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# Alkalosis Vs Acidosis

## Partially Compensated Vs. Fully Compensated Abgs Practice

This is an NCLEX practice question on partially compensated vs fully compensated ABGs. This question provides a scenario about arterial blood gas results. As the nurse, you must determine if this is a respiratory or metabolic problem, alkalosis or acidosis along with if it is uncompensated, partially or fully compensated based on the results. This question is one of the many questions we will be practicing in our new series called “Weekly NCLEX Question”. So, every week be sure to tune into our YouTube Channel for the NCLEX Question of the Week. More NCLEX Weekly Practice Questions. To solve ABGs problems, I like to use the Tic Tac Toe method. If you are not familiar with this method, please watch my video on how to solve arterial blood gas problems with this method. The Tic Tac Toe method makes solving ABG problems so EASY. However, if the ABG values are partially or fully compensated you must take it a step further by analyzing the values further with this method, which is the purpose of this review. My goal is to show you how to use the Tic Tac Toe method for partially and fully compensated interpretation. So let’s begin: NCLEX Practice Questions on Partially vs. Fully Compensated ABGs Problem 1 A patient has the following arterial blood gas results: blood pH 7.43, PaCO2 28 mmHg, and HCO3 18 mEq/L. This is known as: A. Partially compensated respiratory alkalosis B. Fully compensated metabolic acidosis C. Partially compensated respiratory acidosis D. Fully compensated respiratory alkalosis The first thing you want to do is to pull from your memory bank the normal values for arterial blood gases. Here they are: <-Acid Base-> pH: 7.35-7.45 (less than 7.35 ACID & greater than 7.45 ALKALOTIC) PaCO2: 45-35 (greater than 45 ACID & less than 35 ALKALOTIC)** HCO3: 22-26 Continue reading >>

## Acid & Alkaline Nutrition: Shattering The Myths

According to Guy Schenker, DC: Acid/alkaline imbalances always involve respiratory function Acid/alkaline imbalances always involve renal function "The respiratory and renal involvement in an acidosis or alkalosis may be either part of the cause of, or part of the compensation for the acidosis or alkalosis...The most alarming misconception among nutritionists concerned with pH balance, one seems to reign supreme in the minds of an appalling majority of doctors, is that ACIDOSIS is ubiquitous among the sick of this world. Acidosis, they have been given to believe, is an accompaniment to, and even the primary cause of, every disease, every pain, every state of ill health to afflict humankind. "Wouldn’t it be nice if it were that simple? Pump up your patients’ alkaline reserves and cure them of anything? "And an ALKALOSIS? No such thing? Acid is bad, this theory contends, and alkaline is good. And there is no way one can have too much of a good thing. "In truth excess alkalinity is just as harmful as excess acidity. To clear the confusion, all physiological systems are maintained through a negative feedback mechanism that operates in a dualistic manner. Dualistic means that for every normal condition, there are 2 abnormals-abnormally high and abnormally low. To say that there is only one abnormal with respect to pH balance is to display total ignorance of the most basic fundamentals of physiology.” -‘An Analytical System of Clinical Nutrition’, -Guy Schenker, DC, 1989-2010 Your pH balance is uniquely yours Have you had enough of the half-truths about pH balance? Michael and Julie’s metabolic expertise will sort it out for you “In a metabolic alkalosis, there are increasing levels of bicarbonate ion in relation to H+. There are 3 main causes of bicarbonate inc Continue reading >>

