CHAPTER 9 Acid-Base Balance

Respiratory Alkalosis causes (potassium levels decrease.) Respiratory alkalosis results from conditions that cause overstimulation of the respiratory system

1 - Fever: Causes increased metabolism, resulting in overstimulation of the respiratory system. 2 - Hyperventilation: Rapid respirations cause the blowing off of carbon dioxide (CO2), leading to a decrease in carbonic acid. 3 - Hypoxia: Stimulates the respiratory center in the brainstem, which causes an increase in the respiratory rate in order to increase oxygen (O2); this causes hyperventilation, which results in a decrease in the CO2 level. 5 - Overventilation by mechanical ventilators: The administration of O2 and the depletion of CO2 can occur from mechanical ventilation, causing the client to be hyperventilated. 6 - Pain: Overstimulation of the respiratory center in the brainstem results in a carbonic acid deficit. 7 - Severe anxiety and hysteria: Often is neurogenic and related to a psychoneurosis; however, this condition leads to vigorous breathing and excessive exhaling of CO2.

Respiratory Acidosis (potassium level increases) Clinical manifestation

1 - pH < 7.35 CO2 > 45 CO3 < 22 2 - Lethargy 3 - Confusion 4 - Dizziness 5 - Headache 6 - Coma 7 - Decreased blood pressure 8 - Dysrhythmias (related to hyperkalemia from compensation) 9 - Warm, flushed skin (related to pheripheral vasodilation) 10 - Seizures 11 - Respiratory rate increase in an attempt to exhale acids. However, when there is respiratory problem and the lungs is unable to compensate, hypoventilation with hypoxia occur

Bases

1. Contain no hydrogen ions 2. Are hydrogen ion acceptors; they accept hydrogen+ ions from acids to neutralize or decrease the strength of a base or to form a weaker acid. 3. Normal serum levels of bicarbonate (HCO3-) are 21 to 28 mEq/L (21 to 28 mmol/L). acidotic <21 - 28 > alkalotic

Metabolic Acidosis Interventions in kidney disease

1. Dialysis may be necessary to remove protein and waste products, thereby lessening the acidotic state. 2. A diet low in protein and high in calories decreases the amount of protein waste products, which in turn lessens the acidosis.

Diabetic Ketoacidosis (DKA) Interventions

1. Give insulin as prescribed to hasten the movement of glucose into the cells, thereby decreasing the concurrent ketosis. 2. When glucose is being properly metabolized, the body stop converting fats to glucose. 3. Monitor for circulatory collapse caused by polyuria, which may result result from the hyperglycemic state; osmotic diuresis may lead to extracellular volume deficit.

Respiratory acidosis (potassium level increases) Interventions

1. Monitor for signs of respiratory distress. 2. Administer O2 as prescribed. 3. Place the client in a semi-Fowler's position. 4. Encourage and assist the client to turn, cough, and deep breathe. 5. Encourage hydration to thin secretions. 6. Reduce restlessness by improving ventilation rather than by administering tranquilizers, sedatives, or opioids, because these medications further depress respirations. 7. Prepare to administer respiratory treatments as prescribed; suction the client's airway, if necessary. 8. Prepare for endotracheal intubation and mechanical ventilation if CO2 levels rise above 50 mm Hg and signs of acute respiratory distress are present.

Respiratory Alkalosis (potassium levels decrease.) Interventions

1. Monitor for signs of respiratory distress. 2. Provide emotional support and reassurance to the client. 3. Encourage appropriate breathing patterns. 4. Assist with breathing techniques and breathing aids if need and as prescribed (voluntary holding of breath, using a rebreathing mask, CO2 breaths with rebreathing into a paper bag). 5. Provide cautious care with ventilator clients so that they are not forced to take breaths too deeply or rapidly. 6. Prepare to administer calcium gluconate for tetany as prescribed.

The nurse notes that a client's arterial blood gas (ABG) results reveal a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse monitors the client for which clinical manifestations associated with these ABG results? Select all that apply. 1. Nausea 2. Confusion 3. Bradypnea 4. Tachycardia 5. Hyperkalemia 6. Lightheadedness

1. Nausea 2. Confusion 4. Tachycardia 6. Lightheadedness Rationale: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) occurs. Bradypnea describes respirations that are regular but abnormally slow. Hyperkalemia is associated with acidosis.

