Acid-base balance/ventilators
Rule of the B’s.. If the pH & the bicarb are both in the same direction = metabolic
If they are in different directions = respiratory
pH = 7.35-7.45 acidosis/alkalosis
HCO3 (bicarb) = 22
...
Acid-base balance/ventilators
Rule of the B’s.. If the pH & the bicarb are both in the same direction = metabolic
If they are in different directions = respiratory
pH = 7.35-7.45 acidosis/alkalosis
HCO3 (bicarb) = 22-26 (2+2+2 = 6)
CO2 = 45-35
ex:
pH: 7.30 = ↓
bicarb: 20 = ↓ = metabolic acidosis
ex:
pH: 7.58 =↑
bicarb: 32 = ↑ = metabolic alkalosis
ex:
pH: 7.22 =↓
bicarb: 30 =↑ = respiratory acidosis
ex:
You are providing care to a client with the following blood gas results: pH 7.32, CO2 49, HCO3
29, PO2 80 & SaO2 90%. Based on the results, the client is experiencing:
↓ = acidosis, ↑ = respiratory
-opioid: CNS depressant.. know the symptoms (sedation, respiratory depression, etc)..
*principle: acid base signs/symptoms..as the pH goes… so goes my patient!!!
-when pH goes up; patient goes up.. (everything gets irritable!)
-when pH goes down; patient goes down! (systems in your body shut down)
…except with potassium: when pH goes up; potassium goes down… when pH goes down;
potassium goes up!
(up) alkalosis: irritibility, hyper-reflexia (3 & 4), tachypnea, tachycardia, borborygmi
(increased bowel sounds), seizure, aspirate..
(down) acidosis: hypo-reflexia, bradycardia, lethergy (obtunded), paralytic ileus (decreased
bowel sounds), coma, respiratory arrest (ambu-bag!!)
Kussmaul breathing is a deep and labored breathing pattern often associated with severe
metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure… MAC
Kussmaul!!
M: metabolic
AC: acidosis
ex:
pT has respiratory acidosis… (select all that apply)..
+1 reflexes
diarhhea
adynamic ileus
spasm
urinary retention
tachycardia
2nd degree mobits type 2 heart block
hypokalemia
SATA questions: *never only 1… never all of them*
diarhhea will cause a metabolic acidosis.. but once you get acidodic, it will shut your bowels
down = paralytic ileus
…with scenarios.. always ask first “is it lung?” = respiratory
…then ask if the pt is over-ventilating or under-ventilating?
over-ventilating = alkalosis
under-ventilating = acidosis
…it’s about the SaO2!!! (pay attention!!)
if it isn’t lung = metabolic..
if pt has prolonged gastric vomiting or suctioning… it’s always metabolic alkalosis…
why? losing acid = becomes basic..
for everything else that is not lung - choose meta
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