Metabolic and Respiratory Acid-Base Imbalances: Pathophysiology, Causes, and Nursing Management

What is metabolic acidosis?

A condition characterized by decreased serum bicarbonate and pH below 7.35.

What causes metabolic acidosis?

Renal and GI loss of bicarbonate, acid ingestion, and alterations in acid production and excretion.

What is metabolic alkalosis?

A condition characterized by increased serum bicarbonate and pH above 7.45.

What can lead to metabolic alkalosis?

Loss of gastric secretions, renal and GI loss of hydrogen ions, and excessive bicarbonate intake.

What are common risk factors for metabolic acidosis?

Medications (e.g., metformin), kidney disease, liver failure, and congenital lactic acidosis.

What are the complications of metabolic acidosis?

Osteoporosis, worsening kidney disease, shock, and death.

What are the clinical manifestations of metabolic acidosis?

Confusion, lethargy, nausea, vomiting, and hemodynamic instability.

What is the primary laboratory test for metabolic imbalance?

Arterial Blood Gases (ABGs).

What is respiratory acidosis?

A condition characterized by increased serum carbon dioxide and pH below 7.35.

What causes respiratory acidosis?

Hypoventilation and increased physiologic dead space.

What is respiratory alkalosis?

A condition characterized by decreased serum carbon dioxide and pH above 7.45.

What can lead to respiratory alkalosis?

Hyperventilation and decreased carbonic acid.

What are the risk factors for respiratory acidosis?

Acute or chronic processes causing CO2 retention, such as drugs, pneumonia, and COPD.

What are the symptoms of respiratory alkalosis?

Shortness of breath, dizziness, confusion, and sometimes asymptomatic.

What is the role of the nurse in managing metabolic acidosis?

Monitor ABGs, educate clients on dietary recommendations, and manage underlying conditions.

What dietary strategies can help manage metabolic acidosis?

Increasing intake of fruits and vegetables.

What is the treatment for respiratory acidosis due to obstructive airway disease?

Bronchodilators.

What is a common treatment for respiratory alkalosis caused by anxiety?

Anxiolytics and breathing into a paper bag.

What are Kussmaul respirations?

Deep, labored breathing associated with metabolic acidosis, particularly diabetic ketoacidosis.

What is the normal range for arterial blood gas pH?

7.35 to 7.45.

What is the significance of a base excess/deficit in ABGs?

It indicates the amount of excess or insufficient bicarbonate in the blood.

What are common laboratory tests for respiratory imbalance?

ABGs, serum bicarbonate, and electrolytes.

What is the impact of metabolic alkalosis on health?

Can lead to seizures, hypoxia, and neurological symptoms due to hypokalemia and hypocalcemia.

What are the potential neurological effects of chronic respiratory acidosis?

Memory loss, poor coordination, and increased anxiety.

What is the relationship between alkalosis and anxiety disorders?

Anxiety can increase serum lactate levels, contributing to alkalosis.

What is the role of client education in managing respiratory imbalances?

Educate on risks of oversedation, anxiety management, and dietary recommendations.

What is the significance of monitoring capillary glucose in DKA?

To manage insulin administration and prevent complications.

What are the ABG values indicating metabolic acidosis?

pH < 7.35, PaCO2 normal or decreased, HCO3− < 22 mEq/L.

What are the ABG values indicating metabolic alkalosis?

pH > 7.45, PaCO2 normal or increased, HCO3− > 26 mEq/L.