Acid-Base Imbalance Chart

Respiratory Acidosis Metabolic Acidosis Respiratory Alkalosis Metabolic Alkalosis
Causes Depression of the respiratory center (brainstem trauma, over-sedation), respiratory muscle paralysis, disorders of the chest wall, disorders of the lung parenchyma, hypoventilation Lactic acidosis, renal failure, diabetic ketoacidosis, diarrhea High altitudes, hypermetabolic states such as fever, anemia and thyrotoxicosis, early salicylate intoxication, anxiety or panic disorder, improper use of mechanical ventilations Prolonged vomiting, gastric suctioning, excessive HCO3- intake, hyperaldosteronism with hypokalemia, diuretic therapy
pH < 7.35 < 7.35 > 7.45 > 7.45
CO2 Hypercapnia   Hypocapnia, CO2 < 38mmHg  
HCO3-   HCO3- < 24 mEq/L   HCO3- > 26 mEq/L
Compensation Not as effective since kidneys take time, but conserve bicarbonate and eliminate H+ Hyperventilation and renal excretion of excess acids Kidneys decrease H+ excretion and HCO3- absorption Hypoventilation, kidneys conserve H+ and eliminate HCO3-
Manifestations Headache, restlessness, blurred vision, apprehension, lethargy, muscle twitching, tremors, convulsions, coma Headache, lethargy, Kussmaul respirations Dizziness, confusion, tingling extremities, convulsions, coma with sigs of hypocalcemia Weakness, muscle cramps, hyperactive reflexes, hypocalcemia
Treatment Restore adequate ventilation, mechanical ventilation may be required, IV lactate HCO3-, lactate (converted to HCO3- in the liver), treat underlying causes Paper bag, treat hypoxemia and hypermetabolic states NaCl, K+, Chloride IV (Cl replaces HCO3-)

Source: Medical-Surgical Nursing : Assessment and Management of Clinical Problems, 10th Ed (Lewis)💎


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