.) Fat emulsions
VoIumes Expanders
1.) Solutions are used when there has been a massive loss
of plasma vol. (burns & Hge)
2.) Because the solution increases the circulating vol. ; fluid
vol. Overload may occur.
3.) Produces rapid expansion of plasma vol.; generally
reverses over 12hrs and is generally cleared within 24hrs.
4. Solution used for volume expansion.
a.) Dextrose 40 (Rheomacrodex)
Types of Intravenous soIutions
Solution Tonicity 5% dextrose in LR - Hypertonic
0.45% saline (1/2 NS) Hypotonic Dextran
0.9% saline (NS) sotonic Albumin
0.225% saline (1/4 NS) Hypotonic
0.33% saline (1/3 NS) Hypotonic
3% saline (3% NS) Hypotonic
5% saline (3% NS) Hypertonic
5% dextrose in walev (D5W) sotonic
10% dextrose in walev (D10W) Hypertonic
5% dextrose in 0.9% saline (5% D/NS) Hypertonic
b.) Dextrose 70 (Macrodex)
c.) Plasma & human serum albumin prepared from
blood.
LABORATORY TEST FOR EVALUATING FLUID STATUS
A. Urine Specific Gravity
measure the kidney's ability to excrete or conserve water tells
us whether urine is diluted or concentrated.
N
o
value 1.010 -1.025
The lesser the urine vol.; the higher the specific gravity;
the higher is the concentration & vice versa.
5% dextrose in 0.45% saline (5% D/1/2NS) Hypertonic
6% dextrose in 0.225% saline (5%D/1/4NS) sotonic
Lactated Kinger's (LR) sol. sotonic
B. Blood urea Nitrogen (BUN)
Urea endproduct of CHON metab, and excreted in urine
No value 10-20 ma/d/l or 3.5-7.0 mmol/L
High BUN means impaired renal fxn
C. Serum Oreatinine (serum Crea)
- Creatinine endproduct of muscle metabolism
- Most reliable index for renal fxn
- Normal value 0.7 1.5 mg/d/l or 60-130 mmol/L
- scrum area means damage d kidneys
D. Hematocrit (Hct)
- Measure the vol. % age of RBC's
- Normal value temates 39 - 47%
males 44 - 52%
- Conditions that increase Hct DHN (Dehydration),
polycythemia versa.
- Conditions that decrease Hct. Overhydration, anemia.
. EDEMA (fluid accumulation in the tissue interstitial spaces)
Terms K/T edema formation
Anasarca - generalized edema (all over the body)
Ascites - excess fluid in the peritoneal cavity
Non-Pitting Edema - area is firm
Parasentesis - removal of fluid thru a puncture site
Periorbita Edema - poffiness of the eyes
Pitting Edema - indentation remains upon applying
pressure on the edematous site
Pulmonary Edema - fluid in the lungs
Cerebral Edema - fluid in the brains tissue
Dependent Edema- occurs in the dependent parts of the body
(lower ext., sacral ,back part)
Mechanism of Edema FormuIation
a.) BHP fluid overloading
Na and H
2
O retention
liver failure (hypertensive portal circulation)
asciles (accumulation of fluid in the peritoneal)
b.) Decrease COP fluid overloading
- Nephrotic syndrome - CHON loss/ proteinuria
- Liver damage ( albumin synthesis )
- Malnutrition ( CHON in diet ) "kwashiorkor
c.) ncreased Capillary Permeability
Leakage of CONS and ParticIes
i. njury from burns
ii. nflammatory conditions
iii. nfections
iv. Hypersensitivity Rxns/ Allergies (Anaphylactic Rxn)
d.) mpaired Lymphatic flow
i. Obstruction from tumors (Lymphadenoma)
ii. nfxns such as elephantiasis
iii. Parasitism
System ReguIation of Body FIuids
A. RenaI ReguIation
Kidneys major regulators ECF fluid balance
Serum Nq Plasma Volume Arterial Pressure
Release of RENN from Kidneys
Juxtaglomerular Cell
Apparatus
(Cell in Kidneys that excrete renin)
Anglotensis (converting enzyne lungs)
Anglotensis (more active exerts and effects
Release of aldosterone from. Adrenal cortex vasoconstriction
RAA (Renin Anagiotensin AIdosterone System)
Na & H
2
O reabsorption arterialpressure
Plasma Volume
Serum Na
B. Endocrine ReguIation
serum osmolarity or plasma vol.
stimulates thirst center in hypothalamus
water intake
Thirst Center primary regulator of fluid intake
Posterior Pituitary Gland ( Neurohypothesis )
- Secret anduretic Hormone (ADH) i oxytocim
H
2
O reabsorption
f EFC osmolarity /plasma vo. ADH is released
f ECF osmolarity / plasma vol. Stop release of ADH
E.) Gastrointestinal Regulation 80%-95% H
2
O absorption and
nutrient transport into plasma occurs in e small.
