Metabolic Alkalosis Acid Base Balance Made Easy NCLEX Review | ABGs Made Easy for Nurses

Hey everyone, it's Sarah with RegisteredNurseRN.com and in this video, I'm going to be going over

metabolic alkalosis. In the next video, I'm going to be talking about metabolic

acidosis. So if you're studying these, be sure to check out that other video because I'm doing a series on acid and base

imbalances. So in this video, what I'm going to do is I'm going to cover what metabolic acidosis is, how it's affecting the body.

I'm going to go over the causes and give you a clever mnemonic on how to remember the causes.

Then I'm going to go into the signs and symptoms, the nursing interventions, and

work an ABG problem for you with a patient in metabolic alkalosis.

Now after this video, be sure to go to my website,

RegisteredNurseRN.com and take the free quiz that will test your knowledge on metabolic acidosis and metabolic

alkalosis. A quiz should be popping up or a link in the description below.

So let's get started.

First thing we want to do is go over the key concepts of what metabolic

alkalosis is because if you can understand this, you can understand the causes, the signs, and symptoms, and everything like that.

Because for the NCLEX and as a nurse, you need to know

the basics of what's going on so you can provide

quality care to that patient and know what to look for. So in metabolic acid

alkalosis, we have a metabolic problem going on. In the respiratory, we had respiratory issues.

We had CO2 issues, build-up or depletion of CO2. But in metabolic, we're talking about bicarb,

HCO3, which

your kidneys are responsible for that. So what's happening

whenever a patient is going into metabolic alkalosis, it's usually due to because the body has experienced an

excessive loss of

hydrogen ions of acids. So the body has lost all these acids, hydrogen ions, which in turn

has increased the bicarb. So whenever you're losing all that acid, the bicarb is going to go up. And it's the opposite in

acidosis. What happens is you're losing all that bicarb and the acids are going up. The acids go up, causes the bicarb to go down.

So this is the opposite. Or the body has

increased in the production of the amount of bicarb it has, which we'll go over in depth over here.

And you can see what's happening with each. So what happens whenever this happens, the body tries to compensate for that.

It's like, hey, we need everything back to normal.

So we need some other system in the body to correct this. And what happens is that the lungs start

to kick in. And what they want to do is they want to cause

hypoventilation because they think that keeping these CO2 levels high,

which is an acid, will help balance that alkalotic state you have going on in your body.

So it's going to slow down your respirations, hypoventilation, in hopes of keeping that CO2,

which is acid, in the body. So they're going to have respirations like less than 12. And in hope of doing that,

it's going to make your bicarb come back down to normal. So what's going to happen in the body?

This is what kind of labs you're going to have. You're going to have a blood pH, because remember you have an

excessive loss of acid, those hydrogen ions. Your pH is going to become alkalotic because it's not an acid,

so now it's a base. So it's going to be greater than 7.45. A normal pH is 7.35 to 7.45.

And your bicarb is going to shoot up. It's going to be greater than 26.

A normal bicarb is 22 to 26.

And your PaCO2 will either be super elevated, because remember it's trying to keep

that CO2 in the lungs, the acid in the lungs, to help balance the body out, or it'll be normal.

So you have to watch those levels. And a normal PaCO2 is 35 to 45.

So let's look at the causes. Now to help you remember the causes, because in nursing school, on the NCLEX,

it may throw a scenario out at you and say the patient has this condition, this sign and symptoms going on,

what do you expect the ABGs to look like, or something like that. So try to remember the mnemonic

alkali.

We're in alkalosis. And remember for metabolic

acidosis, we remembered acidotic. So for this one, let's remember alkali. Okay, A, for aldosterone production, which is going to be

excessive. And this is in the condition called hyperaldosteronism. Now think back to patho.

What's happening whenever you got way too much aldosterone in the body?

Well, what's happening is that your renin-angiotensin-aldosterone system is being activated.

And what happens is that on your kidneys, you have the adrenal cortex, and it starts releasing

all of this aldosterone.

Remember what aldosterone does. It causes the renal tubules to keep sodium.

