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NUR 105 Med/Surg Acid Base Balance

Metabolic Alkalosis

*increased pH
*Increased HCO3

Metabolic Alkalosis

accumulation of HCO3
decrease in H+ concentration
*if left untreated can cause cardiac arrhythmia, coma, or death

Major Causes

vomiting or gastric suction; loss of hydrochloric acid from stomach
loss of K
excess alkali ingested from antacids(containing HCO3)
use of Sodium Bicarbonate during CPR

Signs & Symptoms

mostly related to movement of Ca (decreased Ca ionization)
tingling of fingers and toes
carpopedal spasm (Trousseau sign)
depressed respirations (b/c of compensation trying to hold CO2)
paralytic ileus (gut shuts down to hold HCO3)

Diagnostic Findings

ABGs (increased pH and HCO3)
decreased respirations (shallow breathing) to hold CO2
urine chloride

Medical Management

eliminate the cause (too much bicarb, to much loss of acid)
use antiemetics, H2 blockers
correct electrolyte imbalances
give calcium gluconate
correct fluid volume depletion

Calcium Gluconate

give to patient to correct calcium imbalance in patient with carpopedal spasms or tingling fingers/toes

In a patient with metabolic alkalosis you will see...

restlessness, followed by lethargy
compensatory hypoventilation
confusion, decreased LOC
nausea and *Profuse vomiting
slow respirations
increased pH
increased HCO3

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