- Physical exam to evaluate symptoms.
- Blood tests to measure blood gases, acid-base balance and electrolyte levels.
- Electrocardiogram (EKG) to check for an arrhythmia.
- Urinalysis that may help find the cause of the metabolic alkalosis.
What lab values should I pay attention to with metabolic alkalosis?
With metabolic alkalosis, it's important to replace the patient's lost fluid and electrolytes, so you will want to pay attention to the related lab values. The lab values that pertain to fluid and electrolytes are Sodium, Calcium, Magnesium, Potassium, Chloride, Phosphorous, Urine Output, Urine Specific Gravity, Urine Osmolality.
What causes metabolic alkalosis?
Metabolic alkalosis results from the loss of acid, retention of base with decreased serum levels of potassium and chloride. Other causes may include: Vomitting. Nasogastric tube drainage or lavage without adequate electrolyte replacement. Fistulas.
What is the pH of blood in metabolic alkalosis?
In metabolic alkalosis, the pH of your blood is high. The most neutral substance, water, has a pH of 7. When the pH of a liquid falls below 7, it becomes acidic. When it rises above 7, it’s alkaline.
How do you treat metabolic alkalosis?
Metabolic alkalosis treatment uses an intravenous (IV) line to deliver fluid and other substances, such as: 1 Saline infusion. 2 Potassium replacement. 3 Magnesium replacement. 4 Chloride infusion. 5 Hydrochloric acid infusion. 6 Stopping the medications that caused the condition, for example high doses of diuretics. More ...
Which laboratory finding indicates metabolic alkalosis?
Metabolic alkalosis is diagnosed by measuring serum electrolytes and arterial blood gases. If the etiology of metabolic alkalosis is not clear from the clinical history and physical examination, including drug use and the presence of hypertension, then a urine chloride ion concentration can be obtained.
What indicates metabolic alkalosis?
Normal human physiological pH is 7.35 to 7.45. A decrease in pH below this range is acidosis, an increase over this range is alkalosis. Metabolic alkalosis is defined as a disease state where the body's pH is elevated to greater than 7.45 secondary to some metabolic process.
What test would confirm metabolic alkalosis and what would it show?
Electrolytes test, such as basic metabolic panel to confirm alkalosis and show whether it is respiratory or metabolic alkalosis.
What lab values show metabolic acidosis?
In metabolic acidosis, the distinguishing lab value is a decreased bicarbonate (normal range 21 to 28 mEq/L). The normal anion gap is 12. Therefore, values greater than 12 define an anion gap metabolic acidosis.
How is metabolic alkalosis diagnosed?
Metabolic alkalosis is diagnosed by measuring serum electrolytes and arterial blood gases. If the etiology of metabolic alkalosis is not clear from the clinical history and physical examination, including drug use and the presence of hypertension, then a urine chloride ion concentration can be obtained.
How does alkalosis affect potassium?
A frequently cited mechanism for these findings is that acidosis causes potassium to move from cells to extracellular fluid (plasma) in exchange for hydrogen ions, and alkalosis causes the reverse movement of potassium and hydrogen ions.
What are three causes of metabolic alkalosis?
Causes of metabolic alkalosisLoss of stomach acids. This is the most common cause of metabolic alkalosis. ... Excess of antacids. ... Diuretics. ... Potassium deficiency (hypokalemia). ... Reduced volume of blood in the arteries (EABV). ... Heart, kidney, or liver failure. ... Genetic causes.
What causes high hco3 levels?
A high level of bicarbonate in your blood can be from metabolic alkalosis, a condition that causes a pH increase in tissue. Metabolic alkalosis can happen from a loss of acid from your body, such as through vomiting and dehydration.
What are the laboratory tests to evaluate acid-base balance?
To detect an acid-base disturbance, both a blood gas analysis and chemistry panel should be performed. This combines traditional blood gas analysis (Henderson-Hasselback equation) and the strong ion approach (by evaluating the contributions of electrolytes, in particular).
