TOPIC 11

Fluid and electrolytes imbalances collaborative care and nursing management using the nursing process:
• Acid-base imbalances
• Respiratory acidosis/alkalosis
• Metabolic acidosis/alkalosis

Introduction

Acid–base imbalance is an abnormality of the human body's normal balance of acids and bases that causes the plasma pH to deviate out of the normal range (7.35 to 7.45).

Learning outcome

At the end of session, participants will be able to:

  1 Explain Acid -base imbalances

2 Explain Respiratory acidosis/alkalosis

   3   Explain Metabolic acidosis/alkalosis

 https:// youtu.be/VMxmDeduKR0

Facts and Definitions

  1.Acid-base homeostasis is necessary to maintain life.

   2.Acid base balance must be within a definite range for cellular function to occur.

   3.The acidity of a substance, determined by the hydrogen ion (H⁺) concentration; is expressed as pH.

4    Normal function of body cells depends on regulation of hydrogen ion concentration

   Hydrogen circulates throughout the body fluids in two forms

   Hydrogen circulates throughout the body fluids in two forms:

  1. The volatile H+ of carbonic acid

  2. The nonvolatile form of H+ inorganic acids (sulfuric, pyruvic, phosphoric & lactic   acid)

ACID-BASE IMBALANCES

·  Patients with a number of clinical conditions frequently develop acid-base imbalances. The nurse must always consider the possibility of acid-base imbalance in patients with serious illnesses.

·  Normally the body has three mechanisms by which it regulates acid-base balance to maintain the arterial pH between 7.35 and 7.45. These mechanisms are the buffer system, the respiratory system, and the renal system

   The buffer system is the fastest acting system and the primary regulator of  acid base balance.

  The lungs help maintain a normal pH by excreting CO₂ and water, which are by-products of cellular metabolism.

 The three renal mechanisms of acid elimination are secretion of small amounts of free hydrogen into the renal tubule, combination of H⁺ with ammonia (NH₃) to form ammonium (NH₄⁺), and excretion of weak acids.

Alterations in Acid-Base Balance

  Acid-base imbalances are classified as respiratory or metabolic. Respiratory imbalances affect carbonic acid concentrations; metabolic imbalances affect the base bicarbonate.

·  Respiratory acidosis (carbonic acid excess) occurs whenever there is hypoventilation.   Respiratory alkalosis (carbonic acid deficit) occurs whenever there is hyperventilation.

  Metabolic acidosis (base bicarbonate deficit) occurs when an acid other than carbonic acid accumulates in the body or when bicarbonate is lost from body fluids.

·   Metabolic alkalosis (base bicarbonate excess) occurs when a loss of acid (prolonged vomiting or gastric suction) or a gain in bicarbonate occurs.

·  Arterial blood gas (ABG) values provide valuable information about a patient’s acid-base status, the underlying cause of the imbalance, the body’s ability to regulate pH, and the patient’s overall oxygen status.

  In cases of acid-base imbalances, the clinical manifestations are generalized and nonspecific. The treatment is directed toward correction of the underlying cause

Acid Base Balance:

                                RATE AT WHICH                     RATE AT WHICH

                                ACIDS / BASES        =              ACIDS / BASES

                                ARE PRODUCED                      ARE EXCRETED

This balance results in a stable concentration of Hydrogen ions (H⁺) and it is

this concentration that is called pH

pH value: Normal value is 7   < 7:          Acidic

                                                     > 7:          Alkaline

                                Arterial Blood:        7.35 – 7.45

  At pH 7.35 – 7.45: 

    Cell wall /membrane integrity is maintained

      Speed of cellular enzymatic actions is maintained

                    Acid-Base Regulation through the:

                                1. Chemical buffering system

                                2. Biological buffering system

                                3. Physiological buffering system       

  THESE BUFFER SYSTEMS ABSORB OR RELEASE H⁺ IONS TO CORRECT

ACID BASE BALANCE

1. Chemical Buffering System

This system is in the ECF It is called Carbonic Acid-Bicarbonate Buffer System .This system is the first to react to pH changes in the ECF. This System reacts within seconds

cellular metabolism--CO2 is produce  ------

  As CO₂ is produced, H⁺ ions increased If CO₂ not removed by the Lungs,the following takes place