## Acid Base Disorders

Arterial blood gas analysis is used to determine the adequacy of oxygenation and ventilation, assess respiratory function and determine the acid–base balance. These data provide information regarding potential primary and compensatory processes that affect the body’s acid–base buffering system. Interpret the ABGs in a stepwise manner: Determine the adequacy of oxygenation (PaO2) Normal range: 80–100 mmHg (10.6–13.3 kPa) Determine pH status Normal pH range: 7.35–7.45 (H+ 35–45 nmol/L) pH <7.35: Acidosis is an abnormal process that increases the serum hydrogen ion concentration, lowers the pH and results in acidaemia. pH >7.45: Alkalosis is an abnormal process that decreases the hydrogen ion concentration and results in alkalaemia. Determine the respiratory component (PaCO2) Primary respiratory acidosis (hypoventilation) if pH <7.35 and HCO3– normal. Normal range: PaCO2 35–45 mmHg (4.7–6.0 kPa) PaCO2 >45 mmHg (> 6.0 kPa): Respiratory compensation for metabolic alkalosis if pH >7.45 and HCO3– (increased). PaCO2 <35 mmHg (4.7 kPa): Primary respiratory alkalosis (hyperventilation) if pH >7.45 and HCO3– normal. Respiratory compensation for metabolic acidosis if pH <7.35 and HCO3– (decreased). Determine the metabolic component (HCO3–) Normal HCO3– range 22–26 mmol/L HCO3 <22 mmol/L: Primary metabolic acidosis if pH <7.35. Renal compensation for respiratory alkalosis if pH >7.45. HCO3 >26 mmol/L: Primary metabolic alkalosis if pH >7.45. Renal compensation for respiratory acidosis if pH <7.35. Additional definitions Osmolar Gap Use: Screening test for detecting abnormal low MW solutes (e.g. ethanol, methanol & ethylene glycol [Reference]) An elevated osmolar gap (>10) provides indirect evidence for the presence of an abnormal solute which is prese Continue reading >>

## Acid/base (alkalosis Vs Acidosis, Metabolic Vs Respiratory)

This is the general way to approach an acid-base disturbance. They’re not really as bad as they seem at first. You just need to remember that CO2 is acidic and HCO3- is basic. So an increase in CO2 makes the body acidotic and an increase in HCO3- makes the body alkalotic. It’s also good to remember to calculate the anion gap when doing these calculations. AG = Na – (Cl- + HCO3-) it’s just the cations minus the anions. If this gap between the cations and anions is large, it means that the anions are stacking their team and have an extra anion helping out. The classic mnemonic is MUDPILES Methanol Uremia Diabetic ketoacidosis Paraldehyde Isopropyl alcohol Lactic acidosis Ethylene glycol Salicylates If the anion gap is big, it’s good to look at the ratio between the change in the gap and the change in the HCO3-. Increase in AG < decrease in HCO3- = coexisting non-anion gap metabolic acidosis Increase in AG > decrease in HCO3- = coexisting metabolic alkalosis Continue reading >>

## Acidosis

For acidosis referring to acidity of the urine, see renal tubular acidosis. "Acidemia" redirects here. It is not to be confused with Academia. Acidosis is a process causing increased acidity in the blood and other body tissues (i.e., an increased hydrogen ion concentration). If not further qualified, it usually refers to acidity of the blood plasma. The term acidemia describes the state of low blood pH, while acidosis is used to describe the processes leading to these states. Nevertheless, the terms are sometimes used interchangeably. The distinction may be relevant where a patient has factors causing both acidosis and alkalosis, wherein the relative severity of both determines whether the result is a high, low, or normal pH. Acidosis is said to occur when arterial pH falls below 7.35 (except in the fetus – see below), while its counterpart (alkalosis) occurs at a pH over 7.45. Arterial blood gas analysis and other tests are required to separate the main causes. The rate of cellular metabolic activity affects and, at the same time, is affected by the pH of the body fluids. In mammals, the normal pH of arterial blood lies between 7.35 and 7.50 depending on the species (e.g., healthy human-arterial blood pH varies between 7.35 and 7.45). Blood pH values compatible with life in mammals are limited to a pH range between 6.8 and 7.8. Changes in the pH of arterial blood (and therefore the extracellular fluid) outside this range result in irreversible cell damage.[1] Signs and symptoms General symptoms of acidosis.[2] These usually accompany symptoms of another primary defect (respiratory or metabolic). Nervous system involvement may be seen with acidosis and occurs more often with respiratory acidosis than with metabolic acidosis. Signs and symptoms that may be seen i Continue reading >>