Collection of an ABG specimen

1. Obtain vital signs. 2. Determine whether the client has an arterial line in place (allows for arterial blood sampling without further puncture to the client). 3. Perform the Allen's test to determine the presence of collateral circulation (see Priority Nursing Actions). 4. Assess factors that may affect the accuracy of the results, such as changes in the O2 settings, suctioning within the past 20 minutes, and the client's activities. 5. Provide emotional support to the client. 6. Assist with the specimen draw; prepare a heparinized syringe (if not already prepackaged). After obtaining a specimen, prevent any air entering the syringe, because air can cause a blood gas analysis alteration. 7. Apply pressure immediately to the puncture site following the blood draw; maintain pressure for 5 minutes or for 10 minutes if the client is taking an anticoagulant to decrease the risk of hematoma. Reassess the radial pulse after removing the pressure. 8. Appropriately label the specimen and transport it on ice to the laboratory. 9. On the laboratory form, record the client's temperature and the type of supplemental O2 that the client is receiving.

Acids

1. Produced as end products of metabolism 2. Contain hydrogen ions 3. Are hydrogen ion donors; they give up hydrogen ions to neutralize or decrease the strength of an acid or to form a weaker base.

The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid-base imbalance? 1. Respiratory acidosis from inadequate ventilation 2. Respiratory alkalosis from anxiety and hyperventilation 3. Metabolic acidosis from calcium loss due to broken bones 4. Metabolic alkalosis from taking analgesics containing base

1. Respiratory acidosis from inadequate ventilation Rationale: Respiratory acidosis is most often caused by hypoventilation. The client with broken ribs will have difficulty with breathing adequately and is at risk for hypoventilation and resultant respiratory acidosis. The remaining options are incorrect. Respiratory alkalosis is associated with hyperventilation. There are no data in the question that indicate calcium loss or that the client is taking analgesics containing base products.

61. The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse's findings? 1. pH 7.25, Paco2 50 mm Hg (50 mm Hg) 2. pH 7.35, Paco2 40 mm Hg (40 mm Hg) 3. pH 7.50, Paco2 52 mm Hg (52 mm Hg) 4. pH 7.52, Paco2 28 mm Hg (28 mm Hg)

1. pH 7.25, Paco2 50 mm Hg (50 mm Hg) Rationale: Atelectasis is a condition characterized by the collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm Hg (35 to 45 mm Hg). In respiratory acidosis, the pH is decreased and the Paco2 is elevated. Option 2 identifies normal values. Option 3 identifies an alkalotic condition, and option 4 identifies respiratory alkalosis.

55. The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

2. Metabolic alkalosis Rationale:Metabolic alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid. The remaining options are incorrect interpretations.

The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? 1. Sodium level of 145 mEq/L (145 mmol/L) 2. Potassium level of 3.0 mEq/L (3.0 mmol/L) 3. Magnesium level of 1.8 (0.74 mmol/L) 4. Phosphorus level of 3.0 mg/dL (0.97 mmol/L)

2. Potassium level of 3.0 mEq/L (3.0 mmol/L) Rationale: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Some clinical manifestations of respiratory alkalosis include lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, diarrhea, epigastric pain, and numbness and tingling of the extremities. All three incorrect options identify normal laboratory values. The correct option identifies the presence of hypokalemia.

The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply. 1. Respirations that are shallow 2. Respirations that are increased in rate 3. Respirations that are abnormally slow 4. Respirations that are abnormally deep 5. Respirations that cease for several seconds

2. Respirations that are increased in rate 4. Respirations that are abnormally deep Rationale: Kussmaul's respirations are abnormally deep and increased in rate. These occur as a result of the compensatory action by the lungs. In bradypnea, respirations are regular but abnormally slow. Apnea is described as respirations that cease for several seconds.

The nurse reviews the arterial blood gas results of a client and notes the following:pH7.45,Paco2of30mmHg(30mmHg),andHCO3- of20mEq/L (20 mmol/L). The nurse analyzes these results as indicating which condition? 1. Metabolic acidosis, compensated 2. Respiratory alkalosis, compensated 3. Metabolic alkalosis, uncompensated 4. Respiratory acidosis, uncompensated

2. Respiratory alkalosis, compensated Rationale: The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Paco2. In this situation, the pH is at the high end of the normal value and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore, the values identified in the question indicate a respiratory alkalosis that is compensated by the kidneys through the renal excretion of bicarbonate. Because the pH has returned to a normal value, compensation has occurred.

