Metabolic Acidosis
What are the tests used?
ABGs, pulse ox, serum electrolytes
What should you monitor?
ECG, for hyperkalemia, ABGs, lab values, electrolyte, renal function test, I&O
What is important to give?
IV fluids for dehydration
What are clinical manifestations?
N/V, diminished appetite, abdominal pain, weakness, fatigue, headache, general malaise, decreasing LOC, dysrhythmias, bradycardia, warm flushed skin, skeletal problems, hyperventilation, dyspnea
What are some S&S?
N/V/D, abdominal discomfort
What is AKA treated with?
NS and glucose
What can hypokalemia cause?
U waves
What is metabolic acidosis?
a bicarb deficit characterized by a low pH(less than 7.35), low bicarb (less than 24), and partial pressure of carbon dioxide less than 38, it may be caused by excess acid in the body or loss of bicarb from the body
What should the physical assessment include?
abdominal exam, VS, peripheral pulses, capillary refill
What is used for too much salicylate?
activated charcoal
How long should sodium bicarbonate be used for?
brief period (2 weeks)
Who should sodium bicarbonate be used caution in?
cardiac disease and renal impairment patients
What is a serious side effect of sodium bicarbonate?
chest pain or dyspnea
What provides the most accurate indicator for fluid balance?
daily weights
What is kussmaul respirations?
deep, rapid respirations associated with compensatory mechanisms
What are risk factors?
diabetes, alcohol abuse, starvation, renal failure, severe sepsis, ingestion of salicylates (aspirin), methanol, ethlyene glycol
What causes a loss of bicarb?
diarrhea, small bowel pancreatic, biliary fistula drainage
What patients are at higher risk of taking these medications?
diuretics, some antidepressants, anticonvulsants, ACE inhibitors
What is the antidote for methanol and ethylene glycol poisoining?
fomepizole
What are early manifestations?
headache and changes in mental status
What can occur during metabolic acidosis?
hyperosmolality
What can cause metabolic acidosis?
ingestion of methanol and ethylene glycol, decreased renal perfusion
What drug can cause lactic acidosis?
metformin
What are the clinical therapies?
monitor ABGs, I&O, LOC, provide oral care, administer sodium bicarb
What are some causes?
overexercise, ketosis from DM, starvation, alcoholism, renal failure, internal fistula, shock, OD on aspirin, phenobarbital, carbonic anhydrase inhibitor drugs, DKA
What can hyperkalemia cause?
peaked T waves
What causes alcoholic ketoacidosis (AKA)?
prolonged alcohol binge with decreased food and vomiting
What should be done with DKA and AKA?
replace fluids
When should you call the HCP about sodium bicarbonate?
severe stomach pain, swelling, rapid weight gain, SOB
What is the treatment of choice?
sodium bicarbonate
What are other treatments?
sodium lactate and citrate
What is the most important thing to monitor?
vitals
When is sodium bicarbonate used?
when pH is less than 7.1
