ch 4 treating disorders of acid-base balance

the goal of treating all acid-base imbalances is

reversing the underlying cause

treatment of respiratory acidosis

improving ventilation and lowering partial pressure of arterial carbon dioxide

if hypoventilation can’t be corrected, patient should have an artificial airway inserted and be placed on mechanical ventilation

treatment for respiratory acidosis with a pulmonary cause also includes

bronchodilator to open constricted airways

supplemental oxygen as needed

drug therapy to treat hyperkalemia

an antibiotic to treat infection

chest physiotherapy to remove secretions from the lungs

removal of a foreign body from patient’s airway if needed

if respiratory acidosis stems from nonpulmonary conditions

underlying cause must be corrected

respiratory alkalosis treatment underlying condition

may include removing causative agent such as a salicylate or other drugs or taking steps to reduce fever and eliminate source of sepsis

respiratory alkalosis if acute hypoxemia is cause

oxygen therapy is initiated

respiratory alkalosis if anxiety is cause

patient may receive a sedative or an anxiolytic

hyperventilation can be counteracted by having patient

breathe into a paper bag

CO2 rebreather mask

if a patient’s respiratory alkalosis is iatrogenic (caused by effects of treatment)

mechanical ventilator settings may be adjusted by decreasing tidal volume or number of breaths delivered per minute

metabolic acidosis

treatment aims to address both symptoms and underlying cause

metabolic acidosis first line of therapy

respiratory compensation with mechanical ventilation

metabolic acidosis for patients with diabetes

expect to administer rapid-acting insulin to reverse diabetic ketoacidosis and drive potassium back into the cell

metabolic acidosis for any patient

monitor serum potassium levels

metabolic acidosis sodium bicarbonate is administered IV to neutralize blood acidity

fluids are replaced parenterally as needed

dialysis may be initiated in patients with renal failure or a toxic reaction to a drug - may get an antibiotic to treat sources of infection or an antidiarrheal

metabolic alkalosis treatment

ammonium chloride IV over 4 hours

diuretics and nasogastric suctioning are discontinued

antiemetic may be administered to treat underlying nausea and vomiting

acetazolamide may be administered to increase renal excretion of bicarbonate