Question | Answer |
Metabolic acidosis is generally caused by | overproduction/underelimination of hydrogen or overelimination/underproduction of bicarbonate |
Overproduction of hydrogen includes | excessive breakdown of fatty acids, lactic acidosis, and excessive intake of acids |
Fatty acid breakdown | occurs in starvation and diabetic ketoacidosis |
Lactic acidosis | anerobic glucose breakdown, occurs in heavy exercise, seizures, and reduced oxygen intake |
Underelimination of hydrogen includes | Kidney and respiratory failure |
Overelimination of bicarbonate includes | Bicarbonates are excreted too quickly, as in diarrhea |
Underproductoin of bicarbonate includes | Kidney and pancreatic failure |
Other underlying causes of metabolic acidosis | hyperthyroidism, infection, burns, circulatory shock, tissue anoxia, oliguric, renal failure, intake of acids (aspirin), GI fistual drainage, GI and pancreatic secretions, intestinal decompression, renal tubular acidosis, DM, sepsis, and anorexia |
Metabolic acidosis cardiovascular s/s | inc HR or cardiac output, signs of hyperkalemia includes dec HR, T waves peaked, QRS complex widened, hypotension, thready pulse |
Metabolic acidosis CNS s/s | depressed or unresponsive |
Metabolic acidosis neruomuscular s/s | hyporeflexia, skeletal muscle weakness, flaccid paralysis |
Metabolic acidosis respiratory s/s | kussmaul (deep, rapid, involuntary) respirations, varied respirations |
Metabolic acidosis integumentary s/s | warm, flushed, dry skin |
What is one of the first signs of acidosis? | Behavioral changes |
Hypokalemia in metabolic acidosis | weak pulse, depressed U waves, shallow respirations and SOB |
What should be done for metabolic acidic pt with hypokalemia? | verify renal function before administration of K, do not give K too rapidly, dilute K, give with orange, grape, tomato or apple juice--Vitamin C/ascorbic acid helps K absorption |
Other disorders that appear with metabolic acidosis | DM, hypovalemia, renal failure, lactic acidosis, addison's dz. |
Care for diabetes mellitus in metabolic acidosis | admin insulin when hyperglycemic, admin glucose with hypoglycemic, insulin can help in uptake of K |
Care for hypovalemia in metabolic acidosis | volume expander, blood transfusions, monitor and treat shock |
Care for renal failure in metabolic acidosis | Dialysis, transplant, dietary modifications (control of protein, Na, fluid, supplemental calories and carbs needed) |
Lactic acidosis | Oxygen and NaHCO3 (sodium bicarbonate) |
Addison's D. | cortisone preperations, high sodium diet, fluids for shock |