Metabolic Acidosis (ABGs)
Two types of metabolic acidosis
high anion gap, normal anion gap
To remember High Anion Gap and Normal Anion Gap, remember:
A.C.I.D.O.T.I.C
Basically, whenever there are too many acids in the body, HCO3 (bicarbonate)
FALLS, PLUMMETS, DECREASES, DROPS LOW
Basically, whenever there is a huge loss of HCO3 (bicarbonate) this causes:
Metabolic Alkalosis
Things that cause Metabolic Acidosis
*too much acid in the body due to DKA Diabetic Ketoacidosis (pts blood sugars are high, ketones are heavily produced, [ketones are acids] and the ketones build up in the body and the bicarbonate, HCO3 plummets) *Decrease of acid secretions (Kidneys not working, like renal failure. the waste is not filtered and the acid increases and builds up, therefore HCO3 (bicarbonate) decreases *Loss of bicarbonate (HCO3) Diarrhea
Signs and Symptoms of Metabolic Acidosis ↓ → ↑ ⥂
-Kussmaul's breathing: deep rapid breathing >20 RR. Breathing to remove the CO2 to compensate for the build up of acid. -Confused, weak, ↓ BP, cardiac changes [due to increased potassium]. nausea and vom
Nursing Interventions depend on what is causing the Metabolic Acidosis [DKA, Renal Failure Diarrhea]
-Watch for respiratory distress. [Kussmaul's breathing] Pt may need to be intubated if pt is blowing out so much PCO2 and the levels drop below 35. -Watch for electrolytes [K+] bc whenever metabolic acidosis occurs, potassium lvls increase and hyperkalemia occurs. Also treating this may cause hypokalemia -Renal Failure cause - may be a candidate for dialysis (High anion) Watch I&Os strictly. -DKA: may need insulin drip, monitor BG, this insulin will help the glucose into cells which metabolizes the glucose rather than ketones. If ketones are metabolized, metabolic acidosis occurs
A C I D O T I C
A: Aspirin toxicity (high anion) ↑ acid in body → hyperventilation → respiratory alkalosis C: Carbs not metabolized. (high anion) Some patients have trouble metabolizing carbohydrates, when this happens, there isnt enough O2 to break down acid the Pyruic Acid [supplies energy to cells] start to turn into Lactic Acid. Pyruic Acid → Lactic Acid Which throws the body off. I: Insufficiency of kidneys (high anion) kidneys are not filtering out the waste in the blood, therefore ↑ waste left in blood, thus → this ↑ acids. When acids increase, bicarbonate (HCO3) plummets D: Diarrhea & DKA Gi fluids and pancreatic fluids are rich in HCO3, whenever that is lost in high quantities, the HCO3 is lost. DKA: Diabetic Ketoacidosis ketones are high [ketones are acids] and HCO3(bicarb) plummets as a result of too many acids! → O: Ostomy drainage (normal anion) esp ileostomy. Fluids drained out of ileostomy are rich in HCO3. Loss of HCO3 → metabolic acidosis T: fisTula: [a hollow passage between an organ and body surface, or between 2 organs] fluids are drained from these spaces and therefore HCO3 (bicarb) plummets → metabolic acidosis I: Intake of high-fat diet: increased waste, acids, ketones. The body cannot compensate for this nasty stuff and therefore the HCO3 plumments → metabolic acidosis C: Carbonic anhydrase inhibitors: Remember the drug *Diamox* this is a diuretic, this causes a decrease in the reabsorption of HCO3 (Bicarb). This causes the HCO3 to be lost via urine. Loss of HCO3 → metabolic acidosis
During Metabolic Acidosis, the respiratory system tries to compensate by increasing respiratory rate in order to remove
CO2! to compensate for the increased acid. (this is similar to how the kidneys try to compensate by releasing HCO3 during respiratory acidosis, but its the respiratory system that is trying to compensate)
Metabolic
Relating to metabolism, the whole range of biochemical processes that occur within us (or any living organism). ... The term "metabolic" is often used to refer specifically to the breakdown of food and its transformation into energy.
Metabolic Acidosis
Too much acid in the body fluids which is causing the HCO3 (bicarbonate) to plummet
Normal Anion Acidosis
conditions where the body loses too much bicarbonate (HCO3) like in diarrhea
High Anion Acidosis
conditions where the body starts to produce too much acid and not enough bicarbonate (HCO3) like in diabetic ketoacidosis [DKA]
Lab values effected by metaolic acidosis includes: pH, HCO3, PaCO2. The lab values will read as:
pH: less than 7.35 (because of the acids, it will be acidic) HCO3(bicarbonate): less than 22 (it will be acidic) PaCO2(Carbon dioxide level): less than 35 *depending on if it is trying to compensate or not. If its compensating, it will be 35-45. If it's not compensating, it will drop below 35.
What is anion gap?
where the doctor looks at various lab results (electrolyes, ch;oride, bicarbonate, sodium) and calculates to see the difference in anions and cations. If there is a gap that is more than 14 mEq/L. It means that it is a high anion gap.
