Fluids and Electrolytes

Card Set Information

Fluids and Electrolytes
2013-12-04 22:49:26
Fluids Electrolytes
Chapter 22 Mosby
Show Answers:

  1. acid-base balance
    homeostasis of the hydrogen ion (H+) concentration in the body fluids.
  2. active transport
    • requires energy, it is a force that moves molecules into cells without regard fro their positive or negative charge and against concentration factors that will prevent entry into the cell via diffusion.
    • active transport moves fluid and electrolytes from an area of lower concentration to an area of higher concentration.
  3. adenosine triphosphate (ATP)
    a substance produced in the mitochondria from nutrients and is capable of releasing energy that in turn enables the cell to work
  4. anions
    ions with negative charge
  5. bicarbonate
    • HCO3-
    • one of the main anions in the extracellular fluid
    • 22 to 24 mEq/L
    • alkaline electrolyte whose major function is the regulation of the acid-base balance
    • acts as a buffer to neutralize carbonic acid ratio needed to keep the bod in homeostasis
    • kidneys selectively regulate the amount of bicarbonate retained or excreted
  6. blood buffers
    • circulate through the body in pairs, neutralizing excess acids or bases by contributing or accepting hydrogen ions
    • four major buffering systems: bicarbonate-carbonic, phosphate, protein and hemoglobin systems
  7. calcium
    • a positively charged ion
    • 4.5 mEq/L
    • 99% concentrated in bones and teeth, 1% found in soft tissue and the extracellular fluid
    • three considerations are important in the blood calcium level: 1) deposition and resorption of bone 2) absorption of calcium from the GI tract 3) excretion of calcium in urine and feces
    • Vit D, calcitonin, and parathyroid hormone (parathormone) are necessary for the absorption and utilization of calcium
    • best food sources: milk, cheese, beans, nuts, cauliflower, lettuce and egg yolks
    • osteoporosis prevention requires 1000 mg/day in premenopausal women and 1500 mg/day in postmenopausal woman not receiving estrogen
    • removed from body via urine and feces
    • necessary for normal blood clotting
    • has a depressing or sedative effect on neuromuscular irritability and thus promotes normal transmission of nerve impulses
    • helps regulate normal muscle contraction and relaxation
    • acts as an enzyme activator for chemical reactions in the body
  8. cations
    ions with a positive charge
  9. chloride
    • extracellular anion
    • 96-105 mEq/L
    • chief anion in interstitial and intravascular fluid
    • accounts for more than two thirds of the anions in the body, it is usually not considered alone
    • combines easily with sodium to form sodium chloride or with potassium to form potassium chloride
    • necessary for the formation of hydrochloric acid in gastric juice
    • valuable electrolyte in regulating the osmotic pressure between the compartments and assisting in the regulation of acid-base balance
  10. diffusion
    movement of particles in all directions through a solution or gas
  11. electrolytes
    • substances that when in solution, separate (or dissociate) into electrically charged particles.
    • develop tiny electrical particles known as ions
  12. extracellular
    outside the cells
  13. filtration
    the transfer of water and dissolved substances from an area of higher pressure to an area of lower pressure
  14. homeostasis
    • a relative constancy in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival
    • necessary for bodily fluids and electrolytes remain within the exact limits of normal
    • daily water I&O is approximately 2500mL
  15. hypertonic
    • a solution of higher osmotic pressure
    • pulls fluid from cells
  16. hypotonic
    • a solution of lower osmotic pressure
    • solutions move into the cells, causing them to enlarge
  17. interstitial
    • fluid between the cells or in the tissues
    • 27% of the fluid in the body
    • examples: lymph, cerebrospinal fluid, gastrointestinal secretions
  18. intracellular
    inside the cells
  19. intravascular
    fluid in the plasma within the vessels
  20. ions
    electronically charged particle resulting from the breakdown of an electrolyte; negatively or positively charged
  21. isotonic
    • a solution of same osmotic pressure
    • solutions expand the body's fluid volume without causing a fluid shift from one compartment to another
  22. magnesium
    • second most abundant cation in the intracellular fluid
    • 1.5-2.4 mEq/L
    • majority found in bone 60%, 39% in muscle and soft tissue and 1% in the extracellular fluid
    • dietary intake 200-400mg daily
    • found in whole grains, fruits, vegetables, meat, fish, legumes and dairy products
