- A relative increase in the H+ concentrations occurs as a result of losing huge amount of bases and holding too much acid
- PH is decreased; PCO2normal; PO2normal; HCO3 decreased
- Diabetes mellitus / diabetic ketoacidosis- an insufficient supply of insulin cause increased fat metabolism, leading to an excess accumulation of ketones or other acids.
- Renal insufficiency or failure – increase waste product of protein metabolism is retained.
- Inability of kidney to produce HCO3.
- Insufficient metabolism of carbohydrate- when an insufficient supply of O2 is available for proper burning of carbohydrate into glucose and water; instead of O2, lactic acid is produced .it result acidosis.
- Excessive ingestion of acetylsalicylic acid, eg aspirin can cause increase H+ concentration.
- Severe diarrhea- intestinal and pancreatic secretion is normally alkaline therefore excessive loss of base leads to acidosis.
- Malnutrition – improper metabolism of nutrients cause fat catabolism leading to the excessive build up of ketones and acids.
- High fat diet- a high intake of fat leading to excessive production of ketones and acids.
Signs and symptoms
- In an attempt to blow of the extra CO2 and compensate for the acidosis hyperpnoea with kussmaual’s respiration occurs
- Head ache
- Nausea, vomiting, diarrhea.
- Fruity smelling breath as a result of fat metabolism
- N.S depression
- Mental dullness
- Stupor, coma
- Twitching, convulsion ,
- Access the level of consciousness and CNS depression.
- Monitor I/O chart
- Replace fluid and electrolytes
- Prepare to administer I.V solution such as N.S, 5% D, ½ NS or bicarbonate to increase buffer base.
- Initiate safety and seizure precaution
- Monitor serum potassium level closely because when acidosis is treated potassium will move back into the cell and serum potassium will be dropped.
- Treatment of DM and diabetic acidosis properly to prevent formation of ketones.
- Treatment of renal failure and do dialysis to remove protein and waste products thereby lesser acidosis
- An increase of Hco3 and a decrease in H+ concentration result of an accumulation of base
- Ph increases, Pco2 normal, Po2 normal, Hco3 increases
- Ingestion of excess Hco3
- Excessive vomiting or gastrointestinal suctioning lead to an excessive loss of acid
- Diuretics- the loss of H+ and chloride causes a compensatory increase in the Hco3 in the blood
- Hyperaldosteronism- increase renal tubular reabsorption of Na occurs, causes loss of H+ ions.
- Massive transfusion of whole blood- the citrate, anticoagulant use for the storage of blood is metabolized to bicarbonate
Signs and symptoms
- In an attempt to compensate respiratory rate and depth, rate go down to conserve Co2
- Nausea, vomiting, diarrhea
- Numbness and tingling in extremities
- Twitching in the extremities
- Hypokalemia, hypocalcemia
- Monitor potassium and calcium level in the blood
- Institute safety precautions
- Administer medication to promote kidney excretion of bicarbonate
- Replace potassium if necessary
ARTERIAL BLOOD GASES
Normal ABG values
- Ph 35 to 7.45
- Pco2 35 to 45 mmHg
- Po2 80 to 100 mmHg
- Hco3 22 to 27 mEq/L
- O2 concentration 95 to 100%
- Obtain vital signs.
- Determine whether the client has an arterial line in place.
- Perform the Allen test to determine the presence of collateral circulation.
- Assess the factor that may affect the accuracy of ABG result. such as, Change in oxygen settings, Suction in last 20 minute, client activity.
- Provide emotional support to patient
- Draw the specimen by a heparinized syringe.
- Apply pressure immediately to the puncture site following the blood draw.
- Maintain pressure for 5 minutes or for 10 minutes if the client is taking anticoagulants.
- Appropriately label the specimen and transport it on ice to the laboratory.
- Apply direct pressure over the client’s ulnar and radial arteries simultaneously.
- While pressure is applied ask the client to open and close the hand repeatedly, the hand should be blanched.
- Release pressure from the ulnar artery while compressing the radial artery.
- Assess the color of the extremity distal to the pressure point.
- If pinkness fails to return within 6 seconds, the ulnar artery is in sufficient, indicating that the radial artery should not be used for obtaining blood specimen.
ANALYZING ABG RESULTS
- In acidosis the Ph is down.
- In alkalosis Ph is up.
- The respiratory function indicator is the Pco2.
- The metabolic function indicator is the Hco3.
Pyramid step 1
- Look at the blood gas report; look at the Ph is it up or down.
- If it is up it reflects alkalosis.
- If it is down it reflects acidosis.
Pyramid step 2
- Look at the Pco2 is it is up or down.
- If it reflects an opposite response to the Ph then you know that it is respiratory imbalance.
- If it is not reflect an opposite response to the Ph then move on to pyramid step 3
Pyramid step 3
- Look at Hco3.
- If Hco3 reflect a corresponding response with Ph, it is a metabolic imbalance.
Pyramid step 4
- Compensation has occurred, if the Ph is in a normal range of 7.35 to 7.45, if Ph is not within the normal range look at the respirator or metabolic function indicator.
- If it is respiratory imbalance look at the Hco3 to determine the state of compensation.
- if the Hco3 is normal; then condition is uncompensated.
- If it is in abnormal then the condition is Partial compensation.
- If it is in metabolic imbalance look at the Pco2.
- If the Pco2 is normal then condition is uncompensated.
- If the Pco2 is abnormal then the condition is partial compensation.
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