Acid Base Balance Nursing Consideration & Management Tips

Understanding acid-base balance is critical to good health and fundamental to several biological processes. Though acids and bases are typically considered two opposing entities, they work in unison as part of the body’s internal chemistry. If these levels become imbalanced, it can cause serious harm to the delicate systems that govern all other operations within our bodies.

Fortunately, we can maintain healthy lifestyles without sacrificing physical or mental well-being by understanding what causes acidity/alkalinity and where to find treatments for related conditions.

In this blog post, we will explain acidity/alkalinity in detail and then look at how experts think about it before finishing up with some tips on maintaining an optimal level — it’s time you start taking your pH seriously.

Fundamentals of Acidity/Alkalinity


Acidity is measured on a scale of 0-14 called the pH scale, with 7 being neutral and any number lower than 7 being acidic. When something is sour, more hydrogen ions (H+) are present than hydroxyl ions (OH-).


Alkalinity is the opposite of acidity and is measured on the same pH scale. When something is alkaline, it means more hydroxyl ions (OH-) are present than hydrogen ions (H+).

The body needs to maintain an optimal balance between acidity and alkalinity to function normally — this is known as acid-base balance. An imbalance in either direction can cause various symptoms, such as fatigue, nausea, dizziness, and headaches.

Experts suggest that the optimal pH for our bodies is slightly alkaline — between 7.35-7.45 — although this may vary depending on individual physiology and lifestyle choices. Keeping your body in this range can help ensure critical biological processes run at peak efficiency.

Nurses Need To Know Arterial Blood Gases

Blood collected from an artery, rather than a vein, is used to measure arterial blood gases (ABG). The most common site for collection is the radial artery. ABGs provide:

  • Information about the pH level of the blood.
  • The partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) in the arteries.
  • Bicarbonate concentration (HCO3).
  • Oxygen saturation (SaO2).


The pH value of blood reflects the balance between acidity and alkalinity. A normal arterial blood pH falls between 7.35 and 7.45 — this is slightly more alkaline than neutral, with a pH of 7.0. If the pH drops below 7.35, this indicates that there is too much acid in the body (acidosis). If the pH rises above 7.45, this suggests that there is too much alkalinity in the body (alkalosis).

PaO2 & PaCO2

Oxygen and carbon dioxide in our blood will also affect the acidity/alkalinity balance. Oxygen (PaO2) helps to remove acid from the body, while carbon dioxide (PaCO2) creates acids when it dissociates into bicarbonate, hydrogen ions, and carbonic acid. When either of these values is off-balance, it can cause a shift towards one side or another on the pH scale.


Bicarbonate concentration (HCO3) is essential for maintaining acid-base balance in the body. It does this by buffering acids and alkalis — that is, it helps to keep them in a stable form so that they don’t drastically affect the pH of the blood.


The percentage of oxygen saturation (SaO2) in arterial blood reflects how efficiently oxygen is delivered throughout the body. This measurement can determine if there is an underlying cause for an acid-base imbalance, such as poor circulation or respiratory issues.

How does the body manage and maintain pH levels?

Arterial blood gas (ABG) tests measure the pH, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), bicarbonate level (HCO3), and oxygen saturation (SaO2) in the blood that was collected from an artery.

Two types of acids must be considered when looking at pH regulation: volatile acids and fixed acids. Volatile acids can form gas in a solution, such as carbonic acid creating CO2, and leave the body via respiration; while fixed acids cannot turn to gas and must exit through the kidneys instead. Apart from this process, chemical buffers also contribute to maintaining pH balance.

The Primary Chemical Buffers in the body are:

Protein buffer systems: amino acids and proteins

Phosphate buffer system: phosphate and hydrogen ions

Bicarbonate- carbonic acid buffer system: bicarbonate, carbon dioxide, and water.

The body has several ways of regulating pH levels to ensure they remain within the optimal range, from buffers that counterbalance any changes in acidity/alkalinity to breathing techniques that expel excess volatile acids.

Nurses need to be aware of these systems to properly diagnose a patient’s condition and adequately treat it.

We won’t delve into the specifics here, but just be aware that such mechanisms exist and certain environments can lead to changes in these buffer systems. You will see acid/base regulation unfolding in your patients by observing their renal and respiratory reactions.

How the Lungs Affect pH

The lungs play a crucial role in maintaining acid-base balance by expelling volatile acids through respiration. When the body senses an increase in acidity, it will signal for increased breathing and vice versa — when there is too much alkalinity present, the body signals decreased breathing.

This “breathing reflex” helps to maintain homeostasis within the body as it quickly shifts levels of carbon dioxide (CO2) and oxygen (O2) to bring pH back into balance.

How Kidneys Sffect pH

While the lungs are responsible for adjusting levels of volatile acids via respiration, the kidneys take care of excess fixed acids by excreting them out of the body through urine. This process is known as renal acid excretion and helps balance acidity and alkalinity.

When levels of fixed acids become too high, the kidneys will signal for increased production of bicarbonate (HCO3) to neutralize them. The excess bicarbonate can then be eliminated through urine, bringing levels back into balance.

Acid Base Balance Nursing Consideration

1. Monitor laboratory values, including electrolytes and blood gases, to ensure proper acid-base balance.

2. Assess patients for signs and symptoms of acid-base imbalance, such as confusion, weakness, fatigue, nausea, and vomiting.