What test determines acidosis and alkalosis?
ABGs also measure base excess/base deficit (BE/BD), which is the best indicator of the degree of acidosis/alkalosis. BE/BD is measured by gauging the amount of acid or base that is required to titrate the patient's blood sample to a pH of 7.40, given a PCO2 level of 40 mm Hg at 37°C.
How do you determine acidosis and alkalosis?
Step 1 — check the pH A pH of less than 7.35 indicates acidosis and a pH greater than 7.45 indicates alkalosis.
What is the most reliable indicator of metabolic acidosis?
The two largest studies show that if the control group is of patients with a base excess (BE) of −5 mmol/L, corresponding to a base deficit of 5 mmol/L, plasma bicarbonate below 20 mmol/L is a good diagnostic indicator of metabolic acidosis [13, 14].
What are three causes of metabolic alkalosis?
Causes of metabolic alkalosisLoss of stomach acids. This is the most common cause of metabolic alkalosis. ... Excess of antacids. ... Diuretics. ... Potassium deficiency (hypokalemia). ... Reduced volume of blood in the arteries (EABV). ... Heart, kidney, or liver failure. ... Genetic causes.
What does high HCO3 mean?
A bicarbonate level that is higher or lower than normal may mean that the body is having trouble maintaining its acid-base balance, either by failing to remove carbon dioxide through the lungs or the kidneys or perhaps because of an electrolyte imbalance, particularly a deficiency of potassium.
What causes metabolic alkalosis quizlet?
Causes of Metabolic Alkalosis? -excessive vomiting -prolonged gastric suctioning -electrolyte disturbances (hypokalemia) -Cushing's disease -excessive NaHCO3 intake -OD on baking soda -diuretics -excessive mineralocorticoids.
What is the difference between metabolic acidosis and metabolic alkalosis?
Acidosis and alkalosis are conditions in which there is a disturbance in the pH balance (acid-base balance) of the body. Acidosis is a condition in which the bodily fluids become too acidic, with an abnormally low pH level. In alkalosis, the opposite is true: the fluids of the body are too alkaline (high in pH).
What tests are used to check for metabolic alkalosis?
Blood tests to measure blood gases, acid-base balance and electrolyte levels. Electrocardiogram (EKG) to check for an arrhythmia. Urinalysis that may help find the cause of the metabolic alkalosis.
Why is metabolic alkalosis important?
Metabolic alkalosis is usually not life-threatening. It does not have lingering effects on your health once it is treated. But it’s important to seek medical care because it can lead to severe complications. Treatment with IV fluids helps many people make a full recovery. Addressing the cause can lower your risk of future episodes.
What causes alkalosis in the body?
Other causes of metabolic alkalosis include medical conditions such as: Cystic fibrosis. Dehydration. Electrolyte imbalances, which affect levels of sodium, chloride, potassium and other electrolytes. High levels of the adrenal hormone aldosterone ( hyperaldosteronism ).
Why does alkalosis occur?
It can occur in a variety of conditions. It may be due to digestive issues, like repeated vomiting, that disrupt the blood ’s acid-base balance. It can also be due to complications of conditions affecting the heart, liver and kidneys.
What to do after alkalosis treatment?
You may wish to make small changes to lower your risk of future episodes. These changes may include: Decreasing the dose of or discontinuing steroids, laxatives, water pills or antacids.
What is the term for the body's acid-base balance?
What is alkalosis ? Alkalosis occurs when your blood and body fluids contain an excess of bases or alkali. Your blood’s acid-base (alkali) balance is critical to your well-being. When the balance is off, even by a small amount, it can make you sick.
What are the symptoms of metabolic alkalosis?
Many metabolic alkalosis symptoms are concerning and need prompt medical evaluation. If you are experiencing an arrhythmia, seizures or confusion, seek care right away.