- A condition called SADH ( Syndrome of n appropriate
Anti-Diaretic Hormone wherein there's an excessive secretion
of ADH.
- Decreased secretion of ADH = "DABETES NSPONS
Para Thyroid GIand (EIectroIyte BaIance)
- Secretes parathyroid hormone (PTH)
- PTH regulates serum Ca concentration
- Serum Ca concentration
- Serum Ca concentration CALCTONN (opposite)
Adrenal Glands - Secretes hormone aldosterone
C. Pulmonary Regular water is normally eliminated thru e
lungs ( insensible H
2
O loss)
D. Cardiovascular Regulation
Adequate blood 001 Lets pump to z e kidneys; good
kidney perfusion allows urine production.
ACID - BASE BALANCE
Basic Concepts of Acid Base Balance
A. Terms used to describe Acid-Base balance.
1.) pH The abbreviation for negative logarithm of hydrogen ion
conception .
2.) CO
2
Carbon Dioxide
3.) PaCO
2
Pressure of dissolved carbon dioxide gas in the blood.
4.) O
2
- Oxygen
5.) Pa O
2
Pressure of dissolved oxygen gas in the blood.
6.) HCO
3
Bicarbonate
7.) mmHg - millimetres of mercury
8.) H
+
- Hydrogen ion concentration.
9.) H2CO
3
Carbonic Acid
B. Normal blood gas values.
1.) pH 7.4 (7.35 -7.45
2.) PaCO
2
(35 to 45 mmHg)
3.) HCO
3
(22 to 28 mEq/L)
4.) PaO
2
(80 to 100mmHg)
C. The hydrogen ion (H
+
) concentration determines the acidity
or alkalinity of a solution; the higher the H
+
concentration
the more the solution.
D. Add-base ratio is determined by sampling arterial blood
this provides a reliable index of overall body function.
20HCO
3
H2CO
3
(base) (acid)
bicarbonate Carbonate acid Maintain the ratio of
a change in the ratio means an imbalance.
a more HCO
3
means more base ALKALOSS
less HCO
3
means less base ACDOLS
HCO
3
alkaline kidneys (metabolic)
pCO
2
acid lungs (respiratory)
E.) The body maintains a normal/ neutral state of acid base
balance. The stable concentration of H
+
balance is reflected
in arterial blood w/a relatively constant pH of 7.35 to 7.45.
HCO
3
level is controlled by e kidneys.
H
2
CO
3
level is measured by pCO
2
level (partial pressure of CO
2
)
* CO
2
determine the unit of acids.
PCO
2
is controlled by lungs.
More pCO
2
means more H
2
CO
3
(Carbonic acid) Acidosis
Less pCO
2
means less H
2
CO
3
More H
2
CO
3
means more H
+
ions Acidosis ( pH)
F. t is necessary for the pH to remain relatively constant for the
various enzyme system of all body organs to function correctly.
G. O
2
saturation levels reflected in blood gas reading do not have a
direct effect on the acid-base balance.
H. A state of acid base decomposition exist when the
acid base levels are either below 7.35
or above 7.45
I. Compensation the system not primarily affected is
responsible by returning the pH to a more
normal level.
J. Correction The problem in the system primarily affected
is connected, thereby returning the pH to a
more normal level.
K. PaCO imbaIance the origin or primary system is respiratory;
or is compensating for a metabolic problem.
L. CO3 imbaIance the origin or primary sys. s metabolic;
or it is compensating for a respiratory
problem.
M. The major clinical manifestation of an acid
Bass imbalance are indicative of CNS involvement.
The severity of the symptoms will depend on the length of
time the imbalance exist, aw well as the severity of the
deviation.
1.) Acidosis (metabolic or respiratory) Symptoms are indicative
of depression of CNS; this is not uncommon.
2.) ALKALOSS (metabolic/respiratory) Symptoms are indicative
of increased stimulation of the CNS; death is a rare
occurrence.
N. The normal ratio of HCO
3
to PaCO2 is 20 to 1. f this ratio is
present the pH is normal.
ReguIation of Acid - Base BaIance
A. Buffer System fastest to respond to a change in the pH.
The most rapid acting of the regulatory system. The buffer
system is activated when there is an excess acid /base present.
