Metabolic ACIDosis

Nursing Diagnoses

Decreased cardiac output Risk for excess fluid volume Risk for injury

Overview

Metabolic ACIDosis (bicarbonate deficit) is seen by a *low pH (<7.35) and a low bicarbonate level (<24 mEq/L).* It can be caused by excess acid in the body or loss of bicarbonate from the body. When metabolic acidosis occurs, the respiratory system compensates by increasing the rate and depth of respirations, CO2 elimination increases, and the PaCO2 decreases.

Risk factors

Acute lactic acidosis Clients with type 1 DM (can develop diabetic ketoacidosis due to the sugar not being able to enter the cell = produces ketones that are an acid) Acute or chronic renal failure Diarrhea (loose a lot of bicarbonate = acidic state), intestinal suction, or abdominal fistulas.

Pharmacological therapy

An alkalinizing solution such as a bicarbonate may be given if the pH is less than 7.2; given via IV. Chronic conditions, medication is given via PO. When metabolic acidosis is due to diarrhea, treatment includes correcting the underlying cause and providing F&E replancement.

Pathophysiology/Etiology

Can result from an accumulation of metabolic acids or impaired renal elimination of metabolic acids. Substances such as aspirin, methanol, and ethylene can cause an increase in body acids. Renal failure impairs the body's ability to excrete excess H+ ions and form bicarbonate. Intestinal suction, severe diarrhea, ileostomy drainage or fistulas can lead to excess losses of bicarbonate. Severe acidosis can decrease cardiac output by affecting myocardial contractility. In acidosis, K+ is retained as the kidney excretes excess H+ ions.

Clinical manifestations

Effects the function of many body systems Weakness and fatigue, headache, and general malaise. GI effects: diminished appetite, nausea, vomiting, and abdominal pain. LOC can decline Skin is often warm and flushed Skeletal problems can occur (due to Ca being released) Deep rapid respirations (Kussmaul respirations), SOB and dyspnea.

Implementation

Metabolic acidosis affects cardiac output by decreasing myocardial contractility, slowing the heart rate, and increasing the risk for dysthymias. Monitor vital signs Monitor ECG pattern for dysthymias Monitor lab values Monitor potential for excess fluid volume Reduce risk for injury