56. A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths per minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats per minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding? 1. A decreased pH and an increased Paco2 2. An increased pH and a decreased Paco2 3. A decreased pH and a decreased HCO3- 4. An increased pH and an increased HCO3-

4. An increased pH and an increased HCO3- Rationale: Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3- to increase. Symptoms experienced by the client would include a decrease in the respiratory rate and depth and tachycardia. Option 1 reflects a respiratory acidotic condition. Option 2 reflects a respiratory alkalotic condition, and option 3 reflects a metabolic acidotic condition.

A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, Paco2 is 90 mm Hg (90 mm Hg), and is 22 mEq/L (22 mmol/L). The nurse interprets the results as indicating which condition? 1. Metabolic acidosis with compensation 2. Respiratory acidosis with compensation 3. Metabolic acidosis without compensation 4. Respiratory acidosis without compensation

4. Respiratory acidosis without compensation Rationale: The acid-base disturbance is respiratory acidosis without compensation. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm Hg (35 to 45 mm Hg). In respiratory acidosis the pH is decreased and the Pco2 is elevated. The normal bicarbonate ) level is 21 to 28 mEq/L (21 to 28 mmol/L). Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance. In addition, the pH is not within normal limits. Therefore, the condition is without compensation. The remaining options are incorrect interpretations.

The nurse is caring for a client having respiratory distress related to an anxiety attack. Recent arterial blood gas values are pH = 7.53, Pao2 = 72 mm Hg(72mmHg),Paco2 =32mmHg(32mmHg),and Hco3 =28mEq/L(28 mmol/L). Which conclusion about the client should the nurse make? 1. The client has acidotic blood. 2. The client is probably overreacting. 3. The client is fluid volume overloaded. 4. The client is probably hyperventilating.

4. The client is probably hyperventilating. Rationale: The ABG values are abnormal, which supports a physiological problem. The ABGs indicate respiratory alkalosis as a result of hyperventilating, not acidosis. Concluding that the client is overreacting is an inaccurate analysis. No conclusion can be made about a client's fluid volume status from the information provided.

A Nitrazine test strip that turns deep blue indicates that the fluid being tested has a pH of what? 4.5 5.5 6.5 7.5

7.5 Nitrazine Test. This test involves putting a drop of fluid obtained from the vagina onto paper strips containing Nitrazine dye. The strips change color depending on the pH of the fluid. The strips will turn blue if the pH is greater than 6.0. A blue strip means it's more likely the membranes have ruptured A pH of 4.5, 5.5, or 6.5 would result in a test strip of yellow, olive-yellow, or blue-green, respectively.

Diabetic ketoacidosis (DKA)

An insufficient supply of insulin in a client with diabetes mellitus can result in metabolic acidosis.

After abdominal surgery, a client is transferred to the postanesthesia care unit (PACU) with a nasogastric tube in place. What action should the nurse take initially when the client vomits 90 mL of bile-colored fluid? Elevate the head of the bed. Check the patency of the tube. Administer the prescribed antiemetic. Encourage the client to take several deep breaths.

Check the patency of the tube. A nasogastric tube attached to suction removes gastric secretions and prevents vomiting. However, if it becomes obstructed, secretions accumulate, leading to distention, nausea, and vomiting. The client initially should be turned on the side to prevent aspiration. An antiemetic may be administered after tube patency is verified. Deep breathing will not prevent vomiting if a nasogastric tube is not patent.

Surgery is performed on a client with a parotid tumor. Postoperative arterial blood gas values are pH 7.32, PCO 2 53 mm Hg, and HCO 3 25 mEq/L (25 mmol/L). Which action should the nurse take? Administer a potent diuretic Obtain a prescription for an alkalinizing agent Have the client breathe into a rebreather bag at a slow rate Encourage the client to cough and then take deep breaths between coughs

Encourage the client to cough and then take deep breaths between coughs The client is in respiratory acidosis, probably caused by depressant effects of the anesthetic or a plugged airway; coughing clears the airway, and deep breaths blow off carbon dioxide. Administering a diuretic will not correct respiratory acidosis and may aggravate hypokalemia if present. An alkalinizing agent is not necessary if clearing the airway rectifies the problem. Having the client breathe into a rebreather bag at a slow rate is the treatment for respiratory alkalosis; the client is in respiratory acidosis.

