Acid Base: Metabolic Alkalosis

Question 1

What is the pathophysiology of metabolic alkalosis?

Answer 1

1. hydrogen ions lost through kidneys, gastric secretions, or shift of H+ into cells
2. Loss of hydrogen ions from vomiting and gastric suction
3. Increased renal excretion prompted by hypokalemia
4. excess bicarbonate from ingesting antacids or overtreatment of metabolic acidosis.
5. More calcium combines with serum proteins, reducing ionized serum calcium
6. Affects potassium balance, can cause hypokalemia
7. High pH depresses respiratory system as CO2 is retained to restore carbonic acid-bicarbonate ratio

Question 2

What things can cause metabolic alkalosis?

Answer 2

1. excessive ingestion of antacids
2. Excessive use of bicarbonate
3. lactate administration in hemodialysis
4. Hyperaldosteronism
5. Hypokalemia
6. Hypochloremia
7. NG suctioning
8. Loop diuretics

Question 3

What are the risk factors for metabolic alkalosis?

Answer 3

1. hospitalization
2. hypokalemia
3. Treatment with bicarbonate
4. Older adults= delicate fluid/electrolyte balance
5. self-induced vomiting
6. Chronic hypercapnia respiratory failure

Question 4

What are the clinical manifestations of metabolic alkalosis?

Answer 4

1. numbness/tingling around the mouth, fingers, and toes
2. dizziness
3. trousseau sign
4. muscle spasms
5. respirations depressed
6. respiratory failure with hypoxemia
7. respiratory acidosis

Question 5

What are the pharmacologic therapies used for metabolic alkalosis?

Answer 5

1. restore normal fluid volume
2. administer potassium chloride solution
3. administer sodium chloride solution
4. Severe alkalosis= administer acidifying solution
5. drugs may also be used to treat underlying cause of alkalosis

Question 6

What are the lifespan considerations for infants and children?

Answer 6

1. higher incidence post cardiac surgery
2. prolonged vomiting
3. NG suctioning
4. Cystic fibrosis
5. Hypokalemia
6. Use of diuretics

Question 7

What are the interventions for infants and children with metabolic alkalosis?

Answer 7

1. monitor LOC, neuromuscular activity
2. Monitor for nausea/vomiting
3. Assess respiration rate, depth
4. ABGs
5. Position to ease respirations, prevent aspiration of vomitus

Question 8

What are the lifespan considerations for older adults?

Answer 8

1. may be consequence of a disorder
2. Loss of fluids/volume contraction lower serum potassium
3. Dehydration (vomiting, diminished thirst=volume depletion)
4. outcome depends on nature of illness and early diagnosis/treatment

Question 9

What are the interventions to monitor for impaired gas exchange?

Answer 9

1. monitor RR, depth, and effort
2. Monitor O2=report levels below 95
3. Assess skin color
4. Monitor mental status/LOC
5. Place in semi-Fowler or Fowler position as tolerated
6. Administer O2 as ordered
7. Schedule nursing care activities to allow rest periods

Question 10

What are the interventions to monitor for fluid volume deficit?

Answer 10

1. assess I&O accurately
2. Assess VS, CVP, and peripheral pulse volume at least every 4 hours for signs of hypovolemia
3. Weight daily under standard conditions
4. Administer IV fluids as prescribed
5. Monitor serum electrolytes, osmolality and ABG values

Question 11

What education should be given to a patient who had metabolic alkalosis before discharge?

Answer 11

1. use appropriate antacids
2. Using potassium supplements as ordered
3. Contacting primary care provider if uncontrolled or extended vomiting develops