Acid – Base Part 2
Upcoming SlideShare
Loading in...5
×

Like this? Share it with your network

Share
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
1,709
On Slideshare
1,709
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
23
Comments
0
Likes
2

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Acid – Base Part 2 Nurse 158 Winter 2009
  • 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
  • 3. Signs/symptoms Metabolic Acidosis – Cardiovascular – hypotension, dysrhythmias peripheral vasodilation, warm/dry skin then cold/clammy skin – Respiratory – rapid, shallow then deep, Kussmaul – CNS – headache, confusion, drowsy, lethargy, weak – GI – NVD, abd. pain
  • 4. Diagnostic findings metabolic acidosis – pH < 7.35 – HCO3 < 22 mEq/L – Hyperkalemia common – ECG changes – Increased AG – Calcium increased – Magnesium decreased – Base excess decreases
  • 5. Base excess (BE) – The amount of HCO3 in ECF – Normal range -3.0 to +3.0 – If above +3.0, metabolic alkalosis – If below -3.0, metabolic acidosis
  • 6. Compensation Metabolic Acidosis – Lungs eliminate CO2 – Kidneys conserve HCO3 – Urine pH <6 – PaCO2 starts decreasing
  • 7. Interventions Metabolic Acidosis – ABGs – I&O, edema – Weights – VS – LOC – GI – ECG – Labs (esp. K) – Protect – Meds/IVs/possible dialysis
  • 8. Medications Metabolic Acidosis – If ketoacidosis = – If diarrhea = – NaHCO3
  • 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
  • 10. Signs & Symptoms Metabolic Alkalosis – Cardiovascular – hypertension, tacky, dysrhythmias – Respiratory – hypoventilation, resp failure – CNS - dizzy, confusion, tremors, irritable, nervous, cramps, hyperreflexia, tetany, paresthesia, seizures – GI – NV, anorexia, paralytic ileus if hypoK
  • 11. Diagnostic findings metabolic alkalosis – pH >7.45 – HCO3 > 26 mEq/L – Hypokalemia – Hypocalcemia – Hyponatremia – Hypochloremia – Chloride responsive/resistant – Base excess increases
  • 12. Compensation Metabolic Alkalosis – lungs retain CO2 – Kidneys conserve H – Kidneys excrete HCO3 – PaCO2 increases – Urine pH >6
  • 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