## Disorders Of Acid-base Balance

Module 10: Fluid, Electrolyte, and Acid-Base Balance By the end of this section, you will be able to: Identify the three blood variables considered when making a diagnosis of acidosis or alkalosis Identify the source of compensation for blood pH problems of a respiratory origin Identify the source of compensation for blood pH problems of a metabolic/renal origin Normal arterial blood pH is restricted to a very narrow range of 7.35 to 7.45. A person who has a blood pH below 7.35 is considered to be in acidosis (actually, physiological acidosis, because blood is not truly acidic until its pH drops below 7), and a continuous blood pH below 7.0 can be fatal. Acidosis has several symptoms, including headache and confusion, and the individual can become lethargic and easily fatigued. A person who has a blood pH above 7.45 is considered to be in alkalosis, and a pH above 7.8 is fatal. Some symptoms of alkalosis include cognitive impairment (which can progress to unconsciousness), tingling or numbness in the extremities, muscle twitching and spasm, and nausea and vomiting. Both acidosis and alkalosis can be caused by either metabolic or respiratory disorders. As discussed earlier in this chapter, the concentration of carbonic acid in the blood is dependent on the level of CO2 in the body and the amount of CO2 gas exhaled through the lungs. Thus, the respiratory contribution to acid-base balance is usually discussed in terms of CO2 (rather than of carbonic acid). Remember that a molecule of carbonic acid is lost for every molecule of CO2 exhaled, and a molecule of carbonic acid is formed for every molecule of CO2 retained. Figure 1. Symptoms of acidosis affect several organ systems. Both acidosis and alkalosis can be diagnosed using a blood test. Metabolic Acidosis: Primary Bic Continue reading >>

## Types Of Disturbances

The different types of acid-base disturbances are differentiated based on: Origin: Respiratory or metabolic Primary or secondary (compensatory) Uncomplicated or mixed: A simple or uncomplicated disturbance is a single or primary acid-base disturbance with or without compensation. A mixed disturbance is more than one primary disturbance (not a primary with an expected compensatory response). Acid-base disturbances have profound effects on the body. Acidemia results in arrythmias, decreased cardiac output, depression, and bone demineralization. Alkalemia results in tetany and convulsions, weakness, polydipsia and polyuria. Thus, the body will immediately respond to changes in pH or H+, which must be kept within strict defined limits. As soon as there is a metabolic or respiratory acid-base disturbance, body buffers immediately soak up the proton (in acidosis) or release protons (alkalosis) to offset the changes in H+ (i.e. the body compensates for the changes in H+). This is very effective so minimal changes in pH occur if the body is keeping up or the acid-base abnormality is mild. However, once buffers are overwhelmed, the pH will change and kick in stronger responses. Remember that the goal of the body is to keep hydrogen (which dictates pH) within strict defined limits. The kidney and lungs are the main organs responsible for maintaining normal acid-base balance. The lungs compensate for a primary metabolic condition and will correct for a primary respiratory disturbance if the disease or condition causing the disturbance is resolved. The kidney is responsible for compensating for a primary respiratory disturbance or correcting for a primary metabolic disturbance. Thus, normal renal function is essential for the body to be able to adequately neutralize acid-base abnor Continue reading >>

## Acidosis Vs. Alkalosis

In this lesson, we're going to learn about acidosis and alkalosis. We'll take a look at the causes, signs, and symptoms that are associated with each condition. Balanced Blood We are constantly having to find balance in our lives. From balancing work and play time to saving and spending money, sleep and awake time. Well, ideally at least. We do this because we know that we function best when we're balanced. There are many similar balances that are going on inside of our bodies. An important balance that must be maintained to allow us to function properly is the balance between acids and bases in our bodies. When these are balanced, the acids pair up with the bases, and our blood is close to neutral. If too much acid is in the blood, then we experience acidosis. If too much base is in the blood, we experience alkalosis. Acidosis and alkalosis are caused by different conditions in our bodies, and they can cause different problems to occur. Acidosis Acidosis results from the build-up of acids in the blood or from the loss of base in the blood. Acids are put into our bloodstream through two systems in the body: the digestive system and the respiratory system. Acidosis that occurs from the digestive system is referred to as metabolic acidosis. In this instance, acids accumulate in the blood due to consumption of acidic foods or foods that are broken down into acids, excess acids being produced during metabolism, kidneys not properly removing acid from the bloodstream during filtration, or production of acid by the body due to other medical conditions, such as diabetes. The other possible way to develop acidosis is by the malfunctioning of the respiratory system, which we refer to as respiratory acidosis. This can happen if breathing is extremely slow or shallow, the lungs do Continue reading >>

