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What are the three processes involved in acid-base homeostasis?
What are the three processes involved in acid-base homeostasis?
Acid production, acid buffering, and acid excretion.
The body normally maintains a slightly [blank] pH.
The body normally maintains a slightly [blank] pH.
Acids release hydrogen (H+) ions.
Acids release hydrogen (H+) ions.
True
What is the name of the major buffer system in the extracellular fluid (ECF)?
What is the name of the major buffer system in the extracellular fluid (ECF)?
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What are two ways that the body can excrete carbonic acid?
What are two ways that the body can excrete carbonic acid?
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What is the primary mechanism for excreting metabolic acids?
What is the primary mechanism for excreting metabolic acids?
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Which of the following is NOT a factor that can lead to respiratory acidosis?
Which of the following is NOT a factor that can lead to respiratory acidosis?
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What are some common symptoms of respiratory acidosis? (Select all that apply)
What are some common symptoms of respiratory acidosis? (Select all that apply)
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Respiratory alkalosis results from a lack of carbon dioxide (CO2) due to alveolar hyperventilation.
Respiratory alkalosis results from a lack of carbon dioxide (CO2) due to alveolar hyperventilation.
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Which of the following can cause metabolic acidosis? (Select all that apply)
Which of the following can cause metabolic acidosis? (Select all that apply)
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Metabolic alkalosis is often caused by excessive vomiting.
Metabolic alkalosis is often caused by excessive vomiting.
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Match the following acid-base imbalances with their corresponding key values:
Match the following acid-base imbalances with their corresponding key values:
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The mnemonic ______ can be used to help remember key values for acid-base imbalances
The mnemonic ______ can be used to help remember key values for acid-base imbalances
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What is the normal range for pH in arterial blood gasses?
What is the normal range for pH in arterial blood gasses?
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What is the normal range for base excess in arterial blood gasses?
What is the normal range for base excess in arterial blood gasses?
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What is the normal range for blood pH?
What is the normal range for blood pH?
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Acids release hydrogen (H+) ions, while bases (alkaline substances) take up H+.
Acids release hydrogen (H+) ions, while bases (alkaline substances) take up H+.
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The human body is naturally slightly acidic.
The human body is naturally slightly acidic.
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Acid-base balance is maintained when acid production equals acid excretion.
Acid-base balance is maintained when acid production equals acid excretion.
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What is the primary buffer system in the extracellular fluid?
What is the primary buffer system in the extracellular fluid?
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What is the ratio of HCO3- to carbonic acid in the HCO3- buffer system?
What is the ratio of HCO3- to carbonic acid in the HCO3- buffer system?
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What are the two main ways that the body excretes acids?
What are the two main ways that the body excretes acids?
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Which of the following conditions is NOT a cause of respiratory acidosis?
Which of the following conditions is NOT a cause of respiratory acidosis?
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Which of the following is a symptom of respiratory alkalosis?
Which of the following is a symptom of respiratory alkalosis?
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What is a common cause of metabolic acidosis?
What is a common cause of metabolic acidosis?
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Which of the following is NOT a treatment for metabolic alkalosis?
Which of the following is NOT a treatment for metabolic alkalosis?
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What does the acronym ROME stand for in the context of acid-base imbalances?
What does the acronym ROME stand for in the context of acid-base imbalances?
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In respiratory acidosis, the pH decreases while the PaCO2 increases.
In respiratory acidosis, the pH decreases while the PaCO2 increases.
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In metabolic alkalosis, both the pH and HCO3 increase.
In metabolic alkalosis, both the pH and HCO3 increase.
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Study Notes
Acid-Base Balance
- The body maintains a balance between acids and bases for optimal cell function.
- Acid-base homeostasis is a dynamic interplay of 3 processes: acid production, acid buffering, and acid excretion.
- Normal acid-base balance is maintained when acid production equals acid excretion.
Intended Student Learning Objectives
- Describe the processes that regulate acid-base balance.
- Interpret acid-base imbalances based on arterial blood gas (ABG) results.
- Identify risk factors for acid-base imbalances.
