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base (increase level of bicarbonate). Blood p.H. is above 7.45. (med. Surg. 2nd ed., white & Duncan) It is usually associated with hypocalcemia and hypokalemia which may account for early sign and symptoms. (Handbook of medsurg. 3rd ed., Springhouse) Metabolic alkalosis is a pH imbalance that occurs when the body accumulates too much of an alkaline substance, such as bicarbonate, and does not have enough acid to effectively neutralize the effects of the alkali. This disturbanceof the body's acid/base balance, can be a mild condition, brought on by vomiting, the use of steroids or diuretic drugs, or the overuse of antacids or laxatives. Metabolic alkalosis can also indicate a more serious problem with amajor organ such as the kidneys. (Metabolic alkalosis, Information about Metabolic alkalosis http://www.faqs.org/health/topics/39/Metabolicalkalosis.html#ixzz3RlJPariV)
The first clue to metabolic alkalosis is often an elevated bicarbonate concentration that is observed when serum electrolyte measurements are obtained. Remember that an elevated serum bicarbonate concentration may also be observed as a compensatory response to primary respiratory acidosis. However, a bicarbonate concentration greater than 35 mEq/L is almost always caused by metabolic alkalosis. Calculation of the serum anion gap may also help to differentiate between primary metabolic alkalosis and the metabolic compensation for respiratory acidosis. The anion gap is frequently elevated to a modest degree in metabolic alkalosis because of the increase in the negative charge of albumin and the enhanced production of lactate. However, normal values for the anion gap vary in different laboratories and between individual patients, so it is important to know the range of normal for the particular clinical laboratory and know the prevailing baseline value for a particular patient.1 In any event, the only definitive way to diagnose metabolic alkalosis is to perform a simultaneous blood gases analysis, which reveals elevation of both pH and PaCO2 and increased calculated bicarbonate. (emedicine.medscape.com)
Neuromascular assessment may discover hyperactive reflexes and muscle weakness if serum potassium is marked low. The rate and depth of the patient¶s respirations may be decreased as a compensation mechanism.45 and a bicarbonate level over 29mEq/L in metabolic alkalosis. The patient or a family member may report irritability. The History may Include extracellular fluid volume depletion which is commonly associated with conditions leading to metabolic alkalosis. over 7. (e. Serum Electrolyte Studies usually show low potassium. calcium and chloride levels in metabolic alkalosis. confusion. Electrocardiogram (ECG) Findings disclose a low T wave merging with a P wave and atrial or sinus tachycardia. belligerence and paresthesia.g. stupors or COMA if alkalosis is severe. 3. A partial pressure of carbon dioxide over 45mmHg indicates attempts at respiratory compensation. vomiting or NGT suctioning). 2. Diagnostic test results/ findings: 1. . Assessment of the patient¶s Level of Consciousness (LOC) may find apathy. Inspection may reveal presence of tetany if serum calcium levels are borderline or low.Assessment Findings/ Clinical Manifestations Patients history (obtained from a family member if necessary) may disclose such risk factor as excessive ingestions of alkali antacids. Arterial Blood Gas (ABG) Analysis may reveal a blood p.H. however this mechanism is limited because of the development of hypoxemia. seizures. which stimulates ventilation. Auscultation may detect cardiac arrhythmias occurring with hypokalemia.
-Intravenous therapy (to attain fluid balance and electrolyte and acid base balance) 3. Depth and Effort. . Place. . Risk for injury related to tetany .Maintain a normal Calcium Level . -Assess Skin color. -Monitor Respiratory Rate. such as shock and tissue ischemia 2. especially in the presence of underlying lung diseases. As a result the client is at risk for Impaired Gas exchange. IV administration of Ammonium Chloride. Deficient Fluid Volume Clients with Metabolic Alkalosis often have accompanying fluid volume deficit.Nursing diagnosis: 1.Remain safe and protected from injury . Disturbed thought Process related to neurologic dysfunction.Avoid signs and symptoms of tetany 5. person with effective treatment. Risk for Impaired Gas Exchange Respiratory Compensation for metabolic alkalosis depresses the regular rate and reduces the depth of breathing to promote carbon dioxide retention.Become oriented to time. Decreased Cardiac output related to AV arrhythmias -Maintain Hemodynamic Stability -Avoid manifestations of profoundly decreasing cardiac output.To release hydrogen chloride and restore concentration of ECF and chloride levels. Medical Interventions (Therapeutic Effects) 1. (indicates hypoxia) -Monitor Mental Status and LOC 4. note and report cyanosis around the mouth.
