Acid and Base Balance and Imbalance

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Treatment of Respiratory Alkalosis

Treat underlying cause

Breathe into a paper bag

IV Chloride containing solution – Cl- ions replace lost bicarbonate ions

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Metabolic Acidosis

Bicarbonate deficit - blood concentrations of bicarb drop below 22mEq/L

Causes:

Loss of bicarbonate through diarrhea or renal dysfunction

Accumulation of acids (lactic acid or ketones)

Failure of kidneys to excrete H+

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Symptoms of Metabolic Acidosis

Headache, lethargy

Nausea, vomiting, diarrhea

Coma

Death

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Compensation for Metabolic Acidosis

Increased ventilation

Renal excretion of hydrogen ions if possible

K+ exchanges with excess H+ in ECF

( H+ into cells, K+ out of cells)

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Treatment of Metabolic Acidosis

IV lactate solution

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Metabolic Alkalosis

Bicarbonate excess - concentration in blood is greater than 26 mEq/L

Causes:

Excess vomiting = loss of stomach acid

Excessive use of alkaline drugs

Certain diuretics

Endocrine disorders

Heavy ingestion of antacids

Severe dehydration

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Compensation for Metabolic Alkalosis

Alkalosis most commonly occurs with renal dysfunction, so can’t count on kidneys

Respiratory compensation difficult – hypoventilation limited by hypoxia

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Symptoms of Metabolic Alkalosis

Respiration slow and shallow

Hyperactive reflexes ; tetany

Often related to depletion of electrolytes

Atrial tachycardia

Dysrhythias

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Treatment of Metabolic Alkalosis

Electrolytes to replace those lost

IV chloride containing solution

Treat underlying disorder

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