## Acidosis/alkalosis:

Bases: Have a higher affinity for protons than water and easily acquire protons in aqueous solution. charged (+1) when protonated (Acids uncharged) uncharged when de-protonated (Acids -1 charge) Most common biological weak base is the amino group, -NH2 Despite the differences between acids and bases the pKa concept can be used to quantitate the relative strength of amino groups. Notice: pKa values for carboxylic acid are less than < 7, pka values for amino groups are >7 (usually 9-11) i.e. a simple biologically important 10 amine, ethanolamine, pKa = 9.5 or choline, a quaternary (40) amine, pKa = 13.9 Choline is a good compound for systems in which a permanent positive charge is desirable, i.e. membranes (hydrophilic head groups) Phosphatidylcholine (lecithin) a key amphiphilic compound in biological membranes Buffering: At or near their pKa both weak acids and weak bases will resist changes in pH, thus acting as buffers Buffering is very important in biological systems, for rapid pH changes have disastrous consequences. The buffering capacity of ethanolamine and acetic acid occur well outside of the pH range normally seen in human blood (pH 7.35-7.45). Thus, other ionizable compounds must serve this function in biological fluids. The most important single buffer in human is the bicarbonate ion -CO2 is added to the system at varying rates by metabolic processes -rate of formation of H2CO3 from CO2 and H2O is slow, so is enhanced by the enzyme, carbonic anhydrase, found in red blood cells (RBC) -CO2 is expired by the lungs at varying rates (respiration) -levels of HCO3- can be adjusted by the kidney via excretion CO2Production: -normally balanced by CO2 expired from the lungs However, certain medical conditions can throw the equation out of balance... Respiratory Acidosi Continue reading >>

## Simple Method Of Acid Base Balance Interpretation

A FOUR STEP METHOD FOR INTERPRETATION OF ABGS Usefulness This method is simple, easy and can be used for the majority of ABGs. It only addresses acid-base balance and considers just 3 values. pH, PaCO2 HCO3- Step 1. Use pH to determine Acidosis or Alkalosis. ph < 7.35 7.35-7.45 > 7.45 Acidosis Normal or Compensated Alkalosis Step 2. Use PaCO2 to determine respiratory effect. PaCO2 < 35 35 -45 > 45 Tends toward alkalosis Causes high pH Neutralizes low pH Normal or Compensated Tends toward acidosis Causes low pH Neutralizes high pH Step 3. Assume metabolic cause when respiratory is ruled out. You'll be right most of the time if you remember this simple table: High pH Low pH Alkalosis Acidosis High PaCO2 Low PaCO2 High PaCO2 Low PaCO2 Metabolic Respiratory Respiratory Metabolic If PaCO2 is abnormal and pH is normal, it indicates compensation. pH > 7.4 would be a compensated alkalosis. pH < 7.4 would be a compensated acidosis. These steps will make more sense if we apply them to actual ABG values. Click here to interpret some ABG values using these steps. You may want to refer back to these steps (click on "linked" steps or use "BACK" button on your browser) or print out this page for reference. Step 4. Use HC03 to verify metabolic effect Normal HCO3- is 22-26 Please note: Remember, the first three steps apply to the majority of cases, but do not take into account: the possibility of complete compensation, but those cases are usually less serious, and instances of combined respiratory and metabolic imbalance, but those cases are pretty rare. "Combined" disturbance means HCO3- alters the pH in the same direction as the PaCO2. High PaCO2 and low HCO3- (acidosis) or Low PaCO2 and high HCO3- (alkalosis). Continue reading >>