    • excreted through kidneys
    • kidneys conserve magnesium
    • low magnesium may cause hypertension, cardiac dysrhythmias, ischemic heart disease, sudden cardiac death
    • decreased intracellular magnesium levels may contribute to the hypertension, abnormal glucose tolerance and insulin resistance common in diabetics
  23. osmosis
    • movement of water from an area of lower concentration to an area of higher concentration
    • equalizes the concentration of ions or molecules on each side of the membrane
    • hot dog in boiling water
  24. passive transport
    • movement of small molecules by diffusion across a cell membrane
    • no cellular energy is required to move substances from a high concentration to a low concentration
  25. phosphorus
    • present as hydrogen phosphate (HPO4-)
    • an intracellular anion
    • approximately 4 mEq/L
    • phosphorus and calcium have an inverse relationship in body
    • 70-80% of phosphorus is found combined with calcium in an individual's bones and teeth, 10% in muscle and 10% in nerve tissue of body
    • dietary intake usually 800-1500mg/day
    • foods high in phosphorus include: beef, pork, fish, poultry, milk, legumes
    • 90% excreted by kidneys, remainder by feces
    • contributes to support and maintenance of bones and teeth, important in many chemical reactions and acts as a buffer to regulate the body's acid-base balance, promotes the effectiveness of many b vitamins, assists in normal nerve and muscle activity and participates in carbohydrate metabolism
  26. potassium
    • dominant intracellular cation
    • 3.5-5 mEq/L
    • level in extracellular fluid is low because it is an intracellular electrolyte
    • 98% found in cells and 2% in extracellular fluid
    • foods high in potassium include: oiranges, bananas, apricots cantaloupe, legumes, leafy vegetables, potatoes, mushrooms, tomatoes, carrots and meat
    • excreted through kidneys (80-90%), feces and perspiration
    • potassium and sodium pair off against each other and the kidneys prefer to conserve sodium
    • serum potassium levels increase in kidney failure
    • a rise in potassium levels necessitates continuous monitoring
    • too little or too much affects the heart muscle and potential to result in a life threatening disturbance in cardiac rhythm
    • main function is regulation of water and electrolyte content within the cell
    • with sodium and calcium it promotes transmission of nerve impulses and also skeletal muscle function, assists in the cellular metabolism of carbohydrates and proteins and control the hydrogen ion concentration
    • when potassium moves out of a cell hydrogen ions and sodium move in
  27. sodium
    • a cation
    • most abundant electrolyte in body
    • 134-142 mEq/L
    • major extracellular electrolyte
    • excreted primarily through kidneys
    • dietary sources are: cheese, table salt, seafood, processed meats, canned vegetables, canned soups, ketchup and snack foods
    • functions include regulation of the water balance. Controls the extracellular fluid volume mainly through osmotic pressure, because water follows the sodium in the body
    • increases cell membrane permeability
    • stimulates conduction of nerve impulses and helps maintain neuromuscular irritability and important in controlling contractibility of muscles, especially the heart
  28. Normal fluid loss
    • Skin 500ml
    • Lungs 350ml
    • Feces 150ml
    • Kidney 1500ml
    • Total  2500ml
  29. Glomerular filtration
    • Nephrons filter blood at 125 mL/min, or about 180 L/day.
    • This leads to an output of 1-2L of urine per day
  30. Minimum amount of urine kidneys to excrete to eliminate waste from body
    30 mL/hr
  31. Fluid:weight
    • 1L of fluid=2.2pds or 1kg gain
    • 2.2pds =1L loss
  32. Urine specific measurements
    • A urine specific gravity of more than 1.030 indicates concentrated urine (seen in conditions of dehydration
    • A urine specific gravity of less than 1.010 indicates dilute urine (seen in conditions of hydration)
  33. Diffusion in lungs
    with each inhalation by the patient, oxygen enters the lungs and moves into the intravascular compartment and into the cells by diffusion
  34. Electrolytes that are cations
    • Sodium (Na+)
    • Potassium (K+)
    • Calcium (Ca++)
    • Magnesium (Mg++)
  35. Electrolytes that are anions
    • Chloride (Cl-)
    • Bicarbonate (HCO3-)
    • Sulfate (SO4-)
    • Hydrogen phosphate (HPO4-)
  36. Hyponatremia
    • a less than normal concentration of sodium in the blood
    • possible with sodium loss or water excess
    • sodium drops to less than 134 mEq/L