20 HCO
3
PacCO2 / H2CO
3
base acid
1.) A buffers is a chemical that helps maintain a normal pH.
2.) The buffer system chemical are paired . The primary chemicals
are sodium bicarbonate & carbonic acid. The buffers are
capable of absorbing or releasing hydrogen ions as indicated.
3.) The body buffers an acid more effectively than it neutralizes a
base.
4.) An effective buffer system depends on normal functioning
respiratory & renal system.
B.) Respiratory System
The second most rapid response in the regulation of acid base
balance . Carbonic acid is transported to the lungs, where it is
converted to carbon dioxide and H
2
O the excreted.
H
2
CO
3
(carbonic Acid)
H
2
O CO
2
1.) The amount of carbon dioxide in the blood is directly related
to the carbonic acid concentration.
2.) ncreased respirations will decrease CO
2
levels; thus the
carbonic acid concentrations and resulting in decreased H
+
and an increased in the pH.
3.) Decreased respirations will cause retention of CO
2
,
increasing the carbonic acid ancentrations & resulting in
increased H+ concentrations, and a in in the pH.
4.) With excessive acid formation; the respiratory center in the
medulla is stimulated , w/c results in an increase in an
ncrease in the dept & rate of respirations. This causes a
decrease in the carbon dioxide levels and returns the pH
to a more normal point.
5.) With excessive base formation, the respiratory rate slows
order to promote retention of CO
2
and decrease the
alkalotic state. Carbon dioxide is considered an acid
substance because it combines w/ H
2
O to from carbonic
acid. The PaCO
2
levels are influenced only by respiratory
causes.
. Respiratory System/Lungs
Maintains N
o
pH by controling the pCO
2
level thru
breathing
f pH is low resulting from acidosis, lungs remove CO
2
by RR (hyperventilation)
f pH is high resulting (alkalosis) retain CO
2
by RR.
C. Renal System the lowest, but most effective, mechanism
of acid- base regulation.
3 renal processes to achieve N
o
pH and No acid base ratio.
1.) HCO
3
reabsorption the kidneys reabsorp Na, &
produce, conserve NaHCO
3
.
2.) HCO
3
production in acidosis the H
+
is , therefore the
H
+
is excreted before the K
+
ion,
thereby precipitating hyperkalemia .
When the acidosis is corrected, the
K
+
will more back into the cell.
3.) H
+
ion excretion n alkalosis the H
+
is decreased; there
is an augmented renal excretion of the
K
+
ion thereby precipitating hypokalemia.
Primary Acid Base mbalances.
1.) Acidosis (more acids than base)
2.) Alkalosis (more base than acids)
A - B imbalances can either be
MetaboIic when kidneys and other organs are involved
except the lungs.
Respiratory when lungs are involved.
!oints to Recall:
All conditions are metabolic
EXCEPT REPRATORY DSORDERS (f lungs are involved)
These conditions result in ALKALOSS
a) Hyperventilation / RR (Loss of CO
2
)
b) BGT suctioning / Gastric Lavage (remove gastric juices/acids)
c) Excessive vomiting or Hyper emesis.
Principle of Compensation the system not primarily affected is
responsible for returning the pH to a more N
o
level.
RenaI Compensation:
Occurs when lungs fail to help maintain N
o
pH. Aim is to bring
pH close to N
o
kidneys will either
a.] retain HCO
3
if pCO
2
is high. (by urine output retains HCO
3
)
b.] remove HCO
3
if PCO
2
is (by urine output removes HCO
3
)
Respiratory Compensation
Occurs when kidneys lose ability to help
maintain N
o
ratio / N
o
P
H.
aim to bring
P
H to N
o
level.
Lungs will either a.] retain CO
2
when HCO
3
is high ( RR).
b.] remove CO
2
if HCO
3
is low ( RR).
Respiratory Acidosis
. Results from hypoventilation or RR
. Renal Compensation- urine output to
HCO
3
retention.
. Causes- chest injuries
- narcotic overdose
(resp. depression)
- COPD ( PCO
2
level) obstruction.
- head injuries (injury to resp. center)
especially in the medulla
V Lab. Findings
Ph less than 7.35
PCO
2
more than 45 mmHg
HCO
3
N
O
to slightly (compensation)
V. S/Sx (due to CNS/Brain depression from
acids)
- tremors
- a sterixis (flapping of hands)
- LOC to coma (level of consciousness)
- hepatic
V. Lab Findings
pH less than 7.35
pCO
2
more than 45mmHg
HCO
3
N
o
to slightly (compensation)
V. S/SX ( due to CNX/Brain depression from acids)
Tremors
A stenxis (flapping o hands)
loc to ---------------------------------------
hepatic
V. nterventions
Administer O
2
in low flow (esp. For COPD)
Semi-fowlers position
Pursed lip breathing & coughing
Suctions airway pm.