What causes metabolic alkalosis?
Loss of acidic gastric contents will cause a metabolic alkalosis.
What is the most commonly used diuretic for metabolic alkalosis?
Acetazolamide: ( more )#N#Acetazolamide is the most commonly used diuretic for metabolic alkalosis and perhaps the most effective.#N#Make sure to monitor potassium levels carefully (acetazolamide may induce hypokalemia, which will aggravate treatment of the metabolic alkalosis).
Is hypoventilation a sign of metabolic alkalosis?
Hypoventilation (due to respiratory compensation for the metabolic alkalosis). Generally not a significant issue. For patients with a weak respiratory drive (e.g., obesity hypoventilation syndrome or COPD), severe metabolic alkalosis may promote hypoventilation.
Can metabolic alkalosis be treated with volume resuscitation?
Instead, resolving the underlying cause is generally sufficient. For example, a patient with hypovolemia may be treated with volume resuscitation.
Is metabolic alkalosis a treatment for renal failure?
This is a potential treatment of metabolic alkalosis among patients with renal failure.
Can alkalosis be reversed?
Alkalosis is moderate to severe (either causing symptoms). The process causing the alkalosis can't be easily reversed (e.g., patient develops contraction alkalosis from diuretics, but you need to continue diuretic therapy to achieve volume control).
Can hypomagnesemia cause alkalosis?
Hypomagnesemia may contribute to alkalosis and make it difficult to successfully treat the hypokalemia. Therefore, hypomagnesemia should also be corrected.
What is metabolic alkalosis?
Metabolic alkalosis is defined as a disease state where the body’s pH is elevated to greater than 7.45 secondary to some metabolic process. Before going into details about pathology and this disease process, some background information about the physiological pH buffering process is important. The primary pH buffer system in ...
What is chloride responsive metabolic alkalosis?
In chloride responsive metabolic alkalosis, this includes repletion of electrolytes, specifically chloride and potassium along with the replenishment of fluid. In scenarios, such as congestive heart failure (CHF) or edematous states, diuresis is essential using potassium-sparing diuretics.
What happens if the expected pCO2 does not match the measured value?
If the expected pCO2 does not match the measured value, an underlying metabolic alkalosis is a likely present.
What is the term for a disease where the body's pH is elevated to greater than 7.45?
A decrease in pH below this range is acidosis, an increase over this range is alkalosis. Metabolic alkalosis is defined as a disease state where the body’s pH is elevated to greater than 7.45 secondary to some metabolic process.
Which two substances regulate cerebral blood flow in the setting of acute experimental metabolic alkalosis?
Arterial carbon dioxide and bicarbonate rather than pH regulate cerebral blood flow in the setting of acute experimental metabolic alkalosis.
What causes bicarbonate to increase in blood?
Several etiologies lead to increases in bicarbonate within the blood. The simplest of which is an overdose of exogenous sodium bicarbonate in a medical setting. Milk-alkali syndrome is a pathology where the patient consumes excessive quantities of oral calcium antacids, which leads to hypercalcemia and varying degrees of renal failure. Additionally, since antacids are neutralizing agents, they add alkaline substances to the body while reducing acid levels thus increasing pH. A pathology that is in line with normal physiology is the body’s natural compensation mechanism for hypercarbia. When a patient hypoventilates, CO2 retention occurs in the lungs and subsequently reduces pH. Over time, the renal system compensates by retaining bicarbonate to balance pH. This is a slower process. Once the hypoventilation is corrected, such as with a ventilator-assisted respiratory failure patient CO2 levels will quickly decrease, but bicarbonate levels will lag in reducing. This causes post-hypercapnia metabolic alkalosis, which is self-correcting. It is possible to calculate the expected pCO2 in the setting of metabolic alkalosis to determine if it is a compensatory increase in bicarbonate, or if there is an underlying pathology driving alkalosis using the following equation:
What is the infusion rate for chloride-responsive metabolic alkalosis?
