Acid-Base Balance

• respiratory acidosis

  carbonic acid excess due to CO2 retention by hypoventilation

  causes: respiratory failure, COPD, severe pneumonia

  compensation: kidneys conserve HCO3-, excrete H+

  interventions: increase respirations, O2, ventilation
• respiratory alkalosis

  carbonic acid deficit due to hyperventilation (CO2 excretion)

  causes: hypoxemia, hypoxia, PE, mechanical over ventilation

  compensation: rarely occurs due to aggressive treatment of causes of hypoxemia; HCO3- excreted by kidneys

  interventions: slow, deep breaths
• metabolic acidosis

  can't excrete acid or excess loss of base

  accumulation of acids: ketoacidosis, lactic acid accumulation (shock)

  loss of bicarb: severe diarrhea

  inability to reabsorb bicard & H+: kidney disease

  compensation: increased CO2 excretion (Kussmaul respirations), kidneys excrete acid
• metabolic alkalosis

  loss of acid: vomiting, gastric suction

  gain of base: baking soda, antacids, mineralocorticoids

  compensation: decrease RR to increase plasma CO2, kidneys excrete HCO3-
• metabolic interventions

  acidosis: treat cause, fluid replacement (.9 or .45), monitor dysrhythmias / potassium levels

  alkalosis: monitor dysrhythmias / potassium levels
• K+ imbalances

  acidosis: K+ increases, ICF -> ECF, kidneys retain

  alkalosis: K+ decreases, ECF -> ICF, kidneys excrete