CO₂ + H₂O   ............   H₂CO₃         ........        H⁺   +      HCO₃

Carbon + Water Carbonic Acid  Hydrogen+bicarbonate      dioxide                                                                   ion

Carbonic Acid -Bicarbonate Buffer System

This is the largest buffer system in the Extracellular Fluid

PHYSIOLOGICAL BUFFERING SYSTEM

    There are 2 physiological buffering systems:    LUNGS

    KIDNEYS                                                                                              

   3.1  Lungs:    Act rapidly to an Acid-Base Imbalance (before the biological system)

 When concentration of H+ alter, the rate and depth of respiration will

    alter:Eg: 

Metabolic Acidosis     Rate of respiration is increased     More CO₂ exhaled

             <7    pH returns to 7 acidity corrected

Metabolic Alkalosis      Rate of respiration is decreased CO₂ retained

             pH returns to 7  Alkalinity corrected

3.2 Kidneys:    Kidneys take from a few hours to several days to regulate acid-base  balance

When pH <7           Kidneys reabsorb HCO₃ pH is corrected

When pH >7           Kidneys excrete HCO₃         pH is corrected

When H⁺>               Kidneys excrete H⁺ ions by:  

                                a) combining H⁺ and PO₄^3- to form Phosphoric Acid H₃PO₄

     Phosphoric acid is then excreted in the urine

                           b) Amino acid is changed to Ammonia in the renal tubules

   Ammonia combines with H to form Ammonium     Ammonium is then excreted in the urine

DISTURBANCES IN ACID BASE BALANCE

Checking Acid-Base Balance in a Client:  

  Arterial Blood Gas Analysis (ABG)

Parameters of Measurement in ABG:    1. pH

                                                                       2. PaCO₂

                                                                        3. PaO₂

                                                                       4. O₂ Saturation

                                                                        5. Base Excess

                                                                         6. HCO₃

pH:    Measures H+ concentration in the body fluids

PaCO₂      Partial pressure of CO₂ in the artery (reflects depth of pulmonary     ventilation)

                Normal value:    35-45mm Hg

   < 35-45 mm Hg      Hyperventilation has occurred

         > 45 mm Hg         Hypoventilation has occurred

PaO₂      Partial pressure of O₂ in arterial blood

                Normal value:  80-100mm Hg  

 < 60mm Hg     Lead to anaerobic metabolism >    Lactic acid production > Metabolic Acidosis                 

                 > 100mm Hg    Hypoxemia

Oxygen Saturation:      Arterial Hemoglobin saturated with O₂

                                                            Normal Value:        95% - 100%              

HCO₃:      Excreted and reabsorbed by the Kidneys to maintain Acid-Base Balance

                Principle Buffer in the ECF

                Normal Value:                        22 – 26 mEq/L

                 < than 22-26mEq/L               Metabolic Acidosis

                       > than 22-26mEq/l                Metabolic Alkalosis

TYPES OF ACID-BASE IMBALANCES:

   1. Respiratory Acidosis: Carbonic Acid Excess

  2.  Respiratory Alkalosis : Carbonic Acid Deficit

  3. Metabolic Acidosis: Bicarbonate Deficit

  4. Metabolic Alkalosis : Bicarbonate Excess

 PaCO2

•   Carbonic acid level is measured by PaCO2 value of the blood

•       partial pressure of CO2 in the arterial blood

•       normal value: 35 – 45 mm Hg

Bicarbonate ( HCO3)

•       The most abundant base in the body fluids

•       Metabolic end product of fats and carbohydrates

•       Normal serum value 22 – 26 mmHg

         ACID - BASE IMBALANCE

                Classifications

    1.     Acidosis or alkalosis

            a. Acidosis: Hydrogen ion concentration in blood   increases above normal and pH is   below 7.35

            b. Alkalosis: Hydrogen ion concentration in blood decreases below normal and   pH is above 7.45

Analysis of Arterial Blood Gases

Step1: Classify the Arterial Gas

                                Normal:  7.35 – 7.45

                                Acidosis: below 7.35

                                Alkalosis: above 7.45 

Step 2: Assess PaCO2

                           Normal: 35 – 45 mmHg

                           Respiratory Acidosis: above 45 mmHg

                            Respiratory Alkalosis: below 35 mmHg               

Step 3: Assess HCO3

                                Normal: 22 –26 mEq/L

                                Metabolic Acidosis: below 22 mEq/L

                                Metabolic Alkalosis: above 26 mEq/L

 

Step 4 : classify degree of compensation

                                 pH is normal: fully compensated

                                  pH is not normal: partially   compensated

Respiratory acidosis

Respiratory acidosis is a condition that occurs when your lungs can’t remove all of the carbon dioxide produced by your body. This causes the blood and other body fluids to become too acidic.