## Alkalosis

The kidneys and lungs maintain the proper balance (proper pH level) of chemicals called acids and bases in the body. Decreased carbon dioxide (an acid) level or increased bicarbonate (a base) level makes the body too alkaline, a condition called alkalosis. There are different types of alkalosis. These are described below. Respiratory alkalosis is caused by a low carbon dioxide level in the blood. This can be due to: Fever Being at a high altitude Lack of oxygen Liver disease Metabolic alkalosis is caused by too much bicarbonate in the blood. It can also occur due to certain kidney diseases. Hypochloremic alkalosis is caused by an extreme lack or loss of chloride, such as from prolonged vomiting. Hypokalemic alkalosis is caused by the kidneys' response to an extreme lack or loss of potassium. This can occur from taking certain water pills (diuretics). Compensated alkalosis occurs when the body returns the acid-base balance to normal in cases of alkalosis, but bicarbonate and carbon dioxide levels remain abnormal. Continue reading >>

## Acidosis And Alkalosis | Harrison's Principles Of Internal Medicine, 19e | Accessmedicine | Mcgraw-hill Medical

Systemic arterial pH is maintained between 7.35 and 7.45 by extracellular and intracellular chemical buffering together with respiratory and renal regulatory mechanisms. The control of arterial CO2 tension (Paco2) by the central nervous system (CNS) and respiratory system and the control of plasma bicarbonate by the kidneys stabilize the arterial pH by excretion or retention of acid or alkali. The metabolic and respiratory components that regulate systemic pH are described by the Henderson-Hasselbalch equation: Under most circumstances, CO2 production and excretion are matched, and the usual steady-state Paco2 is maintained at 40 mmHg. Underexcretion of CO2 produces hypercapnia, and overexcretion causes hypocapnia. Nevertheless, production and excretion are again matched at a new steady-state Paco2. Therefore, the Paco2 is regulated primarily by neural respiratory factors and is not subject to regulation by the rate of CO2 production. Hypercapnia is usually the result of hypoventilation rather than of increased CO2 production. Increases or decreases in Paco2 represent derangements of neural respiratory control or are due to compensatory changes in response to a primary alteration in the plasma [HCO3]. DIAGNOSIS OF GENERAL TYPES OF DISTURBANCES The most common clinical disturbances are simple acid-base disorders; i.e., metabolic acidosis or alkalosis or respiratory acidosis or alkalosis. Primary respiratory disturbances (primary changes in Paco2) invoke compensatory metabolic responses (secondary changes in [HCO3]), and primary metabolic disturbances elicit predictable compensatory respiratory responses (secondary changes in Paco2). Physiologic compensation can be predicted from the relationships displayed in Table 66-1 . In general, with one exception, compensatory res Continue reading >>

## Acid-base Disorders - Endocrine And Metabolic Disorders - Merck Manuals Professional Edition

(Video) Overview of Acid-Base Maps and Compensatory Mechanisms By James L. Lewis, III, MD, Attending Physician, Brookwood Baptist Health and Saint Vincents Ascension Health, Birmingham Acid-base disorders are pathologic changes in carbon dioxide partial pressure (Pco2) or serum bicarbonate (HCO3) that typically produce abnormal arterial pH values. Acidosis refers to physiologic processes that cause acid accumulation or alkali loss. Alkalosis refers to physiologic processes that cause alkali accumulation or acid loss. Actual changes in pH depend on the degree of physiologic compensation and whether multiple processes are present. Primary acid-base disturbances are defined as metabolic or respiratory based on clinical context and whether the primary change in pH is due to an alteration in serum HCO3 or in Pco2. Metabolic acidosis is serum HCO3< 24 mEq/L. Causes are Metabolic alkalosis is serum HCO3> 24 mEq/L. Causes are Respiratory acidosis is Pco2> 40 mm Hg (hypercapnia). Cause is Decrease in minute ventilation (hypoventilation) Respiratory alkalosis is Pco2< 40 mm Hg (hypocapnia). Cause is Increase in minute ventilation (hyperventilation) Compensatory mechanisms begin to correct the pH (see Table: Primary Changes and Compensations in Simple Acid-Base Disorders ) whenever an acid-base disorder is present. Compensation cannot return pH completely to normal and never overshoots. A simple acid-base disorder is a single acid-base disturbance with its accompanying compensatory response. Mixed acid-base disorders comprise 2 primary disturbances. Compensatory mechanisms for acid-base disturbances cannot return pH completely to normal and never overshoot. Primary Changes and Compensations in Simple Acid-Base Disorders 1.2 mm Hg decrease in Pco2 for every 1 mmol/L decrease in HC Continue reading >>