    • Cause: inadequate sodium intake, loss of GI fluids, vomiting, diarrhea, GI or biliary drainage via nasogastric tube or T-tube, fistulas, loss through skin, diaphoresis, large open lesions, shifting of body fluids, massive edema, ascites, burns, small bowel obstruction, lengthy hydrotherapy
    • S/S: headache, irritability, muscle weakness, muscle twitching, tremors, fatigue, apathy, postural hypotension, nausea and vomiting, abdominal cramps, apprehension
    • NSG Considerations: Monitor I&O, V/S, monitor neurologic status, weigh daily, monitor skin turgor, fluid restriction, observe for abnormal GI, renal or skin losses, replace fluid loss with fluids containing sodium
  37. Hypernatremia
    • greater than normal concentration of sodium
    • sodium level exceeds 145 mEq/L
    • caused by excess sodium or decrease in body water
    • S/S: Dry tenacious mucous membranes, low urinary output, firm, rubbery tissue turgor, restlessness, agitation, confusion, flushed skin
    • NSG Considerations: monitor and record v/s, provide safe environment for confused or agitated patient, monitor I&O, weigh daily, decrease sodium intake, monitor water loss from fever, infection, increased respiratory rate, monitor serum sodium level
  38. Hypokalemia
    • a decrease in the body's potassium to a level less than 3.5mEq/L
    • renal excretion major cause of potassium loss
    • Kidneys do not conserve potassium and excrete it even when the body needs the potassium
    • in excessive GI losses from gastric suctioning or prolonged vomiting, potassium tends to become depleted. Severe diarrhea, fistulas, ileostomy, villous adenoma (tumor of the intestine that produces potassium containing mucus), and excessive diaphoresis will also sometimes result in potassium loss.
    • the use of diuretics, such as thiazides or furosemide (Lasix), promotes hypokalemia
    • Causes: decreased potassium intake, increased potassium loss-increased aldosterone activity, GI losses (vomiting, diarrhea, GI suctioning), ileostomy, potassium losing diuretics, loss from cells as in trauma, burns, fistulas, skin losses, diaphoresis; conditions causing very large urine output, potassium shift into cells-treatment of acidosis, metabolic alkalosis, vilious adenoma
    • S/S: skeletal muscle weakness especially lower extremities, leg cramps, parastesias, hyporeflexia, decreased bowel sounds, cramps and constipation, anorexia, nausea, vomiting, diminished deep tendon reflexes, lethargy, confusion paralysis involving the respiratory muscles, coma, orthostatic hypotension, cardiac dysrhythmias, weak irregular pulse, ECG changes, polyuria
    • NSG Considerations: carefully assess patients taking digitalis glycosides, especially if also taking a diuretic, for hypoglycemia, which has capacity to po0tentiate the action of the digitalis glycoside medication and cause toxicity; administer potassium chloride (KCL)supplements prescribed by the physician; whether through a peripheral or central catheter; encourage increased intake of foods high in potassium; monitor bowel sounds; monitor serum potassium level; monitor I&O (about 40 mEq of potassium is lost in each liter of urine, diuresis has potential to put the patient at a risk for potassium loss); during treatment with potassium, it is necessary for the patient's urinary output to be at least 600 ml/day; monitor telemetry
  39. Hyperkalemia
    • an increase in the body's serum potassium level greater than 5 mEq/L
    • major cause of potassium excess is renal disease, in which potassium is not excreted adequately. When severe tissue damage occurs, potassium is released from the cells. Shock often accompanies this damage, resulting in reduced kidney output.
    • other causes of hyperkalemia include excessive use of salt substitutes, potassium supplements, infusion of a large volume of blood nearing its expiration date, drugs such as beta blockers, which inhibit potassium shifts into cells, potassium sparing diuretics such as spironolactone, chemotherapy which causes cell death or lysis with release of high levels of intracellular potassium into the blood, angiotensin converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs and aminoglycosides
    • less common then hypokalemia, more dangerous because of cardiac arrest, which is caused by overstimulation of the cardiac muscle. A serum potassium level of 7 mEq/L or greater risks serious cardiac dysrhythmias.
    • Causes: potassium intake in excess of kidneys ability to excrete, excessive use of salt substitutes, renal failure, adrenal insufficiency, potassium enters the bloodstream from injured cells with extensive trauma, metabolic acidosis, infusion of large volume of blood nearing expiration date, beta blockers, potassium sparing diuretics, tumor lysis syndrome after chemotherapy, angiotensin converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, aminoglycosides.