Hydrogen ions

Expressed as pH; the pH scale is determined by the number of hydrogen ions and goes from 1 to 14; 1 acidotic, 14 alkaloric; 7 is considered neutral. The number of hydrogen ions in the body fluid determines whether it is acid (acidosis), alkaline (alkalosis), or neutral. The pH of body fluid is between 7.35 and 7.45. <7.35 Acidotic - > 7.45 Alkalotic

A nurse is caring for a toddler with severe dehydration and its associated acid-base imbalance. What compensatory mechanism within the body is activated to counteract the effects of the child's acid-base imbalance? Profuse diaphoresis Increased temperature Increased respiratory rate Renal retention of hydrogen ions

Increased respiratory rate The child has metabolic acidosis; the lungs compensate by blowing off excess carbonic acid in the form of carbon dioxide. Diaphoresis is a compensatory mechanism to reduce fever by evaporation, not to compensate for metabolic acidosis. Fever is not a compensatory mechanism to counter metabolic acidosis; fever with dehydration results from inadequate fluid for perspiring and cooling. The kidneys excrete hydrogen and ammonium ions to compensate for metabolic acidosis.

Which insulin should the nurse prepare for the emergency treatment of ketoacidosis? Glargine NPH insulin Insulin Aspart Insulin detemir

Insulin aspart Insulin aspart is a rapid-acting insulin (within 10 to 20 minutes) and is used to meet a client's immediate insulin needs. Glargine is a long-acting insulin, which has an onset of 1.5 hours; for diabetic acidosis, the individual needs rapid-acting insulin. NPH insulin is an intermediate-acting insulin, which has an onset of 1 to 2 hours; for diabetic acidosis, the individual needs rapid-acting insulin. Insulin detemir is a long-acting insulin; for diabetic acidosis, the individual needs rapid-acting insulin.

Propylthiouracil is prescribed for a client diagnosed with hyperthyroidism. The client asks the nurse, "Why do I have to take this medication if I am going to get radiation therapy?" What explanation does the nurse provide? It binds previously formed thyroid hormones. It decreases production of thyroid hormones. Vascularity of the thyroid gland is decreased. The need for thyroid iodine supplements is reduced.

It decreases production of thyroid hormones. Propylthiouracil is a thyroid hormone antagonist that inhibits thyroid hormone synthesis by decreasing the use of iodine in the manufacture of these hormones. PTU does not affect the vascularity of the thyroid gland. Iodine-containing agents are given for severe hyperthyroidism and before a thyroidectomy. PTU does not affect the amount of already formed thyroid hormones.

Metabolic Alkalosis (potassium levels decrease.)

Metabolic alkalosis results from a dysfunction of metabolism that causes an increased amount of available base solution in the blood or a decrease in available acids in the blood

Metabolic Alkalosis (potassium levels decrease.) Interventions

Monitor the client experiencing excessive vomiting or the client with gastrointestinal suctioning for manifestations of metabolic alkalosis. 1. Monitor for signs of respiratory distress. 2. Prepare to administer medications and intravenous fluids as prescribed to promote the kidney excretion of bicarbonate. 3. Prepare to replace potassium as prescribed.

Metabolic Acidosis (potassium level increases) Interventions

Monitor the client experiencing severe diarrhea for manifestations of metabolic acidosis. 1. Monitor for signs of respiratory distress. 2. Monitor intake and output and assist with fluid and electrolyte replacement as prescribed. 3. Prepare to administer solutions intravenously as prescribed to increase the buffer base. 4. Initiate seizure precautions.

A client with colitis has had a hemicolectomy. Three days after surgery the nurse identifies that the client has abdominal distention and absent bowel sounds, and has vomited 300 mL of dark green viscous fluid. The nurse contacts the primary healthcare provider and recommends which intervention? Nasogastric tube for decompression Antiemetic for nausea/vomiting Intravenous (IV) lactated Ringer for fluid replacement Stat electrolytes to assess for probable electrolyte imbalance

Nasogastric tube for decompression Decompression removes collected secretions behind the nonfunctioning bowel segment (paralytic ileus), thus reducing pressure on the suture line and allowing healing. Vomiting will subside as the bowel is decompressed. Although IV lactated Ringer for fluid replacement is important, the primary concern is decompression of the bowel; the amount of fluid removed will direct fluid and electrolyte replacement therapy.