•       pH < 7.35

•       pCO₂ > 45 mm Hg (excess carbon dioxide in the blood)

•       Respiratory system impaired and retaining CO₂ causing acidosis

Causes of respiratory acidosis

·         Airway diseases, such as asthma and COPD

·         Lung tissue diseases, such as pulmonary fibrosis, which causes scarring and thickening of the lungs

·         Diseases that can affect the chest, such as scoliosis

·         Diseases that affect the nerves and muscles that signal the lungs to inflate or deflate

·         Medicines that suppress breathing, including narcotics (opioids), and "downers," such as benzodiazepines, often when combined with each other or alcohol

·         Severe obesity, which restricts how much the lungs can expand

·         Obstructive sleep apnea

·         Chest deformities, such as kyphosis ,

·          Chest injuries, Chest muscle weakness, Long-term (chronic) lung disease

·         Neuromuscular disorders, such as myasthenia gravis, muscular dystrophy

• Overuse of sedative drugs, causing decreased respiration

a Acute respiratory failure from airway obstruction

  b. Over-sedation from anesthesia or narcotics

    c. Some neuromuscular diseases that affect ability to use chest muscles

   d. Chronic respiratory problems, such as Chronic Obstructive Lung Disease

Signs and Symptoms of respiratory acidosis

a.  Compensation s/s: kidneys respond by   generating and reabsorbing bicarbonate ions,

      so HCO₃ >26 mm Hg

 b. Respiratory: hypoventilation, slow or shallow respirations

 c. Neuro: headache, blurred vision, irritability, confusion – cerebral vessels dilate

 d. Respiratory collapse leads to unconsciousness              and cardiovascular collapse

 e Confusion, Fatigue, Lethargy, Shortness of breath, Sleepiness

 Management respiratory acidosis

Therapeutic measures that may be lifesaving in severe hypercapnia and respiratory acidosis include endotracheal intubation with mechanical ventilation and noninvasive positive pressure ventilation (NIPPV) techniques such as nasal continuous positive-pressure ventilation (NCPAP) and nasal bilevel ventilation.

Early recognition of respiratory status and treat cause

   B.      Restore ventilation and gas exchange

                                -CPR for respiratory failure with oxygen

                                 supplementation

                                -intubation and ventilator support if indicated

   C.   Treatment of respiratory infections 

                                 -bronchodilators; antibiotic therapy

   D.  Reverse excess anesthetics and narcotics

                                 - naloxone (Narcan)

     E Continue respiratory assessments- monitor arterial blood gas (ABG) results

   Chronic respiratory conditions:

    Breathe in response to low oxygen    levels –

Adjusted to high carbon dioxide level   through metabolic compensation (therefore, high CO₂ would not trigger breathing)

-Treat with no higher than 2 liters O₂ per cannula (carbon dioxide narcosis)

Drug treats respiratory acidosis

Respiratory Acidosis Medication: Beta2 Agonists, Anticholinergics, Respiratory, Xanthine Derivatives, Corticosteroids, Benzodiazepine Toxicity Antidotes, Opioid Antagonist

Interpret these ABG results

pH - 7.25 - acidic

PaCO2 – 50mmHg - acidic

HCO3 – 22 mEq/L – normal

- Respiratory acidosis, uncompensated

pH - 7.37 - normal

PaCO2 - 60 mmHg- acidic

HCO3 - 38 mEq/L - alkaline

- respiratory acidosis, fully compensated with metabolic alkalosis

Acidosis https://youtu.be/-4HwKsDgf7Y

Respiratory alkalosis

Respiratory alkalosis is a condition marked by a low level of carbon dioxide in the blood due to breathing excessively