Respiratory AIkaIosis:
. Result from Hyperventilation or RR because of Tissue hypoxia.
. Renal Compensation
Urine output, HCO
3
reabsorption
. Causes
Anxiety or hysteria
Exercise (Heavy)
Sepsis / fever
V. Lab Findings
pH greater than 7.45
pCO
2
less than 35 mmHg
HCO
3
No to slightly low (compensation)
Use of O
2
CO
2
excretion
V. S/SX
Paresthesia (burning, tingling sensation)
Lightheadedness
Confusion
V. ntervention (aim is to preserve CO
2
)
Use of paper bond/rebreathing mask to breathe in & out.
Slow deep breathing
level of axienty
MetaboIic Acidosis
. Result from
Accumulation of acids
Loss of HOO
3
. Respiratory Compensation - RR to CO
2
excretion
. Causes
Diabetic ketoacidosis /DKA (Complication of DM)
Fatty acids are formed when ---- are used instead of glucose
from CHO.
4 njection of insulin to make glucose as source of energy .
Anaerobic metabolism (low O
2
result in Lactic Acid formation)
Renal failure (retention of Acids)
Diamned and use of diuretics ( HCO
3
loss)
V. Lab Findings
pH less than 7.35
pCO
2
N
o
to slightly low (comp.)
HCO
3
less than 22
V. S/Sx
Kussmaul's Respiration (breathing associated w/ DKA
w/c are deep & rapid to remove CO
2
Fruity breath (odov of Acetone from fatty acids)
Lethargy , arowsiness (CNS depression from acids)
Hyperkalemia (attempt to lower H
+
ion concentration by
moving K
+
from CF to blood thus K
+
in the blood while
H
+
moves from blood to CF as exchange.
Seizures (CNS irritability from acidosis)
V. Interventions
Protect from injured due to seizures
Raised sideralls
Don't restrain while on seizure
Administer anti comulsant
------------ (dilantin)
Diazepam (Valium)
Phenobarrital
Administer NaHCO
3
Doc for metabolic acidosis
Give insulin to glucose and allow K
+
movement into cells
for DKA.
Monitor cardiac status siucc K
+
cause heart arrest
(N
o
value of K
+
3.5-5.5 mmol/L)
MetaboIic AIkaIosis:
. Result from loss of acids
. Resp. Compensation
RR to pCO
2
retention (Hypovention)
. Causes
- vomiting
- gastric drainage /lavage
- severe hypokalemia ( bec. of K
+
, H
+
moves from
blood to CF thus H
+
)
V. Lab Findings
- pH more than 7.45
stomach
kidneys
- HCO
3
more than 26 Mcq/L
- pCO
2
No to slightly high (Compensatory)
V. S/Sx
muscle weakness/ hyporeflexia (due to K
+
)
Confusion, stupor
RR as Compensation
V. nterventions
Give K
+
supplements (kalium durules)
Encourage K
+
kid foods 9 Fruit & Juices)
Monitor RR ( present resp. Acidosis from RR)
ArteriaI BIood Gases
Laboratory procedure used to determine acid-bases balance.
Specimen is Arterial Blood
Neparinize the syringe a taking bld. sample to prevent clothing.
Apply direct pressure on puncture site for 5-10 mins to control
bleeding
nfo's obtained from ABG
a.) pH c.) PO
2
(No = 80-100mmHg)
b.) pCO
2
(acid) d.) HCO
3
(base)
INTERPRETING ABG RESULTS
1.) nterpret the pH whether it reflects N
o
; Acidosis or Alkalosis
2.) dentify if the imbalance is Respiratory / Metabolic
if the pCO
2
reffects the same interpretation as the pH, the
imbalance is Respiratory)
if HCO
3
reflects the same interpretation as the pH, the
imbalance is metabolic.
if Both have same interpretation as the pH, it is a mixed
imbalanced.
3.) Determine if the imbalance & partially compensated, fully
compensated or uncompensated.
PartiaIIy compensated if either the HCO
3
or pCO
2
has the
opposite interpretation as the pH and
the pH is not normal.
FuIIy Compensated if HCO
3
or pCO
2
has an opposite
interpretation as the pH and pH and
the pH is N
o
if pH is N
o
, values from 7.35-7-39 is considered on the
acid side
7.41 7.45 is on the alkaline side.
Uncompensated if either HCO
3
or pCO
2
remains w/in
Normal range.