Blood Acid-Base Control
- In a State of Acidemia
- Medullary Chemoreceptors Control Ventilation Rate
- Expulsion of CO2 through Lungs Increases pH
- Bicarbonate Reabsorption from the Kidney Increases pH
- Kidney Excretion of H+ Increases pH
Normal Gap Metabolic Acidosis
- HARD-ASS
- Hyperalimentation
- Addison's Disease
- Renal Tubular Acidosis
- Diarrhea
- Acetazolamide
- Spironolactone
- Saline Infusion
Anion Gap Metabolic Acidosis
- Increased Anion Gap
- MUDPILES
- Methanol
- Uremia
- Diabetic Ketoacidosis (DKA)
- Propylene Glycol
- Isoniazid or Iron
- Lactic Acid
- Ethylene Glycol
- Salicylates
Metabolic Acidosis Interventions
- Raise Plasma pH > 7.20
- Treat Underlying Cause
- Sodium Bicarbonate
- Follow ABGs
- Continuously Monitor Patient
Respiratory Acidosis
- Hypoventilation
- Increased PaCO2 > 45
- Barbiturates Depress Central Respiratory Center of Brain
- Opioids Depress Central Respiratory Center of the Brain
- Airway Obstruction
- Respiratory Muscle Weakness/Paralysis
Respiratory Acidosis Interventions
- Improve Respiration
- Bronchodilators
- Respiratory Stimulants
- Drug Antagonists
- Oxygen
- Assisted Ventilation
- Prevent Complications
Metabolic Alkalosis
- Diuretic use
- Vomiting
- Antacid
- Hyperaldosteronism
Metabolic Alkalosis Interventions
- Treat Underlying Cause
- Stop Potassium (K+) Wasting Diuretics
- Spironolactone
- Acetazolamide
- IV Fluids
- Sodium Chloride
- Replace Potassium (K+)
- Monitor Respiratory Rate
- Monitor Heart Rate
- Seizure Precautions
Respiratory Alkalosis
- Hyperventilation
- High Altitude
- Aspirin
- Restrictive Lung Disease
- Pulmonary Embolism
- Pregnancy
- Progesterone
- Rib Fracture
- Anxiety
Respiratory Alkalosis Interventions
- Treat Underlying Cause
- Decrease Tidal Volume and/or Respiratory Rate
- Give Adequate Pain Control and Sedation
- Rebreathing into Paper Bag
- Sedatives
- Antidepressants
- Compensatory Drop in Serum Bicarbonate
- Correct CO2 Slowly
Hyperkalemia
- > 5.0 mEq/L K+
- Abdominal Cramps
- Muscle Weakness
- Diarrhea
- Arrhythmia
- Tall, Peaked T Waves
- IV Calcium
- Infusion of Glucose and Insulin
- Loop or Thiazide Diuretics
- Kayexalate
- Dialysis
- Prevention Education
Hypokalemia
- < 3.5 mEq/L
- Muscle Weakness
- Arrhythmia
- U Wave
- Ileus
- Hyporeflexia
- IV K+ Infusion at 5-10 mEq/hr
- Give Orally with Food
- Monitor Respiratory Status
Hyponatremia
- < 135 mEq Na+
- Nausea and Vomiting
- Decreased LOC
- Confusion / Lethargy
- Seizures
- Assess Airway
- Reduce Diuretic Dosage
- Mannitol (Osmitrol)
- Fluid Restriction
- Hypertonic Solution (3% or 5% NaCl)