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Repost from Gold Standard EMS:

When we’re talking about acid-base balance what we’re really talking about is pH. pH measures the acidity of a solution, in this case it’s blood. The scale ranges from 0-14. 0 being acidic and 14 being alkaline. The body likes to find homeostasis between 7.35 and 7.45. Movement of 0.5 in either direction is not conducive to life.

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Before we start taking corrective action, we must first define the cause of the acidosis or alkalosis so we know how to correct it. To do this, we need three measurements; pH, bicarbonate levels (HCO3), and carbon dioxide levels (CO2).

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The first thing we need to do is determine whether the patient is Acidodic or alkalotic. Given the normal range of 7.35-7.45, anything less than 7.35 is acidotic and anything greater than 7.45 is alkalotic.

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Once that has been determined, we now must figure out whether the cause is respiratory in nature or metabolic in nature. To do this, we need to figure out which set of values are within normal limits.

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Normal limits are as follows; pH - 7.35-7.45, HCO3 - 22-26mEq/L, CO2 - 35-45mmHG

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If your bicarbonate levels are NORMAL (HCO3) and your CO2 are ABNORMAL, carbon dioxide is your problem. Your respiratory system is what expels CO2 as you breathe. Therefor, your acidosis/alkalosis is respiratory in nature. To correct this, you are going to increase ventilations to either blow off the excess CO2 (acidosis) or slow down respirations to allow the low CO2 to build back up to normal limits (alkalosis).

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If your HCO3 levels are ABNORMAL and your CO2 levels are NORMAL, bicarbonate is your issue and your acidosis/alkalosis is metabolic in nature. To correct this, you are going to administer sodium bicarbonate to bring low HCO3 levels back up (acidosis) and you are simply going to keep them alive until the excessive bicarbonate is used up and brought to a normal level (alkalosis).

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