Metabolic acidosis
Clinical Causes of Metabolic Acidosis -Increased metabolic formation of acids
-DKA -Lactic acidosis -Uremic acidosis
Effects of Metabolic Acidosis on the Heart
-Depression of myocardial contractility -Sympathetic over activity (including tachycardia, vasoconstriction, decreased arrhythmia threshold) -Resistance to the effects of catecholamines -Peripheral arteriolar vasodilatation -Vasoconstriction of peripheral veins -Vasoconstriction of pulmonary arteries -Right sided HF -Effects of hyperkalemia on heart -Lethal dysrhythmias -Suppression of muscle contraction -Blood volume is centralized
Effects of Metabolic Acidosis
-Hyperventilation (Kussmaul's respirations) - this is the compensatory response -Shift of oxyhemoglobin dissociation curve (ODC) to the right -Increased catabolism leads to muscle wasting -Increased basic metabolic rate -Need good nutrition: PO or NGT -Hyperglycemia - Stress response -Hyperkalemia - Shift from intracellular
Effects of Metabolic Acidosis on the Lungs
-Pulmonary Vasoconstriction -Hyperventilation (Kussmal Respirations) -Deep and rapid -Respiratory muscle failure -Will be put on a vent
Effects of Metabolic Acidosis on the Kidneys
-Reduced renal blood flow from decrease cardiac output -Decreased U/O
Clinical Causes of Metabolic Acidosis -Loss of bicarbonate
-Renal tubular acidosis -Diarrhea
Clinical Causes of Metabolic Acidosis Toxins
-Salicylate overdose -Ethylene and propylene glycol -Methanol -Paraldehyde
Clinical Causes of Metabolic Acidosis
-Sepsis -Hepatic failure -Hyperkalemia -Adrenal insufficiency -Leukemia -lymphoma -other malignancies
Clinical Causes of Metabolic Acidosis Global or regional reductions in oxygen delivery
-Shock -Cardiac arrest -Severe anemia -Severe hypoxemia -Limb or splanchnic ischemia
Management of Metabolic Acidosis
-Treat the underlying cause -Decrease acid formation ↓CO in shock states -Decrease -bicarbonate loss Treat diarrhea (CDIF) -Removal of toxin by dialysis or cathartics -Administering -NaHCO3 in extreme cases <7.2 bicarb will be IVP >7.2 bicarb will be put in IVF -Seizure precautions
S & S of Metabolic Acidosis
-Weakness -Altered mental status -SOB -Kussmaul's respirations -Fatigue -Tachycardia (if pH is >7) -Bradycardia (if pH is <7) -Anorexia -Headache -Ventricular dysrhythmias -Seizures -Coma
Effects of Metabolic Acidosis on Cell
Cell Membrane pump malfunction Shift of K+ out of cells -Hyperkalemia
Effects of Metabolic Acidosis on Brain
Confusion Drowsiness Coma
Effects of Metabolic Acidosis on GI Tract
Reduced slpanchnic blood flow ↓ ↓ Gut Perfusion ↓ ↑ Gut Permeability ↓ Gut bacteria oozing into regional lymph nodes and capillaries ↓ Inflammatory process is activated from the endotoxins of the gram-negative bacteria ↓ Sepsis or multi organ dysfunction
Effects of Metabolic Acidosis on Red Blood Cells
Right shift -Oxygen is more readily released to the tissues → enhanced oxygen transport to tissues with long term hypoxia