So you're keeping all this sodium in the body, but that causes you to lose all of these hydrogen ions.

Also potassium. So you're losing all those hydrogen ions. And whenever you lose hydrogen ions, remember,

when hydrogen ions go away, bicarb increases.

So all of a sudden you have all this aldosterone being pumped into the body. You're

keeping your sodium. You're peeing out your potassium, your hydrogen ions.

You're getting rid of those, losing all these acids, and the bicarb starts to elevate, and your blood pH starts to become

alkalotic.

Okay, next one, L, loop diuretics. Any type of diuretic therapy, especially the loop diuretics,

which is Lasix, and your thiazides, like

HCTZ, hydrochlorothiazide.

What happens is that the patient just starts urinating all the time, and they're wasting from all that urine, all those hydrogen ions,

like chloride. And again, whenever you lose all those hydrogen ions, the bicarb starts to increase.

So you start to have alkalotic conditions. The blood pH

starts to become alkalotic because you lost all those acids, and your bicarb increases. Okay, next, K.

Remember the K in alkali ingestion?

This is

patients who've consumed way too many foods that are very alkalotic, like bacon soda,

antacids, milk, things like that. What happens is that they take those into their stomach,

eat those way too much, and enters a bloodstream, and causes it to become very alkalotic because those

substances are very alkalotic themselves.

Okay, next, the A for

anticoagulant, known as citrate.

Citrate is actually used in the storage of blood, the blood bags that you get for transfusion.

So if a patient gets a massive transfusion of blood, and

citrate is used as the storing agent,

they are at risk for bicarb, which I'll go into why here in a second. And patients who are on continuous forms of renal replacement

therapy. This is an alternative form of hemodialysis that is a

lot more gentler on the patient, who may not be

hemodynamically stable to do

dialysis. And

what's used is citrate as one of the things in that therapy. And what citrate does is the body looks at citrate, and it

metabolizes it as bicarb. So here's all this citrate going into your body, either through the blood transfusion or the continual renal

therapy, replacement therapy, and your body starts to metabolize that as bicarb. So that

dramatically increases your bicarb level. So any of that.

Okay, next, L.

Remember this one. This is another very, very, very important cause. Loss of fluids, any

severe vomiting or

NG suction.

And these fluids, your vomit and all that, and your NG, which is your GI stomach fluids,

are very rich in those hydrogen ions, like potassium.

So whenever you're just getting rid of those, either throwing them up or it's coming through the NG tube,

you're suctioning all those out, the patient is very much at risk for metabolic

alkalosis, because those are

hydrogen ions that you're removing from the body. When hydrogen ions leave the body, the bicarb likes to go up.

So remember that. And the last one, I, for increased sodium bicarb

administration, and sometimes physicians may order sodium bicarb if a patient's a metabolic

acidosis to help stable out that condition.

But you can also give them way too much of it and put them in alkalosis. So it's a

seesaw of a balancing act. Okay, so how do these patients present?

What do they look like to you as the nurse who are in metabolic alkalosis?

And one thing is that they're going to have bradypnea. If the body is trying to compensate, remember,

the body's going to slow down that breathing to keep that CO2 in there,

which is acidotic in the body, because the body is alkalotic. It's too basic.

So the lungs are going to slow down the rate of breathing to conserve that CO2.

They don't want to breathe that much out.

So you may have respirations of less than 12 breaths per minute.

And also, you're going to have some symptoms of hypokalemia.

And if you notice, in a lot of these causes, you're losing a lot of hydrogen ions.

Potassium. So whenever you're doing that, you're going into hypokalemia.

So a lot of your symptoms you're going to be seeing are hypokalemic symptoms, like tetany, tremors,

muscle weakness, tired, EKG changes. And remember, we talked about this in the hypokalemia fluid and electrolyte video,

where the patient may have some depressed ST segments, flat inverted

T waves, or prominent U waves.

So now let's talk about the nursing

interventions and work and arterial blood gas problem that you may encounter on the NCLEX exam or on your nursing lecture exams.

So what are you going to do for this patient who is in metabolic alkalosis?

