Abnormalities in Acid Base Balance

Disturbances in acid-base balance are classified as either 'acidosis,' indicating an excess of H+ ions in the blood (reduced pH) or alkalosis, indicating the opposite. In practice, acidosis is the more common, varied, and serious problem. Disturbances in acid-base balance are usually labeled according to their origin. For example, respiratory acidosis reflects a primary problem in gas exchange with impaired excretion of CO2, whereas metabolic acidosis reflects the over-production of fixed acid or loss of bicarbonate. Compensation refers to the body's ability to offset the primary problem. Thus, the response to a primary metabolic acidosis is to increase the excretion of CO2 - respiratory compensation. If the pH returns to normal the problem is said to be 'fully compensated' whereas most disturbances tend to be only partially compensated (Table 3).

Table 3 Changes in blood and ECF during acid-base disturbance, the mechanism and degree of compensation

Problem

H]

[HCO3-]

PCo2 Compensation

Metabolic

Acidosis

Î

1°#

2°#

Partial respiratory

Alkalosis

#

1°Î

2°"

Partial respiratory

Respiratory

Acidosis

Î

1°Î

Complete renal

Alkalosis

#

2°#

1°#

Complete renal

Î, Increase;

#, decrease

; 1°, primary;

2°,

secondary.

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