3. Provide education to patients on how to maintain proper pH levels in the body through diet and lifestyle changes.

4. Monitor treatments that may affect the pH balance of blood, including medications and intravenous fluids.

5. Monitor for adverse effects of treatments, such as drug-induced alkalosis or acidosis.

6. Develop strategies to prevent acid-base imbalances from occurring and provide support and advice on eating habits and lifestyle changes that may help prevent them.

7. Provide comfort measures, such as oral or rectal medications, to ease acid-base imbalance symptoms.

8. Monitor for signs of dehydration and provide fluid replacement therapy when necessary.

9. Collaborate with other healthcare providers to promptly administer appropriate treatments.

10. Provide emotional support to patients and families affected by acid-base imbalances.

11. Educate patients on the importance of regular medical check-ups and how to recognize early signs and symptoms of acid-base imbalance.

12. Develop individualized care plans for patients with chronic conditions that may affect their acid-base balance.

13. Participate in research and studies to improve diagnosis, management, and treatment of acid-base imbalances.

14. Advocate for policy changes related to access to care and treatment options for those living with acid-base imbalance conditions.

15. Stay abreast of the latest developments in acid-base balances through continuing education and other professional development opportunities.

16. Foster collaboration between patients, physicians, nurses, and other healthcare providers to ensure optimal outcomes for those affected by acid-base imbalance conditions.

17. Work with local communities to raise awareness about the importance of acid-base balance and how individuals can maintain healthy body pH levels.

18. Provide resources and support to patients and families affected by acid-base imbalances.

19. Consult with other professionals, such as nutritionists and dieticians, to develop personalized plans for managing acid-base imbalances.

20. Utilize various technologies, such as computerized pH meters, to help assess and monitor patients’ acid-base levels.

Acid Base Compensation

In some cases, if the body cannot adjust CO2 and HCO3 levels through breathing or renal excretion, it will resort to a process known as “compensation.” This is when other systems in the body attempt to compensate for an imbalance by moving acidity or alkalinity from one area to another.

For example, suppose there is too much acidity in the blood due to low bicarbonate levels (HCO3). In that case, the body may compensate by reducing the number of hydrogen ions (H+) in other body parts, such as tissues and cells.

Points to Consider About acid Base Balances

It’s important to note that acid-base balance is a dynamic process — pH, PaO2, PaCO2, HCO3, and SaO2 constantly change in response to the body’s environment. As such, nurses need to be able to interpret ABG results to identify any underlying issues and provide appropriate treatment.

What actions do you plan to take regarding this matter?

Correcting acid/base disorders is complex and tailored to the underlying cause. Let’s look at a few classic examples and how it could be treated. 

 Case 1: Respiratory Acidosis

This occurs when there is a decrease in oxygen entering the body, causing increased CO2 levels and a drop in pH. Treatment would involve helping patients improve their breathing rate with supplemental oxygen or other respiratory therapies to lower CO2 levels.

Case 2: Metabolic Alkalosis

This happens when there is an excess of bicarbonate (HCO3) in the bloodstream, which causes an increase in alkalinity and a rise in pH. Treatment for this would involve diuretics to help rid the body of excess bicarbonate, or medications such as acetazolamide can block its production.

Case 3: Respiratory Alkalosis

This occurs when there is a decrease in CO2 levels due to increased breathing, leading to an increase in alkalinity and a rise in pH. Treatment for this would involve decreasing the patient’s breathing rate with sedatives or other respiratory therapies and administering supplemental oxygen.

Case 4: Metabolic Alkalosis

This happens when there is a decrease in hydrogen ions (H+) due to vomiting or diuretics, leading to an increase in alkalinity and a rise in pH. Treatment for this would involve addressing the underlying cause, such as replacing lost electrolytes through vomiting and discontinuing any medications that may have caused it.

Tips for Maintaining Optimal pH

Now that we have discussed what causes pH levels to shift. Let’s look at maintaining an optimal balance between acidity and alkalinity.

1. Eat a balanced diet: Eating a balanced diet is one of the most critical steps in maintaining good health and keeping pH levels within an optimal range. Choose foods high in antioxidants, vitamins, minerals, and fiber but low in sugar and processed ingredients — remember to include plenty of fruits and vegetables!

2. Regular exercise: It can help increase oxygen saturation in the blood and improve circulation, ultimately leading to a more balanced pH level. Try to get at least 30 minutes of moderate activity each day, such as walking, swimming, or biking.

3. Drink plenty of water: Staying hydrated is vital for keeping your body functioning correctly; it helps flush toxins out of your system and can also help to maintain a healthy acid-base balance. Aim for 8 glasses of water per day.

4. Manage stress: Stress has been linked to many health issues, including an imbalance in pH. Try to keep stress at bay with yoga, meditation, and deep breathing exercises — they will do wonders for your physical and mental well-being.

By keeping these nursing pH management tips in mind, you can help ensure that your body functions optimally and maintains a balanced acid-base level.

Final Words

Acid base balance for nurses is essential to critical care and monitoring. It requires a keen understanding of the body’s systems and how they affect each other. With proper assessment, intervention, and treatment, nurses can help prevent or correct an acid-base imbalance before it becomes a severe issue for the patient.

Nurses can ensure they receive the best possible care by staying current on the latest developments in acid-base balance, utilizing technologies such as computerized pH meters, and working with patients to create personalized treatment plans.

Leave a Comment