Just like metabolic acidosis, you are going to treat the cause, because there's various causes that cause this.

So if the patient's vomiting, you are going to give the prescribed

anti-emetic, like Zofran, to help them stop from throwing up. Because remember, vomit is rich in

hydrogen ions, and you get rid of that, you're going to make the body

alkalotic, and the bicarb is going to go up. And stop suctioning,

especially the NG suctioning. You want to remember that, because that's a lot of exam questions.

And whenever, if they do have NG suction, make sure you're watching how much

you're removing from the body in the suction container.

Okay, next, stop diuretics.

And because those diuretics, like Lasix, your loop diuretics, you want to remember that, and your thiazides, if the patient's on that, and their

ABGs are showing metabolic acidosis, you want to stop those, and you want to watch that potassium and chloride levels, because you're wasting a lot

of those hydrogen ions through the urine. And

watch their arterial blood gases, because remember, they're trying to keep the

PO2, the carbon dioxide, I mean the PaCO2, the carbon dioxide, so their

levels can go greater than 45. And if they go too high, they may go into

respiratory distress, they're going to be bradypenia, they may need to be intubated.

So you want to definitely watch those levels. And the doctors, in some cases, may order Diamox.

We talked about this in acidosis.

Diamox can cause metabolic acidosis, because it's one of those carbonic

anhydrase inhibitors,

which reduces the reabsorption of HCO3, which is bicarb, but this is actually used sometimes to

treat it.

But you have to watch out, because this is a diuretic, and it can cause

hypokalemia. So watch that. You want to look at your potassium levels before you give that. So that is some nursing interventions.

Now let's work an arterial blood gas problem that you may encounter on the NCLEX exam, or in your nursing lectures exams.

And I'm going to go over if it's compensated, not compensated, how to tell, and things like that. Now

I use the tic-tac-toe method on solving arterial blood gases. As nurses,

this is a fast, quick way to learn how to do that.

And I have a video, a card should be popping up, or a link in the description, on the tic-tac-toe method.

I go in-depth, how to set up the problems, and things like that, because it makes working these problems easy.

Okay, so let's do this problem. Okay, the bicarb, the HCO3, is 42. The pH is

7.6, and the PaCO2 is 53.

So let's plug them in our tic-tac-toe. Bicarb 42. We know a normal bicarb is 22 to 26.

This is 42. So this is

basic. So we're gonna put

bicarb under base. So HCO3 under here. We're gonna look at our pH. Our pH is 7.6.

We know a normal pH is 7.35 to 7.45.

So this is acidic. Anything greater than 7.45 is acidic. So we have a tic-tac-toe.

What's great about this method is it tells us, are we dealing with metabolic or respiratory issue?

So we got metabolic, because HCO3, bicarb, represents metabolic. So it's basic. So we have metabolic

alkalosis. Now, we need to see if the body is trying to compensate. And remember, to do that, the body is going to stimulate the

respiratory system to help try to correct that. So we're gonna look at our PaCO2 levels, and they are

53. Normal PaCO2 is 35 to 45. So it's elevated.

So we're gonna put it over here because it's acidic, has a lot of

carbon dioxide, and carbon dioxide is an acid. So PaCO2 over here.

So now, is the body trying to compensate?

Absolutely. So what it's done is it's slowed down respirations, and

you're having bradypnea,

hypoventilation, and you're keeping all that carbon dioxide in your lungs, and it's elevated that in hopes of

putting some acid in the body to make the conditions more normal.

So it's partially compensated. Now, it would be fully compensated if it actually got this

pH down to normal. So if the pH was

7.41 and

this was still high, then it did it, done what it needed to do. It got the pH back to normal, and that would hopefully

get that bicarb back down to normal. But this is partially compensated, so metabolic alkalosis partially compensated.

Okay, thank you so much for watching, and please be sure to check out my other videos on metabolic

acidosis and the other fluid and electrolytes videos, and don't forget to take that free quiz to test your knowledge on

acidosis and alkalosis for metabolic disorders, and please consider subscribing to this YouTube channel, and thanks for watching.