BICARBONATES

Acute and Chronic

Metabolic Acidosis [Base
Bicarbonate Deficit]
And Alkalosis
[BaseBicarbonate Excess]

Acute and Chronic Metabolic Acidosis [Base

Bicarbonate Deficit]

Metabolic Acidosis is a
common clinical Disturbance
characterized by a low pH
[Increased H+ concentration]
and a low plasma bicarbonate
concentration. It can be
produced by a gain of
hydrogen ion or loss of

Clinical Manifestations

Signs and symptoms may vary

with the severity of the Acidosis
but includes:
Headache
Confusion
Drowsiness
Increased Respiratory Rate and
depth

 If pH drops to less than 7Peripheral Vasodilation and

decreased Cardiac Output occur
Decreased Blood Pressure
Cold and Clammy Skin
Dysrhytmias
Shock
Chronic Renal Failure- Chronic
Metabolic Acidosis is usually seen

Assessment and Diagnostic

Findings
Arterial Blood Gas Measurements- valuable in
diagnosing Metabolic Acidosis.
Low bicarbonate Level [less than 22 mEq/L] and
a low pH [less than 7.35]
Decrease in serum Bicarbonate Level- cardinal
feature of Metabolic Acidosis
Hyperkalemia may accompany metabolic
Acidosis as a result of the shift of Potassium out
of the cells.
As the acidosis is corrected , potassium moves
back to the cell and Hypokalemia may occur.

 Hyperventilation- decrease
the CO2 level as a
compensatory action.
Calculation of the anion gap
helps to determine the cause
of metabolic acidosis.
Electrocardiogram- detects
dysrhytmias caused by the
increased potassium.

Medical Management
Treatment is directed at correcting the
metabolic Imbalance.
If the problems results from excessive
intake of chloride, treatment is aimed in
eliminating the source of the chloride.
Bicarbonate is administered- if necessary
Serum Potassium Level is monitored
closely- because of the hyperkalemia that
occurs with metabolic acidosis and
hypokalemia occurs when metabolic
acidosis was cured.
Hypokalemia is corrected

Chronic Metabolic Acidosis

Low serum calcium levels are

treated before the chronic metabolic
acidosis is treated- to avoid tetany
resulting from an increase in pH and
a decreased in Ionized Calcium.
Alkalyzing agents may be
administered
Hemodialysis and Peritoneal Dialysis
may include.

Acute and Chronic

Metabolic Alkalosis
[Base Bicarbonate
Excess]

Clinical Manifestations
Acute Metabolic Alkalosis
Decreased calcium ionization such as
tingling of the toes and fingers, dizziness
and hypertonic Muscles.
Ionized fraction of serum calcium decreases
Hypocalcemia is a predominant symptom of
alkalosis
Respirations are depressed- compensatory
action by the lungs

 Atrial Tachycardia may

occur
As the pH increases and
hypokalemia develops,
venticular disturbances
may occur.
Decreased motility and
paralytic ileus may also be

Chronic Metabolic Alkalosis

The same as the Acute

Metabolic alkalosis
As potassium decreases,
frequent premature
ventricular contractions or U
waves are seen on the ECG.

Assessment and Diagnosis Findings

Arterial Blood Gases- reveals a pH

greater than 7.45 and a serum
bicarbonate concentration greater
than 26 mEq/L.
PaCO2 increases - lungs attempts to
compensates due to excess
bicarbonate by retaining CO2
Hypoventilation happens in
semiconcious, unconcious, and
debilitated patients than in alert

 Hypokalemia may accompany

metabolic alkalosis
Urine Chloride Levels- may
help identify the cause of
Metabolic Alkalosis

Medical Management
Acute and Chronic Metabolic Alkalosis
are both treated by correcting the
underlying acid-base because of the
underlying disorder: volume depletion
from GI loss , the patients fluid I&O ,
must be monitored carefully
Sufficient chloride must be supplied
for the kidney to absorb sodium with
chloride.

 Restoring normal fluid volume by

administering sodium chloride fluids
In patient with hypokalemia, potassium is
administered to replaced both K+ and Cllosses.
Cimetidine (tagamet), reduce the
production of gastric HCL
Carbonic Anhydrase inhibitors are useful to
patients who cannot tolerate rapid volume
expansion. (eg. Patients with Heart Failure)