Patients with chloride-responsive metabolic alkalosis are given 0.9% saline solution IV; infusion rate is typically 50 to 100 mL/hour greater than urinary and other sensible and insensible fluid losses until urinary Cl rises to > 25 mEq/L (> 25 mmol/L) and urinary pH normalizes after an initial rise from bicarbonaturia.
What helps differentiate chloride-unresponsive alkaloses?
Urinary K and the presence or absence of hypertension help differentiate the chloride-unresponsive alkaloses.
What causes a high pH?
Common causes include prolonged vomiting, hypovolemia, diuretic use, and hypokalemia. Renal impairment of HCO 3− excretion must be present to sustain alkalosis. Symptoms and signs in severe cases include headache, lethargy, and tetany. Diagnosis is clinical and with arterial blood gas and serum electrolyte measurement. The underlying condition is treated; oral or IV acetazolamide or hydrochloric acid is sometimes indicated.
Which ion is most reactive in acid-base regulation?
Acid-Base Regulation Metabolic processes continually produce acid and, to a lesser degree, base. Hydrogen ion (H+) is especially reactive; it can attach to negatively charged proteins and, in high concentrations... read more
Is hypokalemia a metabolic disorder?
Thus, hypokalemia is both a cause and a frequent consequence of metabolic alkalosis. The most common causes of metabolic alkalosis are. Volume depletion (particularly when involving loss of gastric acid and chloride [Cl] due to recurrent vomiting or nasogastric suction) Diuretic use.
What is the pH of metabolic alkalosis?
Uncompensated metabolic alkalosis occurs when metabolic alkalosis is present, with pH basic (over 7.45) and HCO₃ basic (over 26 mEq/L); but the respiratory system does not act to correct it, marked by PaCO₂ in the normal range (35 - 45 mmHg).
What is the pH level of fully compensated metabolic alkalosis?
Fully compensated metabolic alkalosis occurs when metabolic alkalosis is present, with pH normal but closer to basic (7.40 - 7.45) and HCO₃ basic (over 26 mEq/L); and the respiratory system acts to correct it, marked by a PaCO₂ level that's acidic (over 45 mmHg).
Is HCO3 a metabolic system?
And if we look at HCO3, or bicarbonate, which represents the metabolic system, if it is over 26, then that is basic. And then we know that we are dealing with metabolic alkalosis. So in this case, we have uncompensated metabolic alkalosis. We have alkalosis that is caused by the metabolic system. And the respiratory system is chilling out and not doing anything to try to fix the situation.
Can you get metabolic alkalosis from taking too many tums?
If a patient has gotten metabolic alkalosis from taking too many TUMS, they will require some patient education to not do that anymore.
Is pH normal for metabolic alkalosis?
That's the trick with fully compensated metabolic alkalosis. The pH may be technically within the normal range. But the way to determine this is still metabolic alkalosis is that the pH is on the alkalotic side (7.40 - 7.45) and the other two blood gases, HCO₃ and PaCO₂ are outside the normal range.
What does a pH of 7.45 mean?
Check the pH. A pH over 7.45 is alkalotic, and indicative of alkalosis.*
Can nasogastric tube suction cause metabolic alkalosis?
Prolonged nasogastric tube suctioning and excess diuretic therapy can also result in metabolic alkalosis. Diuretics are just one of the many important medications covered in our Pharmacology Flashcards for Nursing Students
What is metabolic alkalosis?
Metabolic Alkalosis is an acid-base imbalance characterized by excessive loss of acid or excessive gain of bicarbonate produced by an underlying pathologic disorder. Metabolic alkalosis causes metabolic, respiratory, and renal responses, producing characteristic symptoms.
What causes a person to vomit when they have alkalosis?
Other causes may include: Vomitting. Nasogastric tube drainage or lavage without adequate electrolyte replacement. Fistulas.