• ppH >7.45
• CO₂ < 35 mm Hg
• Carbon dioxide deficit, secondary to hyperventilation

Respiratory alkalosis may be produced as a result of the following causes:

Hyperventilation with anxiety from:

           - uncontrolled fear, pain, stress (e.g. women in labor, trauma victims)

         -High fever.    Stress^[1]

          Mechanical ventilation during anesthesia

·         Pulmonary disorder^[3]

·         Thermal insult^[6]

·         High altitude areas^[7]

·         Salicylate poisoning (aspirin overdose)^[7]

·         Hyperventilation (due to heart disorder or other, including improper mechanical ventilation)^[1][8]

·         Vocal cord paralysis (compensation for loss of vocal volume results in over-breathing/breathlessness).^[9]

·         Liver disease^[7]

·         drugs cause respiratory alkalosis

·         Iatrogenic causes of respiratory alkalosis include medications like progesterone, methylxanthines (e.g., theophylline), salicylates (also cause primary metabolic acidosis), catecholamines and nicotine as well as excessive minute ventilation provided by mechanical ventilation (especially in chronic obstructive pulmonary

• Over breathing (hyperventilation)
• Central nervous system (brain) abnormalities

The diagnosis of respiratory alkalosis is done via test that measure the oxygen and carbon dioxide levels (in the blood), chest x-ray and a pulmonary function test ,

There are two types of respiratory alkalosis: chronic and acute as a result of the 3–5 day delay in kidney compensation of the abnormality.^[13][3]

·         Acute respiratory alkalosis occurs rapidly, have a high pH because the response of the kidneys is slow.^[14]

·         Chronic respiratory alkalosis is a more long-standing condition, here one finds the kidneys have time to decrease the bicarbonate level.^[14]         

Signs and Symptoms:

Compensation: Kidneys-eliminating bicarbonate ions

                        HCO3<22mmHg

Respiratory-hyperventilating :shallow,rapid breathing

Neuro-panicked,light-headed.tremors-may develop tetany.numb hands and feet (carpopedal) r/t symptoms of hypocalcemia

(elevated pH more Ca ions are bound to serum albumin and less ionized “active” calcium available for nerve and muscle conduction)

•       seizures, loss of consciousness - due to cerebral constriction

•       Cardiac: (H+ pulled from the cells in exchange of K+ -hypokalemia)

                                - palpitations, sensation of chest tightness

                                - ECG changes

Management of Respiratory Alkalosis

        Encourage client to breathe slowly in a   paper  bag to rebreathe CO₂

      * Breathe with the patient

     * Provide emotional support and reassurance               

    * Anti-anxiety agents

     * Sedation

•       On ventilator, adjustment of ventilation settings (decrease rate and tidal volume)

•         Prevention

                                - pre-procedure teaching

                                 -  emotional support

                                 - monitor blood gases 

          

 

Metabolic Acidosis   https://youtu.be/0Er2a9-OxGc

          Deficit of bicarbonate in the blood

•       pH <7.35

•       NaHCO₃ <22 mEq/L

Causes of Metabolic Acidosis

•       Caused by an excess of acid, or loss of bicarbonate from the body

•       Acute lactic acidosis from tissue hypoxia:

        (lactic acid produced from anaerobic metabolism with shock, cardiac arrest)

•       Ketoacidosis:

   (fatty acids are released and converted to ketones when fat is used to supply glucose        needs as in uncontrolled Type 1 diabetes or starvation)

•       Acute or chronic renal failure

          (kidneys unable to regulate electrolytes)

•        Excessive bicarbonate loss (severe diarrhea, intestinal suction, bowel fistulas)

•       results from other disease and often accompanied by electrolyte and fluid imbalances

•       Hyperkalemia often occurs as hydrogen ions enter cells to lower pH and K+ enter intravascular

  Signs and Symptoms

•       Compensation s/s:

        -  increase the depth and rate of respiration (an effort to lower the CO₂ in    the blood    paCO₂ <35 mm Hg)

•       Neuro changes: (electrolytes imbalance)

                        - headache, weakness, fatigue, confusion, stupor and coma

•       Cardiac: dysrhythmias and possibly cardiac arrest from hyperkalemia

•       GI: anorexia, nausea, vomiting

·                         Hyperventilating., Shortness of breath.

