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pH Scale 1-14
pH 7.35 -7.45 pH 7.45 Alkalosis
MM/2011
*
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*Ratio of Acids to
Base must remain
balanced for
normal cellular
function
MM/2011
*
ACID Base
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*pH 7.35 -7.45
(balance of CO2 and HCO3)
*PaCO2 35-45 mmHg
*HCO3 22-26 mEq/L
*Base excess +2- -2 mEq/L
*PaO2
*O2sat
CO 2 HCO3
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* CO2 combines with water (H2O) to formcarbonic acid
*A change in pH triggers the lungs toincrease or decrease ventilation.
* Activation of the lungs to compensate
for an imbalance starts to occur within 1
to 3 minutes.
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*
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*As the blood pH decreases, thekidneys will compensate byretaining HCO3 bicarb
* As the pH rises, the kidneysexcrete HCO3- through the urine.
*the system may take from hours todays to correct the imbalance.
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*
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*pH 7.35-7.45 = normal
*pH < 7.35 = acidosis*pH > 7.45 = alkalosis
1A. Classify the pH:
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*
*If the pH is normal but the CO2 or HCO3 isabnormal then classify the pH as:
*Acidosis < 7.4 -
*Alkalosis > 7.4
*The more abnormal component (CO2 orHCO3) should be consistent with this analysis
1B. Classify the pH:
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*
*2. Assess the PaCO2*Normal 35-45 mmHg
*Acidosis > 45 mmHghypercapnia; CO2 is being retained
*Alkalosis < 35 mmHg
hypocapnia; more CO2 is being exhaledthan normal
pH CO2
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*pH 45
*Cause: Interferencewith gas exchange in thelungs
*Examples:
emphysema, respiratordepression (e.g narcoticoverdose ,Cystic fibrosis,pulmonary disease
*PH> 7.45 CO2 < 35
*Cause: Hyperventilation
* due to encephalitis,
fevers, hysteria ,nervousness, mechanical
over-ventilation
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*
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*
*3. Assess the bicarbonate (HCO3)*
Normal 22-26 mEq/L*Acidosis < 22 mEq/L bicarbonate levels are
lower than normal
*Alkalosis > 26 mEqL - bicarbonate levels are
higher than normal
pH HCO3
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* pH < 7.35 HCO37.45 HCO3>26
* Cause: Loss of hydrochloric
acid vomiting, gastric
* Suctioning
* Excessive diuretic
therapy
* Exessive sodium
bicarbonate intake
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*
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7.35-7.45
pH
35-45
CO2
22-26
HCO3 ANALYSIS CLINICAL DATA
7.50 28 23 Pre-op, anxious
client
7.37 60 24 COPD
7.35 30 16 Renal failure
7.53 43 34
Abdominal
surgery with NGT
suction
7.35 45 24 Pneumonia
Check O2
See lab Man Page 67
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MM/2011
7.23 65 24
Receiving
Morphine via
PCA
7.53 42 31 Diuretic therapy
(Lasix)
7.27 46 14
Mixed condition
-
GI Bleed
BP 90/50 P 128
(shock)
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MM/2011
pH 7.35 -7.45 CO2 35-45 HCO3 22-26 O2 sat Analysis
7.50 29 24 86%
36 year old comes to ED with Acute onset SOB ,Chest pain
HX of Smoking , Pt. is anxious and c/o of spasms in hands
Medications Birth control Pills
BP 140 /80 P110 R 44 T 37
What is priority ?
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MM/2011
pH 7.35 -7.45 CO2 35-45 HCO3 22-26 O2 sat
7.25 61 26 89
32 year old male unconscious . HX of drug abuse
BP 110 /80 P116 R 6 T 36
What is priority
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MM/2011
pH 7.35 -7.45
CO2 35-45 HCO3 22-26 O2 sat Analysis
7.15 30 10 94%
18 year old with HX of Diabetes
Flu for last 3 days not eating
Pt. is lethargic
BP 98/70 P 120 RR 32 T 38
What is priority ?
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MM/2011
pH 7.35 -7.45
CO2 35-45 HCO3 22-26 O2 sat Analysis
7.49 45 30 95%
75 year old with SBO post Lysis of adhesions colostomy
1 day post op
Draining 700ml /6Hr from NG tube/ Abd soft - BS
BP 110 /90 P 100 RR 16 T 37
What is priority ?
