This document discusses acid-base disorders including metabolic acidosis, metabolic alkalosis, and mixed acid-base disturbances.
[1] Metabolic acidosis is caused by an increase in acids other than carbonic acid in the extracellular fluid or a loss of bicarbonate, with symptoms affecting the cardiovascular, respiratory, central nervous and gastrointestinal systems.
[2] Metabolic alkalosis occurs when hydrogen ions are lost or bicarbonate increased, commonly seen with hypokalemia, and causes symptoms like hypertension, dysrhythmias, and gastrointestinal issues.
[3] Mixed acid-base disturbances involve two or more concurrent disorders that can balance or exacerbate each other, requiring treatment
2. Metabolic Acidosis
• pH decreases/HCO3 decreases
• Acids (other than carbonic acid) increase in ECF
{AG > 14 mEq/L}
• Or loss of HCO3 {normal AG}
• Rarely spontaneous
• Usually accompanied by other problems
• Renal disease
• GI losses
• Poisoning
9. Metabolic Alkalosis
• Increase pH/ increase HCO3
• Occurs when H is lost
• Or increase in HCO3
• Or both
• Common with hypoK (thiazides,
furosemide), also with hypoCl, hypoCa
• Antacids
13. Interventions Metabolic Alkalosis
– Correct underlying cause
– Provide sufficient chloride
– Restore normal fluid balance
– Assess LOC
– VS, O2 sats, I&O,
– Protect from injury
– Monitor ECG’s and ABG’s and lytes
– Weights
– Maximize lung expansion with positioning
14. Medications Metabolic Alkalosis
– Normal saline IV replacement
– K supplement if hypoK
– Histamine-2 receptor antagonists
– If chloride responsive – acetazolamide
(Diamox)
– If chloride resistant – supplement to correct K
and Mg
15. Mixed Acid-Base Disturbances
• Two or more disorders at a time
• pH is dependent on the type of each
• Resp acidosis and alkalosis can’t
• Treat underlying cause of EACH disorder
• Mathematical formulas can help ID
• Anion gap and urine pH help with ID
16. • Mixed metabolic acidosis and respiratory
acidosis
– Acute pulmonary edema
– Cardiac arrest: inadequate ventilation
– pH value decreases and more pronounced
(HCO3 decreases while CO2 increases)
17. • Mixed metabolic alkalosis and respiratory
acidosis
– COPD with K wasting diuretics, V, diarrhea
– COPD with quick improvement in ventilation
– pH values balances (HCO3 and CO2 both
increased)
18. • Mixed metabolic acidosis and respiratory
alkalosis
– Due to rapid correction of metabolic acidosis
– Salicylate intoxication
– Gram negative septicemia
– pH values balanced (HCO3 and CO2
decreased)
19. • Mixed metabolic alkalosis and respiratory
alkalosis
– Postop severe hemorrhage
– Received massive transfusions
– Excessive NG drainage
– pH values increased and more pronounced
(HCO3 increased with CO2 decreased)
20. • Mixed metabolic acidosis and metabolic
alkalosis
– Gastroenteritis, V/D
– Usually no change in values
– Hypovolemia
21. • Chronic and acute respiratory acidosis
– Can lead to increased CO2 levels!!!!
– Close monitor by pulmonologist
– Respiratory therapy involved