·                       Fatigue., Chronic exhaustion.

           Headaches., Drowsiness. , Confusion. Dizziness

·                     Sweating, Breathlessness.

·                       Numbness and /or tingling in your fingertips, toes and lips.

·                     Irritability. , Nausea. , Muscle spasms or twitching

Nursing Diagnoses:

                a.             Decreased Cardiac Output

                b.             Risk for Excess Fluid Volume

                c.              Risk for Injury

Metabolic Acidosis   https://youtu.be/0Er2a9-OxGc

          Deficit of bicarbonate in the blood

•       pH <7.35

•       NaHCO₃ <22 mEq/L

Causes of Metabolic Acidosis

•       Caused by an excess of acid, or loss of bicarbonate from the body

•       Acute lactic acidosis from tissue hypoxia:

        (lactic acid produced from anaerobic metabolism with shock, cardiac arrest)

•       Ketoacidosis:

   (fatty acids are released and converted to ketones when fat is used to supply glucose        needs as in uncontrolled Type 1 diabetes or starvation)

•       Acute or chronic renal failure

          (kidneys unable to regulate electrolytes)

•        Excessive bicarbonate loss (severe diarrhea, intestinal suction, bowel fistulas)

•       results from other disease and often accompanied by electrolyte and fluid imbalances

•       Hyperkalemia often occurs as hydrogen ions enter cells to lower pH and K+ enter intravascular

  Signs and Symptoms

•       Compensation s/s:

        -  increase the depth and rate of respiration (an effort to lower the CO₂ in    the blood    paCO₂ <35 mm Hg)

•       Neuro changes: (electrolytes imbalance)

                        - headache, weakness, fatigue, confusion, stupor and coma

•       Cardiac: dysrhythmias and possibly cardiac arrest from hyperkalemia

•       GI: anorexia, nausea, vomiting

·                         Hyperventilating., Shortness of breath.

·                       Fatigue., Chronic exhaustion.

           Headaches., Drowsiness. , Confusion. Dizziness

·                     Sweating, Breathlessness.

·                       Numbness and /or tingling in your fingertips, toes and lips.

·                     Irritability. , Nausea. , Muscle spasms or twitching.

 

Nursing Diagnoses:

                a.             Decreased Cardiac Output

                b.             Risk for Excess Fluid Volume

                c.              Risk for Injury

Metabolic acidosis develops when too much acid is produced in the body. It can also occur when the kidneys cannot remove enough acid from the body. There are several types of metabolic acidosis:

·         Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances called ketone bodies (which are acidic) build up during uncontrolled diabetes.

·         Hyperchloremic acidosis is caused by the loss of too much sodium bicarbonate from the body, which can happen with severe diarrhea.

·         Kidney disease (uremia, distal renal tubular acidosis or proximal renal tubular acidosis).

·         Lactic acidosis.

·         Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol.

·         Severe dehydration.

Lactic acidosis is a buildup of lactic acid. Lactic acid is mainly produced in muscle cells and red blood cells. It forms when the body breaks down carbohydrates to use for energy when oxygen levels are low.

·         Cancer

·         Carbon monoxide poisoning

·         Drinking too much alcohol

·         Exercising vigorously for a very long time

·         Liver failure

·         Low blood sugar (hypoglycemia)

·         Medicines, such as salicylates, metformin, anti-retrovirals

·         MELAS (a very rare genetic mitochondrial disorder that affects energy production)

·         Prolonged lack of oxygen from shock, heart failure, or severe anaemia

·         Seizures

·         Sepsis -- severe illness due to infection with bacteria or other germs

·         Severe asthma

Metabolic Alkalosis       

                                               

•       pH >7.45

•       HCO₃ > 26 mEq/L

 Causes of Metabolic Alkalosis

 Caused by a bicarbonate excess, due to loss of acid, or a bicarbonate excess in the body

•     1  Loss of hydrogen and chloride ions through excessive vomiting, gastric suctioning, or excessive diuretic therapy

•        2. Response to hypokalemia

•        3. Excess ingestion of bicarbonate rich antacids or excessive treatment of acidosis with Sodium Bicarbonate