A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe? NPH insulin Inhaled insulin Regular insulin Insulin glargine

Regular insulin Regular insulin is rapid acting and should be used for diabetic coma. Insulin glargine is long-acting insulin, which is not indicated in an emergency. NPH insulin is intermediate-acting insulin; it is not indicated for use in an emergency. Inhaled insulin has not been approved for management of diabetic ketoacidosis.

ABGs calculation

See ABG table in documents

A client presenting to the emergency department with chest pain and dizziness is found to be having a myocardial infarction and subsequently suffers cardiac arrest. The healthcare team is able to successfully resuscitate the client. Lab work shows that the client now is acidotic. How does the nurse interpret the cause of the acidosis? The fat-forming ketoacids were broken down. The irregular heartbeat produced oxygen deficit. The decreased tissue perfusion caused lactic acid production. The client received too much sodium bicarbonate during resuscitation efforts

The decreased tissue perfusion caused lactic acid production. Cardiac arrest causes decreased tissue perfusion, which results in ischemia and cardiac insufficiency. Cardiac insufficiency causes anaerobic metabolism, which leads to lactic acid production. Fat-forming ketoacids occur in diabetes. An irregular heartbeat does not cause acidosis. Too much sodium bicarbonate causes alkalosis, not acidosis.

After surgical implantation of radon seeds for oral cancer, what side effects of the radiation does the nurse observe in the client? Nausea or vomiting Hematuria or occult blood Hypotension or bradycardia Abdominal cramping or diarrhea

The mucosa of the mouth and the vomiting center in the brainstem may be affected, producing nausea and vomiting. Hematuria or occult blood and hypotension or bradycardia are not side effects of radiation therapy to the oral cavity. Neither abdominal cramping nor diarrhea is an expected response because of the distance between the radon seeds and the intestines.

Performing the Allen's Test Before Radial Artery Puncture

Used to find out if the blood flow to your hand is normal. 1. Explain the procedure to the client. 2. Apply pressure over the ulnar and radial arteries simultaneously. 3. Ask the client to open and close the hand repeatedly. 4. Release pressure from the ulnar artery while compressing the radial artery. 5. Assess the color of the extremity distal to the pressure point. 6. Document the findings.

Potassium (K+)

When the client experiences an acid-base imbalance, monitor the potassium level closely because the potassium moves in or out of the cells in an attempt to maintain acid-base balance. The resulting hypokalemia or hyperkalemia predisposes the client to associated complications. a - During acidosis, the body protects itself from the acidic state by moving hydrogen ions into the cells. Therefore, potassium moves out to make room for hydrogen ions, and the potassium level increases. b. During alkalosis, the cells release hydrogen ions into the blood in an attempt to increase the acidity of the blood; this forces the potassium into the cells, and potassium levels decrease.

Normal Venus Blood Gas Values

pH 7.31 - 7.41 Pvo2 40 - 50 (partial pressure of oxygen)

Normal Arterial Blood Gas Values

pH 7.35 - 7.45 Paco2 35 - 45 (partial pressure of carbon dioxide in arterial blood) Bicarbonate (HCO3) 22 - 26 Pao2 80 - 100 (Pao2, partial pressure of oxygen in arterial blood)

Metabolic Acidosis (potassium level increases) Clinical Manifestations

pH < 7.35 CO2 varies CO3 < 22 1 - Lethargy 2 - Confusion 3 - Dizziness 4 - Headache 5 - Coma 6 - Decreased blood pressure 7 - Dysrhythmia ( related to hyperkalemia from compensation) 8 - Cold, clammy skin 10 - Muscle weakness 11 - Deep, rapid respirations (compensatory by the lungs) kussmaul's respiration.