- Apply the nursing process when caring for patients with acid-base imbalances.
- Assess patients with specific acid-base imbalances.
Acid Buffering
- All body fluids contain buffers that work within seconds.
- Buffers are pairs of chemicals that work together to maintain the normal pH of body fluids.
- A buffer takes up excess H+ when there are too many.
- A buffer can release H+ when there are too few.
- The major buffer system in extracellular fluid (ECF) is the HCO3- buffer system, consisting of a lot of HCO3- and a small amount of carbonic acid (20:1 ratio).
- Other buffers include hemoglobin (Hgb), protein buffers, phosphate buffers, and cellular and bone buffers.
- Buffers normally keep the blood from becoming too acidic.
Acid Excretion
- The lungs excrete carbonic acid in the form of CO2 and H2O when you exhale.
- Rising carbon dioxide (PaCO2) levels trigger faster, deeper respirations to excrete the excess CO2.
- Falling PaCO2 levels trigger slower, shallower respirations.
- The kidneys excrete metabolic acids, secreting H+ into the renal tubular fluid and putting HCO3- back into the blood simultaneously.
Normal Ranges for ABG
- pH: 7.35-7.45
- PaCO2: 35-45 mmHg (4.7-6 kPa)
- HCO3- : 21-28 mEq/L (21-28 mmol/L)
- PaO2: 80-100 mmHg (10.7-13.3 kPa)
- SaO2: 95%-100%
- Base Excess/Deficit: -2 to +2 mEq/L
ROME Mnemonic
- Respiratory: Opposite relationship between pH and PaCO2
- Metabolic: Equal relationship between pH and HCO3-
Respiratory Acidosis
- Causes: Alveolar hypoventilation (lungs cannot excrete CO2, increasing carbonic acid). This can be caused by malfunctioning brainstem respiratory control, respiratory depressant drugs, head injury, acute asthma, airway obstruction, atelectasis (collapsed lung), COPD, pneumonia, or impaired neuromuscular functions.
- Symptoms: Decreased level of consciousness (confusion, lethargy, coma). Headache, lightheadedness, and dysrhythmias.
- Lab results: Low pH (<7.35), high PaCO2 (>45 mmHg/6 kPa), normal or high HCO3- (compensated).
Respiratory Alkalosis
- Causes: Alveolar hyperventilation (rapid or deep breathing) caused by stimulation of brainstem respiratory control, aspirin overdose, gram-negative sepsis, head injury, meningitis, or acute pain.
- Symptoms: Lightheadedness, numbness/tingling in extremities, excitement/confusion, dysrhythmias.
- Lab results: High pH (>7.45), low PaCO2 (<35 mmHg/4.7 kPa), normal or low HCO3- (compensated).
Metabolic Acidosis
- Causes: Increased metabolic acids (e.g., ketoacidosis from diabetes, starvation; hypermetabolic state; severe kidney disease; ingestion of acid precursors, circulatory shock, diarrhea, pancreatic fistula, or intestinal decompression).
- Symptoms: Decreased level of consciousness, increased respiratory rate and depth, abdominal pain, dysrhythmias.
- Lab results: Low pH (<7.35), normal PaCO2, low HCO3- (<21 mEq/L/21 mmol/L).
Metabolic Alkalosis
- Causes: Excessive bicarbonate intake (e.g., sodium bicarbonate administration), massive blood transfusion (liver converts citrate to HCO3-), loss of metabolic acids (e.g., excessive vomiting, gastric suction, increased aldosterone, or hypokalemia).
- Symptoms: Possible excitement/confusion followed by decreased level of consciousness, lightheadedness, numbness/tingling, dysrhythmias, muscle cramps.
- Lab results: High pH (>7.45), normal or high PaCO2 (if compensated), high HCO3- (>28 mEq/L/28 mmol/L).
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Description
This quiz covers the essential processes that regulate acid-base balance in the human body. Students will learn to interpret arterial blood gas results and identify risk factors for acid-base imbalances. The application of nursing principles in caring for patients with these imbalances is also discussed.
