[Acid-Base imbalances] Metabolic Alkalosis / 대사성 알칼리증

1. 대사성 알칼리증: 

i) excessive loss of acids

ii) increased amount of bicarbonate (HCO3)

iii) disease processes & drugs

 

2. 보상작용 'hopefully fixing the blood's pH and bicarb level. -> respiratory system stimulates hypoventilate which will retain PaCO2(carbon dioxide)

 

3. Lab values (Metabolic Alkalosis)

i) HCO3: increases >26

ii) Blood pH: increases >7.45

iii) PaCO2: >45 or normal (may be normal but if it is increased this is the body's way of trying to compensate)

Normal Values for ABGs
1. pH= 7.35~7.45
2. Bicarbonate (HCO3): 22~26
3. PaO2: 80~100mmHg
4. PaCO2: 35~45mmHg
5. SaO2: 95~100%

 

4. S&S

- Bradypnea (hypoventilation) <12 bpm and respiratory failure

- low potassium -> dysrhythmia, tetany, tremors, muscle weakness/cramping, tired, irritable, Seizure..

 

5. Cause: ALKALI

(A) Acid loss via stomach due to nasogastric suction or vomiting

(L) Low chloride level which increases the bicarb level

(K) K+ loss (hypokalemia): this state causes wasting of chloride and increases reabsorption of bicarb

(A) Aldosterone elevatee (hyperaldosteronism) 

-causes the renal tubule in the kidneys to keep sodium which wastes hydrogen ions (K) and this leads you to keep bicarb

(L) Loop & thiazide: causes the kidneys to waste hydrogen ions and chloride through the urine which in turn increases the bicarb

(I) Increased sodium bicarb administration (trying to correct metabolic acidosis)

 

6. NRS Action

-Monitoring ECG (at risk for dysrhythmias)

-respiratory status (risk for respiratory failure) and neuro status

-Replacement for low K and CI

-antiemetics for vomiting

-Hold diuretics that worsen alkalosis (loop and thiazides)

-Acetazolamide (Diamox) : a carbonic anhydrase inhibitor and a diuretic which reduces the reabsorption of bicarb.