acidious vs alkalosis (forgive the spelling) - page 2
can someone please put this all in basic terminology?? 3 years into the program acidious and alkalosis still confuses me. what is the deal???? instead of a profession definition i would like... Read More
Jul 31, '03Joined: Jul '02; Posts: 5Think of the acronym ROME.
ROME (RO / ME)
Respiratory Opposite / Metabolic Equal
respiratory acidosis (pH down) (PCO2 up) opposite
respiratory alkalosis (pH up) (PCO2 down) opposite
RO = respiratory opposite , directions of pH and gas
metabolic acidosis (pH down) (HCO3 down) equal
metabolic alkalosis (pH up) (HCO3 up) equal
ME = metabolic equal , directions of pH and gasLast edit by route six six on Jul 31, '03
Aug 1, '03Occupation: ACNP, RN, Paramedic Specialty: 30 year(s) of experience in Emergency Nursing Advanced Practice ; From: US ; Joined: Mar '03; Posts: 257; Likes: 58Originally posted by KarafromPhilly
pH describes the hydrogen ion concentration, right? Therefore a lower hydrogen ion concentration equals a lower pH, and the patient is said to be acidotic. .
Nope, wrong. Try again!
ph = -log[H+] (Ph is equal to the negative log of the hydrogen ion concentration). So the more hydrogen ions you have (more acid) the lower the pH(more acidic)
Aug 1, '03Joined: Jul '03; Posts: 231; Likes: 2Easy way to remember the norms:
pCO2= 35-45 (same as last 2 numbers of pH)
HCO3= 22-26 (the age you wish you were)
Last edit by glascow on Aug 1, '03
Aug 1, '03Occupation: Student, LPN Joined: Apr '03; Posts: 150; Likes: 2One thing that helped me...
Acidosis - "pH is slidin on Down....."
Alkalosis - "KicKin the ph up"
may be dumb to someone else, but it got me started.. lol
Aug 25, '05Joined: Aug '05; Posts: 3[QUOTE=MRed94]With this, our teacher gave us a tic tac toe board, and had us use it always to determine what kind of problem it was, and then to determine if it is fully, partially, or not compensated.
I have heard about this tic tac toe board for ABG's and would like to learn more about it. I can't visualize how it works with the information that you provided. Is there any way you would be able to send me the infor via postal mail. I would pay for postage. Please let me know. Thank you
Jan 29, '07Occupation: Med/Surg Specialty: 8 year(s) of experience in ER, Med/Surg ; From: US ; Joined: Aug '06; Posts: 481; Likes: 517Is this similar to your "tictactoe" board?
Maybe this will help others.
I'm just starting to get an understanding of it too.
Jan 29, '07Joined: Dec '05; Posts: 860; Likes: 105Quote from KarafromPhillyOK, along these lines I have a dumb question. I understand the whole respiratory/metabolic acidosis/alkalosis phenomenon, but here's my question: pH describes the hydrogen ion concentration, right? Therefore a lower hydrogen ion concentration equals a lower pH, and the patient is said to be acidotic. But...how do we move from hydrogen ion concentration to O2 and CO2? Is something being displaced, or what? I'm sure this has been addressed somewhere in the reading I've done, but I went right past it. Can anybody help me out? Thanks.
From this dummy..forget about hydrogen ions just focus on co2 and o2..hydrogen ions are not listed on the abg.
Jan 29, '07Occupation: Emergency Department Specialty: ER/Ortho-Neuro-Med-Surg ; From: US ; Joined: Sep '04; Posts: 11,171; Likes: 3,262From an older thread:
Jan 30, '07Joined: Dec '05; Posts: 1,375; Likes: 248Thanks everyone for trying to simplify what is a nightmare for me. I will be copying and pasting the info to study in hopes that one day it will click like the crebs cycle did.
