Kidneys acid-base imbalances

In the renal buffering process, sodium (Na+) is exchanged for hydrogen ions (H+) and binds with some of the bicarbonate (NaHCOj), which later breaks down again as Na" is actively removed through a Na - K+ mechanism (discussed in more detail in Chapter 5). The H" ions are bound with carbonic anhydrase on the border of the proximal tubules of the kidneys, which convert the H first to H COj and then to H O and CO. Some H+ ions also bind with the ammonia (NHj) produced in the kidneys as a result of amino acid catabolism and an abundant anion found in the glomerular filtrate, chloride (CT), to form ammonium chloride (NH Cl), a weak acid that is excreted in the urine. Thus it is clear that other electrolytes are involved in the acid-base balancing process and can be affected by acid-base imbalances. These impacts will be discussed with each electrolyte. 6... 

Symptoms of hypokalemia may indicate the need for a urinalysis and blood tests to determine the amount of potassium being excreted by the kidneys and related electrolyte and acid-base imbalances. 

Newborns have less developed function of some organs at birth, with premature infants being at greatest risk for demonstrating diminished organ function. The most common organ function that is not fully developed is that of the kidneys. Additionally, the respiratory function of premature infants may be diminished, as well as the function of the liver. The complications associated with diminished organ function can result in a number of fluid, electrolyte, and acid-base imbalances. The nurse should be alert for these imbalances. /Tn... 

In all cases of acid-base imbalance, three basic rules should be followed (1) rely on a medical doctor for diagnosis and prescribed treatment, (2) treat the primary cause of the acidosis or alkalosis, and (3) make every effort to aid the various compensatory responses of the lungs and kidneys. 

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