Acid-Base Balance

- maintains pH
- increase in H+ = decrease in pH
- 0 = very acidic/low pH
- 14 = very basic/alkaline/high pH
- 7 = neutral
- artery is the best place to measure balance
- major organs involved are lungs, kidneys and bones

- acidosis: low pH, high H+, low bicarbonate
- alkalosis: high pH, low H+, high bicarbonate

- neutralize H+
- MOST IMPORTANT buffering system is carbonic acid-bicarbonate pair!!

CO2 + H2O <-> H2CO3 <-> H+ + HCO3-

1) volatile: carbonic acid (H2CO3) eliminated as CO2 and H2O gas from lungs
2) nonvolatile: sulfuric, phosphoric, and other acids; eliminated by renal tubules

- lungs eliminate CO2
- kidneys reabsorb and generate HCO3-
- respiratory drive is done through chemoreceptors in brainstem, carotid artery, and aorta

- protein: albumin
- ion exchange
- ammonia NH3

1) respiratory acidosis
2) respiratory alkalosis
3) metabolic acidosis
4) metabolic alkalosis

elevation of CO2 from ventilatory depression; equation shift right

decrease in CO2 from hyperventilation; equation shift left

increase in H+ and CO2, decrease in HCO3
- equation shift left

- elevation in HCO3; decrease in H+ and CO2; shift right

- impaired gas exchange
- impaired respiratory control (brainstem)
- inadequate neuromuscular function

- manifestations: headache, blurred vision, irritability, muscle twitching, paralysis
- compensation: renal H+ excretion, HCO3 resorption
- treatment: mechanical ventilation

hyperventilation, hypoxemia, acute pain, anxiety, alcohol withdrawal, brainstem stimulation (injury, drugs)

- manifestations: light headed, dizzy, paresthesia
- compensation: renal H+ resorption, HCO3 excretion (slow tho)
- treatment: rebreathing

anything that causes a removal/decrease in bicarbonate
- starvation
- alc
- burns
- end stage renal failure
- diarrhea
- circulatory shock

- manifestations: hyperventilation (Kussmaul breathing)
- compensation: increased respiration
- treatment: address underlying cause

- *increase in bicarbonate
- decrease in acid
- massive transfusion with citrated blood

- manifestations: confusion, hyporeflexia (absent reflex response), tetany
- compensation: hypoventilation
- treatment: address underlying cause