•       The most common causes are volume depletion (particularly when involving loss of gastric acid and chloride (Cl) due to recurrent vomiting or nasogastric suction) and diuretic use. Metabolic alkalosis involving loss or excess secretion of Cl is termed chloride-responsive

Signs and symptoms

1 Compensation: Lungs respond by  decrease the depth and rate of respiration in effort to retainCO2 and increase pH

2. Neuro: altered mental status, numbness and tingling around mouth, fingers,     toes, dizziness, muscle spasms (similar to hypocalcemia due to less ionized    calcium levels)

3. Hypokalemia - H+ moves out of cell & K+ moves inside cell

Metabolic Alkalosis Treatment & Management

The management of metabolic alkalosis depends primarily on the underlying etiology and on the patient’s volume status. In the case of vomiting, administer antiemetics, if possible. If continuous gastric suction is necessary, gastric acid secretion can be reduced with H2-blockers or more efficiently with proton pump inhibitors. In patients who are o

on thiazide or loop diuretics, the dose can be reduced or the drug can be stopped if appropriate. Alternatively, a potassium-sparing diuretic or acetazolamide can be added.

  1 Correcting underlying cause will often improve alkalosis

2.Restore fluid volume and correct electrolyte imbalances (usually IV NaCl with KCL). 

 3.With severe cases, acidifying solution may be administered.

Restore fluid volume and correct electrolyte imbalances (usually IV NaCl   with KCL)    With severe cases, acidifying solution may   be administered

Metabolic alkalosis is corrected with the aldosterone antagonist spironolactone or with other potassium-sparing diuretics (eg, amiloride, triamterene). If the cause of primary hyperaldosteronism is an adrenal adenoma or carcinoma, surgical removal of the tumor should correct the alkalosis.

Correcting underlying cause will often   improve alkalosis

            Nursing Diagnoses:

    a.    Impaired Gas Exchange

     b. Ineffective Airway Clearance

     c. Risk for Injury

Interpreting results

•       pH  - 7.5

•       PaCO2  - 40 mmHg

  HCO3  - 30 mEq

•       pH  - 7.5- alkalosis

•       PaCO2  - 40 mmHg - normal

•       HCO3  - 17 mEq/L   - metab alkalosis

•        Metabolic alkalosis ,uncompensated

 

Metabolic Acidosis

Metabolic acidosis occurs when your body produces too much acid ,or your kidney  don't reproduces  

What causes metabolic acidosis?

The four leading causes of metabolic acidosis include:

  Diabetes-related acidosis. Diabetes-related acidosis develops when ketone bodies build up in your body from untreated diabetes. Your body produces ketone bodies while it turns (metabolizes) fats into energy. Your body uses ketone bodies for energy when sugars (glucose) aren’t available.

   Hyperchloremic acidosis. Hyperchloremic acidosis develops when your body loses too much sodium bicarbonate. It may occur if you take too many laxatives or have severe diarrhea.

    Lactic acidosis. Lactic acidosis develops when you have too much lactic acid in your body. Lactic acid is an organic acid that your muscle cells and red blood cells produce for energy when you don’t have a lot of oxygen in your body. Causes include liver failure, low blood sugar, alcohol use disorder, cancer and intense exercise.

   Renal tubular acidosis. Renal tubular acidosis develops when your kidneys don’t pass enough acids into your pee. As a result, your blood becomes more acidic.

·    Causes include untreated diabetes, the loss of bicarbonate in your body and kidney conditions. 

  Unmanageable diarrhea and kidney failure are the most common causes of metabolic acidosis. remove enough acids from your blood.

Common signs and symptoms of metabolic acidosis include:

·         Accelerated heartbeat (tachycardia).

·         Confusion or dizziness.

·         Feeling very tired (fatigue).

·         Loss of appetite.

·         Headache.

·         Rapid breathing or long, deep breathing.

·         Nausea and vomiting.

·         Feeling weak.

·         Breath that smells sweet or fruity.

