Metabolic Acidosis

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What are the tests used?

ABGs, pulse ox, serum electrolytes

What should you monitor?

ECG, for hyperkalemia, ABGs, lab values, electrolyte, renal function test, I&O

What is important to give?

IV fluids for dehydration

What are clinical manifestations?

N/V, diminished appetite, abdominal pain, weakness, fatigue, headache, general malaise, decreasing LOC, dysrhythmias, bradycardia, warm flushed skin, skeletal problems, hyperventilation, dyspnea

What are some S&S?

N/V/D, abdominal discomfort

What is AKA treated with?

NS and glucose

What can hypokalemia cause?

U waves

What is metabolic acidosis?

a bicarb deficit characterized by a low pH(less than 7.35), low bicarb (less than 24), and partial pressure of carbon dioxide less than 38, it may be caused by excess acid in the body or loss of bicarb from the body

What should the physical assessment include?

abdominal exam, VS, peripheral pulses, capillary refill

What is used for too much salicylate?

activated charcoal

How long should sodium bicarbonate be used for?

brief period (2 weeks)

Who should sodium bicarbonate be used caution in?

cardiac disease and renal impairment patients

What is a serious side effect of sodium bicarbonate?

chest pain or dyspnea

What provides the most accurate indicator for fluid balance?

daily weights

What is kussmaul respirations?

deep, rapid respirations associated with compensatory mechanisms

What are risk factors?

diabetes, alcohol abuse, starvation, renal failure, severe sepsis, ingestion of salicylates (aspirin), methanol, ethlyene glycol

What causes a loss of bicarb?

diarrhea, small bowel pancreatic, biliary fistula drainage

What patients are at higher risk of taking these medications?

diuretics, some antidepressants, anticonvulsants, ACE inhibitors

What is the antidote for methanol and ethylene glycol poisoining?

fomepizole

What are early manifestations?

headache and changes in mental status

What can occur during metabolic acidosis?

hyperosmolality

What can cause metabolic acidosis?

ingestion of methanol and ethylene glycol, decreased renal perfusion

What drug can cause lactic acidosis?

metformin

What are the clinical therapies?

monitor ABGs, I&O, LOC, provide oral care, administer sodium bicarb

What are some causes?

overexercise, ketosis from DM, starvation, alcoholism, renal failure, internal fistula, shock, OD on aspirin, phenobarbital, carbonic anhydrase inhibitor drugs, DKA

What can hyperkalemia cause?

peaked T waves

What causes alcoholic ketoacidosis (AKA)?

prolonged alcohol binge with decreased food and vomiting

What should be done with DKA and AKA?

replace fluids

When should you call the HCP about sodium bicarbonate?

severe stomach pain, swelling, rapid weight gain, SOB

What is the treatment of choice?

sodium bicarbonate

What are other treatments?

sodium lactate and citrate

What is the most important thing to monitor?

vitals

When is sodium bicarbonate used?

when pH is less than 7.1


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