ABGs

Question 1

S/S of ACIDOSIS

similar whether cause is metabolic or acidotic

Answer 1

Cardio:

1. Delayed electrical conduction
   - bradycardia
   - tall T waves
   - widened QRS complex
   - prolonged PR interval
2. Hypotension
3. Thready peripheral pulses

CNS - depressed activity

1. lethargy
2. confusion
3. stupor
4. coma

Neuromuscular

1. hyporeflexia
2. skeletal muscle weakness
3. flaccid paralysis

Respiratory

1. Kussmaul respirations (fast but shallow) if metabolic
   - so HYPOventilation b/c depth is shallow

Skin

1. Metabolic - warm, flushed, dry skin
2. Respiratory - pale to cyanotic, dry skin

Question 2

Causes of Metabolic Acidosis

Answer 2

• DKA (diabetic ketoacidosis)
• starvation
• excessive ingestion of acids (aspirin, ethanol)
• kidney failure
• liver failure
• dehydration
• diarrhea

Question 3

Causes of Respiratory Acidosis

Answer 3

Respiratory depression (HYPOVENTILATION)
 - anesthetics
 - drugs = opioids
 - electrolyte imbalance
Inadequate chest expansion 
 - muscle weakness
Airway obstruction
Alveolar-capillary block

Question 4

Treatment: Metabolic Acidosis

Answer 4

Hydration
Treat underlying cause:
1. DKA - insulin, F/E balance
2. Diarrhea - rehydrate, anti-diarrheal drugs
3. Bicarbonate - only if serum bicarb < 10 (ph 7.2)
– dose 1 mEq/kg

Question 5

Treatment: Respiratory Acidosis

Answer 5

Treat underlying cause - ⇡O2

1. Drugs - bronchodilators, anti-inflammatory, mucolytics
2. O2 - lowest FiO2 possible (toxicity)
3. Pulmonary hygiene - high Fowler’s, ⇡fluid intake, breaking techniques
4. Ventilation support - if respiratory muscle fatigue
5. Prevention - monitor breathing status - breath sounds, muscle retractions & use of accessory muscles, color of nail beds, oral mucus membranes

Question 6

S/S of ALKALOSIS

Answer 6

Over stimulation
CNS:
- anxiety, irritability, tetany, seizures
- positive Chvostek's sign
- positive Trousseau's sign
Neuromuscular
- hyperreflexia
- muscle cramping and twitching
- skeletal muscle weakness
Cardio
- ⇡HR
- normal or low BP
- ⇡digitalis toxicity
Respiratory
- ⇡rate and depth of ventilation in respiratory alk.
- ↓ respiratory effort assoc w/ skeletal muscle weakness in metabolic alkalosis

Question 7

Causes of Metabolic Alkalosis

Answer 7

• Ingestion of antacids
• Parenteral base administration - blood transfusion, sodium bicarb, TPN
• Prolonged vomiting
• NG suctioning
• Hypercortisolism
• Hyperaldosteronism
• Thiazide diuretics

Question 8

Causes of Respiratory Alkalosis

Answer 8

Hyperventilation, fear, anxiety
Mechanical ventilation
Salicylate toxicity (aspirin)
High altitudes
Shock
Early-stage acute pulmonary problems

Question 9

Treatment: Metabolic Alkalosis

Answer 9

1. GI loss - antiemetics; replace F/E

2. Diuretics - D/C diuretics; replace F/E

Question 10

Treatment: Respiratory Alkalosis

Answer 10

O2 therapy; re-breathing techniques

Anxiety reduction interventions