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Dear students, please complete this quiz to test your understanding of Topic 11

Interpret these ABG results:

pH - 7.25

PaCO2 – 50mmHg

HCO3 – 22 mEq/L

Answer

pH - 7.25 – acidic

PaCO2 – 50mmHg - acidic

HCO3 – 22 mEq/L – normal

- Respiratory acidosis, uncompensated

Interpret these ABG results:

pH - 7.37

PaCO2 - 60 mmHg

HCO3 - 38 mEq/L

Answer

pH - 7.37 - normal

PaCO2 - 60 mmHg- acidic

HCO3 - 38 mEq/L - alkaline

 - respiratory acidosis, fully compensated with metabolic alkalosis

Blood and urine tests can help diagnose

Interpret these ABG results:

pH - 7.37

PaCO2 - 60 mmHg

HCO3 - 38 mEq/L

Answer

pH - 7.37 - normal

PaCO2 - 60 mmHg- acidic

HCO3 - 38 mEq/L - alkaline

 - respiratory acidosis, fully compensated with metabolic alkalosis

Blood and urine tests can help diagnose

Treatments include:

• Sodium citrate if you have kidney disease or kidney failure.
• Fluids delivered through a vein in your arm (IV fluids).
• IV sodium bicarbonate, which helps balance the acids in your blood.
• Insulin if you have diabetes-related acidosis.
• Removing toxic substances from your blood, including aspirin, methanol (a substance in adhesives, paints and varnishes) or ethylene glycol (a substance in antifreeze) Inotropes help your heart beat stronger, which helps get more oxygen in your body and lowers the amount of acids in your blood. .

Treatment plan, which may include medications and changes to your lifestyle

• Monitoring your blood sugar closely.
• Taking medicines as prescribed by your healthcare provider.
• Eating low-acid, high-alkali foods.
• Limiting the amount of alcohol, you consume.

Prevention

You can’t prevent metabolic acidosis. However, you can help reduce your risk

• Drinking a lot of water and other fluids.
• Managing your blood sugar levels if you have diabetes.
• Reducing the amount of alcohol that you consume. Moderate alcohol consumption in men and people assigned male at birth (AMAB) is two drinks or fewer per day. In women and people assigned female at birth (AFAB), moderate        Severe cases may involve kidney or other organ failure and death

What is the difference between metabolic acidosis and respiratory acidosis?

Metabolic acidosis involves your digestive system and your urinary system. Your kidneys can’t properly filter acids from your bloodstream. Kidney disease, kidney failure, untreated diabetes, loss of bicarbonate and blood poisoning may cause a more acidic pH in your body.

Respiratory acidosis involves your respiratory system. Your lungs can’t remove enough carbon dioxide from your bloodstream. Asthma, brain injuries and excessive or disordered substance use may affect your lungs’ ability to remove carbon dioxide. my risk of 

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 Students, please answer the questions in this forum

How can I reduce my risk of developing metabolic acidosis?

What causes metabolic acidosis?

Interpret these ABG results:

•       Q1 pH - 7.5

•       PaCO2 - 40 mmHg

HCO3 - 30 mEq/L

•       pH  - 7.5- alkalosis

•       PaCO2  - 40 mmHg - normal

•       HCO3  - 17 mEq/L   - metabolic  alkalosis

•        Metabolic alkalosis, uncompensated

 

Q2  pH - 7.38

•       PaCO2 – 50 mmHg

•       HCO3 – 35 mEq/L

Answer Q2 pH - 7.38        - normal (acidosis)

•       PaCO2 – 50 mmHg - acidosis

•       HCO3 – 28 mEq/L    - alkalosis

•       Respiratory acidosis, fully compensated with metabolic alkalosis

•       Q 3 Ph   7.39                                           

•       PaCO2 – 32 mmHg

HCO3   -  20 mEq/ L

•       Answer Q3 v Ph   7.39    - normal ( acidosis)         

•       PaCO2 – 32 mmHg  - alkalosis

•       HCO3   -  20 mEq/ L  - acidosis

•       Metabolic acidosis, fully compensated with respiratory alkalosis

•       Q 4 Ph 7.49

•       PCO2 – 50 mmHg

•       HCO3 – 32 mEq/L

AnswerQ4  Ph 7.49       - ( abnormal) alkalosis

•       PCO2 – 50 mmHg     - acidosis

•       HCO3 – 32 mEq/L      - alkalosis

•       Metabolic alkalosis, partially compensated with respiratory acidosis