Jan 31, '07Occupation: ER Nurse - Pedi and Adult Specialty: 6 year(s) of experience in Tele, ICU, ER ; From: US ; Joined: Aug '06; Posts: 502; Likes: 95Gads explaining it bites LOL. Helps to get into it a little, believe it or not.
Acidosis refers to an excess of H+ ions running around in your blood in comparison to HCO3 (bicarb). Usually, you have about 20 bicarb bits to every one H+ (acid) bit. Picture them actually floating around in the blood stream LOL. If that balance is thrown off, you get an acid (H+)-base (bicarb) inbalance.
In the normal course of things, your kidney makes bicarb and your lungs expell CO2 (consider that the acid ok?). Each does this in such a way that the ratio is maintained at 20:1. Everything is happy.
Now, if your patient is hyperventillating (huff puff huff puff), they are blowing off that acid, right? They're blowing off TOO much acid, so the ratio is now maybe 40:1 (only ONE H+ [acid] for 40 bicarbs). That's bad. Now your blood has too much bicarb (base) in it, doesn't it? You are alkalotic and it will show as an pH higher than 7.45. Because it's your lungs' fault (huff puff), it's respiratory alkalosis. Your body doesn't like this state of affairs so it says "hey kidneys, fix this!" (since the lungs can't, obviously). Your kidneys respond by providing more Bicarb in order to restore that 20:1 ratio. They're compensating. Look at the numbers now.
pH: 7.5 (alkalosis)
CO2: 30 (too low - not enough H+ running around - your lungs blew it out (huff puff)
HCO3: 24 (this is a normal value - your kidneys don't know there's a problem yet!)
What is it? Uncompensated respiratory alkalosis.
Incidently, there are other compensatory mechanisms in your body - I'm being VERY VERY basic here.
Try another one: Your patient is a COPD'er. He has trouble exhaling all the air from his lungs with each breath. Therefore, he's NOT blowing off as much acid (H+) as he should be. He has lots of extra H+ floating around in his blood. His ratio is maybe 20:5. All that extra H+ (because he's not exhaling all the way) makes him acidotic. It's respiratory acidosis because the fault is in the lungs:
pH: 7.25 (acidotic)
CO2: 60 (lots of extra H+ floating around in the blood)
HCO3: 25 (normal - the kidney havn't caught on yet)
What is it? Respiratory acidosis
I think of it this way. Look at your pH and decide if it's acidosis (too low) or alkalosis (too high)
Then look at both CO2 and HCO3. Which value will give you the same label as your pH? Example:
pH: 7.55 - alkalosis
CO2: 36 - normal, looks like the lungs didn't do it (if CO2 was high, you'd "label" the value acidosis, if low, you'd call it alkalosis)
HCO3: 32 - oops this is high! Kidney's fault! (a high HCO3 will give you the "label" of alkalosis [too many HCO3's compared to H+'s] and a low HCO3 will be labeled acidosis.
"Label" each value (pH, HCO3 and CO2) with either acidosis or alkalosis. Whatever matches the pH label is your culprit.
Note: if the pH is normal but your CO2 and HCO3 are both off, someone's compensating. Whoever is MOST off is usualy your culprit (lungs or kidneys). Btw - your body will only compensate to get your pH INTO normal range, just barely. Normal is 7.35 to 7.45, so when pH is in the normal range but it's compensated, use 7.4 as your "center", if pH is below that, the problem is acidosis, and if above, it's alkalosis.
pH: 7.35 (normal) but on the acidotic side of 7.4
CO2: 55 (high)
HCO3: 29 (high but not AS MUCH higher than normal as the CO2)
What is it? Compensated respiratory acidosis
Yikes - hope this made ANY sense at all. Anyone, feel free to correct!Last edit by EmerNurse on Jan 31, '07
Jan 31, '07Joined: Dec '05; Posts: 1,375; Likes: 248EmerNurse- THANK YOU FOR MAKING IT MAKE SENSE!!! I wish I had that explanation months ago! I actually get it and can remember that!