Acidosis Vs Alkalosis Signs and Symptoms

SopranoKris, MSN, RN, NP · Mar 30, 2017

Think about what is occurring physiologically in the body during each: acidosis is an abundance of H+. What is that going to do to the body? If it's respiratory acidosis, what is the body going to do naturally to correct it? (Hint: think too much CO2). If it's metabolic acidosis, elevated K+ can lead to seizures, coma or can even be fatal, for example diabetic ketoacidosis. The body has gained too much acid or lost too much base (e.g. diarrhea)

If it's alkalosis, the body has lost too much acid or gained too much base (e.g. vomiting). Having too little K+ can cause cramping, weakness, etc.

What other effects can you think of?

EmxoRenee · Mar 30, 2017

Thanks for your response!

This is what I've been trying to do. I try to think about why the imbalance has happened, and what is causing it to help me determine signs and symptoms. I think where I get confused is because the body then tries to compensate through whichever system is not causing the imbalance.

For example, with respiratory alkalosis. I know it can be caused by hyperventilation. But then my thought process is that the body would try to hypoventilate to hold onto some CO2 to gain acid and bring the ph back into balance. But I'm not sure if this is actually correct or not.

I dont know if i just overthink it, or if I'm getting the different signs and symptoms mixed up. This topic just overwhelms me a bit!

Thanks so much for your help! â˜º

Esme12, ASN, BSN, RN · Mar 30, 2017

Normal values:

PH = 7.35 - 7.45

C02 = 35 - 45

HC03 = 21-26

Respiratory acidosis = low ph and high C02

hypoventilation (eg: COPD, narcs or sedatives, atelectasis)

*Compensated by metabolic alkalosis (increased HC03)

For example:

ph 7.20 C02 60 HC03 24 (uncompensated respiratory acidosis)

ph 7.33 C02 55 HC03 29 (partially compensated respiratory acidosis)

ph 7.37 C02 60 HC03 37 (compensated respiratory acidosis)

Respiratory alkalosis : high ph and low C02

hyperventilation (eg: anxiety, PE, pain, sepsis, brain injury)

*Compensated by metabolic acidosis (decreased HC03)

examples:

ph 7.51 C02 26 HC03 25 (uncompensated respiratory alkalosis)

ph 7.47 C02 32 HC03 20 (partially compensated respiratory alkalosis)

ph 7.43 C02 30 HC03 19 (compensated respiratory alkalosis)

Metabolic acidosis : low ph and low HC03

diabetic ketoacidosis, starvation, severe diarrhea

*Compensated by respiratory alkalosis (decreased C02)

examples:

ph 7.23 C02 36 HC03 14 (uncompensated metabolic acidosis)

ph 7.31 C02 30 HC03 17 (partially compensated metabolic acidosis)

ph 7.38 C02 26 HC03 20 (compensated metabolic acidosis)

Metabloic alkalosis = high ph and high HC03

severe vomiting, potassium deficit, diuretics

*Compensated by respiratory acidosis (increased C02)

example:

ph 7.54 C02 44 HC03 29 (uncompensated metabolic alkalosis)

ph 7.50 C02 49 HC03 32 (partially compensated metabolic alkalosis)

ph 7.44 C02 52 HC02 35 (compensated metabolic alkalosis)

*Remember that compensation corrects the ph.

Now a simple way to remember this......

CO2 = acid, makes things acidic

HCO3 = base, makes things alkalotic

Remember ROME

R-Respiratory

O-Opposite

M-Metabolic

E-Equal

Ok always look at the pH first...

pH

pH>7.45 = alkalosis

Then, if the CO2 is high or low, then it is respiratory...If the HCO3 is high or low then it is metabolic. How you remember that is that the respiratory system is involved with CO2 (blowing air off or slowing RR), and the kidneys (metabolic) are involved with HCO3 (excreting or not excreting).

Here is how you think thru it: pH = 7.25 CO2 = 40 HCO3 = 17

Ok, first, the pH is low so think acidosis. CO2 is WNL. HCO3 is low. Draw arrows if it helps. The abnormal values are both low (think Equal). Metabolic imbalances are equal. So, this must be metabolic acidosis!

Now, for compensation...If you have a metabolic imbalance, the respiratory system is going to try to compensate. Respiratory = CO2. If the CO2 is normal in the ABG, then there is no compensation going on. Compensation in acidosis will decrease the CO2 because you want to get rid of the acid (CO2). In alkalosis, it will increase because you want to add more acid (CO2)

If you have a respiratory imbalance, the kidneys will try to compensate. Kidneys = HCO3. If the HCO3 is normal in the ABG, then there is no compensation going on. Compensation in acidosis will increase HCO3 because you want to hold on to the base to make it more alkalotic. In alkalosis, it will decrease because you want to excrete the base to make it more acidic.

Esme12, ASN, BSN, RN · Mar 30, 2017

Check out this Interactive Online Continuing Education for Nurse Professionals

RNCocoL · Apr 1, 2017

You are awesome. I am not in nursing school yet but my a&p prof briefly discussed this topic and I was so confused. I will be saving this information. Thanks again!