Respiratory Alkalosis (potassium levels decrease.) Clinical Manifestations

pH > 7.45 CO2 < 35 CO3 > varies 1 - Dizziness 2 - Lightheadedness 3 - Confusion 4 - Headache 5 - Low Blood Pressure 6 - Tachycardia 7 - Dysrhythmias 8 - Nausea 9 - Vomiting 10 -Diarrhea 11 - Epigastric Pain 12 - Tetany 13 - Numbness 14 - Tingling of extremities 15 - Seizures 16 - Respiratory rate and depth decrease as a compensatory action by the lungs. However, when that is a respiratory problem and lungs are unable to compensate, hyperventilation can occur.s

Metabolic Alkalosis (potassium levels decrease.) Clinical Manifestation

pH > 7.45 CO2 Varies CO3 >26 1 - Lethargy 2 - Irritability 3 - Confunion 4 - Headache 5 - Low Blood Pressure 6 - Tachycardia 7 - Dysrhythmia 8 - Anorexia 9 - Nausea 10 - Vomiting 11 - Tetany 12 - Tremors 13 - Tingling of extremities 14 - Muscles Cramps 15 - Hypertonic Muscles 16 - Seizures

Respiratory Acidosis causes (potassium level increases) Any condition that causes an obstruction of the airway leading to hypoventilation or depresses the respiratory system can cause respiratory acidosis.

▪ Asthma: Spasms resulting from allergens, irritants, or emotions cause the smooth muscles of the bronchioles to constrict, resulting in ineffective gas exchange. ▪ Atelectasis: Excessive mucus collection, with the collapse of alveolar sacs caused by mucous plugs, infectious drainage, or anesthetic medications, results in ineffective gas exchange. ▪ Brain trauma: Excessive pressure on the respiratory center or medulla oblongata depresses respirations. ▪ Bronchiectasis: Bronchi become dilated as a result of inflammation, and destructive changes and weakness in the walls of the bronchi occur. ▪ Bronchitis: Inflammation causes airway obstruction, resulting in inadequate gas exchange. ▪ Central nervous system depressants: Depressants such as sedatives, opioids, and anesthetics depress the respiratory center, leading to hypoventilation (excessive sedation from medications may require reversal by opioid antagonist medications); carbon dioxide (CO2) is retained and the hydrogen ion concentration increases. ▪ Emphysema and chronic obstructive pulmonary disease: Loss of elasticity of alveolar sacs restricts air flow in and out, primarily out, leading to an increased CO2 level. ▪ Hypoventilation: CO2 is retained and the hydrogen ion concentration increases, leading to the acidotic state; carbonic acid is retained and the pH decreases. ▪ Pneumonia: Excess mucus production and lung congestion cause airway obstruction, resulting in inadequate gas exchange. ▪ Pulmonary edema: Extracellular accumulation of fluid in pulmonary tissue causes disturbances in alveolar diffusion and perfusion. ▪ Pulmonary emboli: Emboli cause obstruction in a pulmonary artery resulting in airway obstruction and inadequate gas exchange.

Metabolic Acidosis (potassium level increases) Causes

▪ Diabetes mellitus or diabetic ketoacidosis: An insufficient supply of insulin causes increased fat metabolism, leading to an excess accumulation of ketones or other acids; the bicarbonate then ends up being depleted. ▪ Excessive ingestion of acetylsalicylic acid (aspirin)Causes an increase in the hydrogen ion concentration. ▪ High-fat diet: Causes a much too rapid accumulation of the waste products of fat metabolism, leading to a buildup of ketones and acids. ▪ Insufficient metabolism of carbohydrates: When the oxygen supply is not sufficient for the metabolism of carbohydrates, lactic acid is produced and lactic acidosis results. ▪ Malnutrition: Improper metabolism of nutrients causes fat catabolism, leading to an excess buildup of ketones and acids. ▪ Renal insufficiency, acute kidney injury, or chronic kidney disease: Increased waste products of protein metabolism are retained; acids increase, and bicarbonate is unable to maintain acid-base balance. ▪ Severe diarrhea: Intestinal and pancreatic secretions are normally alkaline; therefore, excessive loss of base leads to acidosis.

Metabolic Alkalosis (potassium levels decrease.) Causes

▪ Diuretics: The loss of hydrogen ions and chloride from diuresis causes a compensatory increase in the amount of bicarbonate in the blood. ▪ Excessive vomiting or gastrointestinal suctioning: Leads to an excessive loss of hydrochloric acid. ▪ Hyperaldosteronism: Increased renal tubular reabsorption of sodium occurs, with the resultant loss of hydrogen ions. ▪ Ingestion of and/or infusion of excess sodium bicarbonate: Causes an increase in the amount of base in the blood. ▪ Massive transfusion of whole blood: The citrate anticoagulant used for the storage of blood is metabolized to bicarbonate.