There is also an appropriate level of nutrition for every diet. and heart. Potassium Chloride and NSS. because acetazolamide also enhances potassium excretion. one which ensures that our bodies are not only receiving the essential ingredients for good health. You're also likely to have trouble concentrating on your daily tasks.uses to replace losses from Gastric drainage. potassium administration before giving this drug may be necessary. 3. Electrolyte replacement with potassium chloride and discontinuation of diureticsCorrect metabolic Alkalosis resulting from potent diuretic therapy 4. People with a potassium deficiency are said to be suffering from Hypokalemia. but are receiving those in quantities and in ratios which enable us to attain our lifestyle goals.2. You will know that you are deficient in potassium if you find yourself experiencing an overall weakness and seem to be constantly fatigued. bone mass. y y y y y y y y y y y Corn Meat Beans Fish Fowl Most grains Coffee Plums Prunes Cranberries Distilled water Potassium is a mineral salt (electrolyte) that is essential for maintaining the balance of pH levels in our body fluids. There are a number of causes that can bring on potassium deficiency The usual suspects are a poor or inadequate diet that precludes potassium rich foods. may be prescribe to correct metabolic alkalosis without rapid volume expansion. Oral and IV acetazolamide.enhances renal bicarbonate excretion. and adrenal functions. but that doesn't mean that we are getting the nutrients which we need. muscle function. Low levels of potassium can cause potassium deficiency and bring on a whole host of health problems. It plays an important role in regulating our blood pressure. People with diabetes and kidney problems are also likely to suffer from mineral imbalance. Dietary Management: There are appropriate diet plans for whatever shape we happen to be in. nervous system. kidney. For people with Metablic Alkalosis they need to have these kind of foods to replace the acid loss and potassium. and may have difficulty with muscular coordination. We might be eating plenty of food. or too many experimental and fad diets. .
With hemodialysis. The main indication of dialysis in metabolic alkalosis is in patients with advanced renal failure.Potassium deficiency can lead to high blood pressure problems. strokes. So. Dialysis: Both peritoneal dialysis and hemodialysis can be used with certain modifications of the dialysate to correct metabolic alkalosis. cardiac arrhythmias. digoxin cardiotoxicity). if you suspect something of the sort. Otherwise. and heart irregularities. Aside from the aforementioned cantaloupe. metabolic alkalosis may be corrected by using a low-bicarbonate dialysate (bicarbonate can be as low as 18 mmol/L). acetate-free . hypertension. go see your doctor. hepatic encephalopathy. who usually have volume overload and are resistant to acetazolamide.55) or when sodium or potassium chloride cannot be administered because of volume overload or advanced renal failure. Seek the advice of a nephrologist when severe alkalosis is present and HCl therapy or dialysis is contemplated. HCl may also be indicated if rapid correction of severe metabolic alkalosis is warranted (eg. potassium rich foods include: Bananas Oranges Apricots Avocado Strawberries Potatoes Tomatoes Cucumber Cabbage Cauliflower Chard Bell pepper Eggplant Squash Crimini mushrooms Brussels sprouts Turmeric Parsley Spinach Broccoli Tuna Halibut Surgical Management: All metabolic alkalosis (specialized) y y Hydrochloric acid: Intravenous HCl is indicated in severe metabolic alkalosis (pH >7.
Prognosis Mortality rates have been reported as 45% in patients with an arterial blood pH of 7. may be used.biofiltration (buffer-free dialysate).55 and 80% when the pH was greater than 7.65. in which bicarbonate is not present in the dialysate but is infused separately as needed. y . In peritoneal dialysis. dialysis can be performed using isotonic sodium chloride solution as the dialysate.
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