    • S/S: nonspecific, serum potassium level and ECG tracings are often the best clinical indicators, irritability, nausea, vomiting, diarrhea, colic, cardiac dysrhythmias, ECG changes, irregular pulse rate, hypotension, numbness, tingling, paresthesias, skeletal muscle weakness, especially of lower extremities
    • NSG Interventions: decrease intake of foods high in potassium, administer kayexalate (watch for CHF), loop diuretics, decrease or stop medications associated with high potassium level, monitor underlying disorders leading to high potassium level, assess V/S, monitor telemetry to detect dysrhythmias, monitor I&O, hemodialysis in acute symptomatic hyperkalemia, monitor bowel sounds and number and character of bowel movements, monitor serum potassium level.
  40. Hypocalcemia
    • develops when the serum level is less than 4.5 mEq/L
    • possible deficiencies can arise from-infusion of excess amounts of citrated blood, excessive loss through diarrhea, inadequate dietary intake of calcium or vitamin D, surgical removal of parathyroid glands, decreased parathyroid function, pancreatic disease, small bowel disease
    • signs and symptoms are neuromuscular irritation and increased excitability with the possibility of tetany characterized by excessive muscle cramps, laryngeal spasms, stridor, carpal spasms, pedal spasms, and contraction of facial muscles
    • Causes: excess binding of calcium ions, large amount of citrated blood, excess alcohol, alkalosis, dietary deficiency of calcium and vitamin, chronic renal failure, pancreatic disease, disease of small bowel; malabsorption, severe diarrhea, anticonvulsants, such as phenobarbital and phenytoin, diuretics, draining intestinal fistulas, deficiency of parathyroid hormone or vitamin D, increased magnesium, thyroid surgery, injury or disease of parathyroid gland, severe burns, low serum albumin levels
    • S/S: anxiety, confusion, irritability, osteoroporosis, pathologic fractures, tingling around nose, mouth, ears, fingers, toes, twitching, muscle spasm of feet and hands, tentany, laryngeal spasms, nausea, vomiting, hyperactive deep tendon reflexes, diarrhea, cardiac dysrhythmias, cardiac arrest, calcium deposits in body tissues, diminished response to digitalis glycosides
    • NSG Considerations: monitor v/s; monitor respiratory status, including rate, depth, and rhythm; be alert for stridor, dyspnea or crowing; monitor pertinent laboratory values including calcium, albumin and magnesium; encourage intake of a diet high in calcium rich foods, vitamin D and protein, administer calcium and vitamin D as prescribed by the physician; monitor treatment of underlying causes, acute hypocalcemia necessitates either IV calcium gluconate or calcium chloride; for acute hypocalcemia, keep a tracheotomy tray and resuscitation bag at bedside in case of laryngeal spasms; monitor telemetry; monitor serum calcium, albumin and magnesium levels, monitor I&O
  41. Hypercalcemia
    • occurs when calcium levels exceed 5.8mEq/L. It may occur when calcium stored in the bone enters the circulation.
    • Causes: loss from bone, immobilization, metastic bone cancer, multiple myeloma, excess intake, dietary, antacids containing calcium, increased absorption, increased parathyroid hormone, increased vitamin D
    • S/S: anorexia, nausea, vomiting; behavioral changes, including confusion; thirst polyuria; renal calculi; decreased deep tendon reflexes; constipation; paralytic ileus; lethargy, coma; cardiac dysrhythmias, cardiac arrest; hypertension; decreased muscle tone; decreased GI motility; bone pain
    • Nursing Considerations: assist in the promotion of excretion of calcium in the urine; administer diuretics as ordered by the physician; encourage drinking 3000 to 4000 L of fluids per day; monitor I&O; be aware that in life threatening hypercalcemia, measures to increase calcium secretion will sometimes include hemodialysis or peritoneal dialysis
  42. Hypomagnesemia
    • develops when blood levels fall to less than 1.5 mEq/L
    • usually parallels decreased potassium, because if magnesium level is low, the kidneys tend to excrete more potassium
    • causes signs and symptoms of increased neuromuscular irritability similar to those observed with hypocalcemia
    • Causes: decreased intake, prolonged malnutrition, starvation; impaired absorption from the GI tract, alcoholism, hypercalcemia, diarrhea, draining intestinal fistula; conditions causing large losses of urine; prolonged IV feedings without magnesium supplementation
    • S/S: anorexia, mental changes, agitation, depression, confusion, dysphagia, hyperactive deep tendon reflexes, nausea and vomiting, paresthesias, tetany, tremors, seizures, ataxia, cramps, spasticity, tetany, tachycardia, hypotension, cardiac dysrhythmias
    • NSG Considerations: monitor v/s, assess neuromuscular status, assess dysphagia, increase intake of magnesium rich foods, administer magnesium supplements as prescribed by the physician, monitor I&O, monitor telemetry, institute seizure precautions, monitor respiratory status
  43. Hypermagnesemia
    • develops when blood levels exceed 2.5 mEq/L
    • rarely occurs when kidney function is normal
    • three major causes are renal function, excess magnesium administration and diabetic ketoacidosis when there is water loss
    • Causes: renal failure, diabetic ketoacidosis with severe water loss
    • S/S: hypotension, vasodilation, heat, thirst, nausea and vomiting, loss of deep tendon reflexes, respiratory depression
    • NSG considerations: promote urine excretion; administer diuretics as prescribed by the physician; decrease intake of foods or medications high in magnesium; monitor I&O
  44. Acid-base balance description
    • homeostasis of the hydrogen ion concentration in the body fluids.
