Metabolic Acidosis

Diagnostic tests

ABG's serum electrolytes tests for underlying primary disorder

Implementation 6

Administer prescribed diuretics as ordered, monitor response. Loop and high-ceiling diuretics such as furosemide can lead to further electrolyte imbalances, esp. hypocalemia-significant risk in metabolic acidosis correction

Implementation 4

Assess hourly urine output, maintain accurate record of I & O, Note urine output <30 mL hr or positive fluid balance of 24 hour total I & O calculations. Heart failure and inadequate renal perfusion may lead to decreased urine output

Evaluation

Client maintains a pH w/in normal range Clients VS remain w/in personal normal range Client maintains adequate oxygenation of tissues Client is able to demonstrate measures to control the disease process to prevent further complications of pH balance.

Planning

Client will describe ad demonstrate preventitive measures related to chronic disease process pH will remain within normal range Disease process causing a/b imbalance will be controlled to reduce production of alkaline loss Client will maintain vital signs within normal range for age and condtion

Diagnosis for metabolic acidosis

Decreased Cardiac Output Risk for Excess Fluid Volume Risk for Injury

As metabolic acidosis is corrected

K shifts back into intercellular space. This shift can lead to hypokalemia and cardiac disrhythmias

Implementation 5

Obtain daily weight using same scale same time of day

Pathophys and etiology of MA

accumulation of metabolic acids excess loss of bicarbonate increase in Cl levels

Metabolic acidosis follows

acute lactic acidosis tissue hypoxia (shock cardiac arrest) Clients type 1 DM ketoacidosis acute renal failure impairs excretion of metabolic acids Diarrhea, intestinal suction or abdominal fistulas increase bicarbonate loss

if pH is less than 7.2

alkalizing solution given/IV sodium bicarbonate

Chronic acidosis skeletal problems

as Ca and phosphate are released from bone

Potassium is retained

as the kidneys excrete H+ in acidosis

Safety precations for acidosis

bed in lowest position, side rails up, keep personal items close and orient x3 as needed

Pancreas secretes

bicarbonate rich fluid into small intestine

Lactic acid is formed

buy lactate and H+

Cardiac dysrhthmias develop

cardiac arrest may occur

Acidosis depresses

cell membrane excitability, affecting neuromuscular function increases amount of free Ca in EFC by interfering with protein binding

Metabolic acidosis from diarrhea is treated

correcting underlying cause and providing fluid and electrolyte replacement.

Severe acidosis <7.0

depresses myocardial contactility leading to decreased cardiac output

Gastrointestinal functions cause

diminished appetite, N/V, abdominal pain

Acid-base balance effects

electrolyte balalance

Hyperchloremic acidosis

excess IV Cl infusion

Ketoacidosis (starvation, DM)

fatty tissues is broken down and fatty acids are released and converted to keytones

Lactic acidosis from decreased tissue perfusion (shock, cardiac arrest)

focuses on correcting .0 the underlying problem to increase tissue perfusion.

Potassium is displace

from inter-cellular space as H+ enters to maintain cations and anions in the cells in acidosis

Calcium is released

from its bonds with plasma proteins, increasing the amount of ionized (free) Ca in the blood in acidosis

Lactic acidosis results (exercise, MI)

from tissue hypoxia and a shift to anerobic metabolism by the cells

Decreased cardiac output and impaired tissue perfusion indicators

hypotension, diminished pulse strength, and slowed capillary refill

Monitor neurological function

including mental status, LOC, and muscle strength. As pH falls, the resulting decline in mental functioning leads to confusion, stupor, and decreased LOC.

Deep rapid respirations

known as Kussmaul respirations, shortness of breath, or dyspnea

Other alkalinizing solutions

lactate, citrate, and acetate solutions (which metabolize to bicarbonate)

LOC

may decline into stupor and coma

Magnesium levels

may fall in acidosis

Rapid correction of acidosis

may result in alkalosis and hypokalemia, possibly hypernatremia and hyperosmolarity leading to water retention and fluid overload

Risk for injury

mental status and brain function affected by acidosis

Implementation 3

monitor and maintain fluid replacement Monitor serum Na+ levels and osmolality Monitor heart and lung sounds, CVP, respiratory status. Report increased dyspnea, advantageous lung sounds, third heart sound (S3) due to volume of blood flow through the heart, and high CVP readings indicate hypovolemia

Implimentation

monitor vital signs, peripheral pulse, capillary refill.

Implamentation 2

monitory ECG pattern for disrhythmias and changes characteristic of hyperkalemia

Progressive ECG changes

such as widening of QRS compex indicates disrhythmias

Metabolic acidosis is rarely primary disorder

usually develops from another disease

General manifestations

weakness, fatigue, headache, general malaise

Diabetic ketoacidosis is treated

with intravenous insulin and fluid replacement

Alcoholic ketoacidosis is treated

with saline solution and glucose