    • hydrogen ion concentration is determined by the ratio of carbonic acid (H2CO3) to bicarbonate (HCO3-) in the extracellular fluid. ratio needed for homeostasis is 1 part carbonic acid to 20 parts bicarbonate
    • pH is symbol to indicate hydrogen ion balance
    • pH is measurement of hydrogen ion concentration in the body
    • atrial blood gases reveal whether the blood is acid, neutral or alkaline
    • the more hydrogen ions in a solution the more acid the solution
    • the fewer hydrogen ions in a solution, the more alkaline the solution
    • terms base and alkaline are interchangeable
    • an inverse relationship exists between hydrogen ion concentration and the pH level. As the numbers of hydrogen ion increase the acidity of the solution increases and the pH decreases.
    • alkalinity -the number of hydrogen decreases and the pH increases.
    • pH of 7.35 is acid
    • pH greater than 7.45 is alkaline
    • normal pH of arterial blood is approximately 7.45
    • normal pH of venous blood and interstitial fluid is approximately 7.35
    • between 7.35 and 7.45 is considered normal pH
    • two general types of disturbances can cause a pH imbalance-increase or a decrease in the base substance of bicarbonate or adding or subtracting the acid substance carbonic acid
    • body's metabolism affects the base side of balance-so a bicarbonate imbalance causes metabolic acidosis or alkalosis
    • body's respiratory system affects the acid side of the balance-so a carbonic acid imbalance causes respiratory acidosis or alkalosis
    • four types of acid-base imbalance: respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis
    • 3 systems to keep pH in range: the blood buffers, respiratory system and the kidneys
    • 4 major buffer systems: bicarbonate-carbonic acid system-most important, responsible for mainly buffering blood and interstitial fluid, kidneys assist the bicarbonate buffer system in regulating production of bicarbonate, lungs assist by regulating the production of carbonic acid, which results from combining carbon dioxide and water; other systems are the phosphate, protein and hemoglobin buffer systems
    • once the buffer systems are exhausted the body calls on the second line of defense: the lungs. By speeding up or slowing down respirations, the lungs have the capacity to increase or decrease the amount of carbon dioxide in the blood; removing carbon dioxide from the blood lowers the carbonic acid level. Lungs take minutes to adjust the pH. the lungs are able to eliminate large amounts of acid (in the form of carbon dioxide) from the body. Chemorecptors in the medulla of the brainstem provide the stimulus to increase respirations.
    • Third line of defense is the kidneys. Much more selective control, by the ability to excrete varying amounts of acid or base into the urine. If the acidity of blood rises above normal, the kidneys will selectively eliminate more acids so the hydrogen ion concentration increases in the blood. If the blood becomes too alkaline, the kidneys will selectively eliminate more bases, especially bicarbonate. Slowest of the systems, but they are efficient enough to return the pH to exactly normal. Response takes hours to days
  45. Acid-Base Imbalance
    • an upset in the acid-base balance results in either acidosis (when blood pH is less than 7.35) or alkalosis (when blood pH is greater than 7.45)
    • kidneys and lungs major organs responsible for regulating acid and base substances. If imbalance occurs represents imbalance in function of lungs, kidneys or both
    • Diseases that pose risk for imbalance: diabetes, chronic obstructive pulmonary disease, end stage renal disease, severe vomiting and diarrhea
  46. Respiratory Acidosis
    • any condition that impairs normal ventilation
    • retention of carbon dioxide occurs with a resultant increase of carbonic acid in the blood
    • as pH falls and the normal 20:1 bicarbonate to carbonic acid ratio is upset the Pco2(partial carbon dioxide) level increases
    • treatment is aimed at improving ventilation and support patients respirations.Intermittent positive pressure breathing to promote exhalation of carbon dioxide, antibiotic administration for any respiratory infection, adequate hydration (2-3L/day) to keep the mucous membranes moist and aid in removal of secretions, and use of bronchodilators to help reduce bronchial spasms will be possible elements of the treatment regimen
    • Causes: compromise in any of the three essential parts of breathing-ventilation, perfusion or diffusion; chronic obstructive pulmonary disease; pneumonia; respiratory failure; atelectasis; barbiturate or sedative overdose; paralysis of respiratory muscles; traumatic injuries to the thorax; obesity; airway obstruction; head injuries; stroke; drowning; cystic fibrosis
    • S/S: CNS-lethargy; disorientation; occipital headache; decreased deep tendon reflexes; dizziness; decreasing level of consciousness; seizures; coma Cardiopulmonary-dyspnea; tachycardia; hypotension; cardiac dysrhythmias Musculoskeletal system-tremors; weakness
    • Laboratory Data: pH less than 7.35; Paco2 greater than 45 mm; Pao2 normal or less than 80mm Hg, depending on severity of acidosis, O2 saturation normal or less than 95% depending on severity of acidosis, HCO3-normal in early respiratory acidosis, K+ greater than 5 mEq/L
  47. Respiratory Alkalosis
    • caused by hyperventilation
    • respirations that increase in rate, depth or both have the potential to result in the loss of excessive amounts of carbon dioxide with a resultant lowering of the carbonic acid level in the blood. The pH raises due to the decrease in carbonic acid, which is blown off with each exhalation.
    • common treatment is sedation and reassurance
    • Causes: hyperventilation, anemia, hypermetabolic states, disorders of the CNS, drugs, asthma, pneumonia, inappropriate mechanical ventilator settings
    • S/S: anxious, appearance, irritability, confusion, tingling of the extremities, fainting, dizziness, seizures, tachypnea, cardiac dysrhythmias, tentany, muscle weakness
    • Laboratory Data: pH 7.45 or greater, Paco2 less than 35mm HG, Pao2 normal, 02 saturation normal, HCO3- 22 to 24 mEq/L, K+ less than 3.5 mEq/L
  48. Metabolic Acidosis
    • a result of either a gain of hydrogen ions or a loss of bicarbonate-retaining too many acids (H+ ions) or losing too many bases (HCO3-)
    • examples are diabetic ketoacidosis from ketone accumulation, lactic acid elevation, and d acidosis from loss of too many bases in severe diarrhea or renal failure
    • hyperventilation occurs as the lungs attempt to compensate by blowing off carbon dioxide to lower the Pco2 level
    • a patient with diabetic ketoacidosis will often develop Kussmaul's respirations (deep, rapid breathing) which serve to blow off carbon dioxide in an attempt to reverse the condition of metabolic acidosis
    • Causes: starvation, dehydration, diabetic ketoacidosis, lactic acidosis, renal failure, shock, severe diarrhea, drugs, renal tubular acidosis, renal failure
    • S/S: lethargy, headache, decreasing LOC, coma, Kussmaul's respiration, dysrhythmias, warm, flushed skin, anorexia, nausea, vomiting, diarrhea, abdominal pain, weakness
    • Laboratory data: pH less than 7.35; Paco2 normal or less than 35 mm Hg if lungs are compensating; O2 saturation normal; HCO3- less than 22 mEq/L; K+ greater than 5 mEq/L
  49. Metabolic Alkalosis
    • when a significant amount of acid is lost from the body or an increase in the bicarbonate level occurs
    • common causes are vomiting gastric content and gastric suctioning; also possible in patients who ingest excess amounts of alkaline agents such as bicarbonate-containing antacids
    • depresses the CNS
    • respiratory rate is decreased
    • Causes: excessive vomiting, prolonged gastric suctioning, electrolyte disturbance, cushings syndrome, drugs, hyperaldosteronism
    • S/S: headache, irritability, lethargy, decreases in LOC, seizures, atrial tachycardia, slow, shallow respirations with periods of apnea, cardiac dysrhythmias, nausea, vomiting, anorexia, numbness and tingling of extremities, tremors, hypertonicity of muscles, muscle cramps tetany
    • Laboratory data: pH greater than 7.45; Paco2 normal or greater than 45 mm Hg if lungs are compensating; Pao2 normal; O2 saturation normal; HCO3- greater than 26 mEq/L; K+ less than 3.5 mEq/L
  50. meta