bicarbonates.pptx

8/10/2019 BICARBONATES.pptx

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BICARBONATES

Acute and Chronic

Metabolic Acidosis [BaseBicarbonate Defcit]And Alkalosis

[BaseBicarbonate Excess]


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Acute and Chronic Metabolic Acidosis [BaseBicarbonate Defcit]

Metabolic Acidosis is acommon clinical Disturbance

characterized by a low !"Increased !# concentration$and a low lasma bicarbonateconcentration% It can beroduced by a &ain o'

hydro&en ion or loss o'


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Clinical Mani estations

Si&ns and sym toms may (arywith the se(erity o' the Acidosis

but includes) !eadache Con'usion Drowsiness Increased Res iratory Rate and

de th


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I' ! dro s to less than +,

-eri heral *asodilation anddecreased Cardiac Out ut occur

Decreased Blood -ressure Cold and Clammy S.in Dysrhytmias

Shoc. Chronic Renal /ailure, ChronicMetabolic Acidosis is usually seen


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Assessment and DiagnosticFindings

Arterial Blood 0as Measurements, (aluable india&nosin& Metabolic Acidosis%

1ow bicarbonate 1e(el "less than 22 mE341$ and

a low ! "less than +%56$ Decrease in serum Bicarbonate 1e(el, cardinal'eature o' Metabolic Acidosis

!y er.alemia may accom any metabolic

Acidosis as a result o' the shi't o' -otassium outo' the cells% As the acidosis is corrected 7 otassium mo(es

bac. to the cell and !y o.alemia may occur%


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!y er(entilation, decrease

the CO2 le(el as acom ensatory action% Calculation o' the anion &a 8

hel s to determine the causeo' metabolic acidosis%

Electrocardio&ram, detectsdysrhytmias caused by theincreased otassium%


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Medical Management Treatment is directed at correctin& the

metabolic Imbalance% I' the roblems results 'rom e9cessi(e

inta.e o' chloride7 treatment is aimed in

eliminatin& the source o' the chloride% Bicarbonate is administered, i' necessary Serum -otassium 1e(el is monitored

closely, because o' the hy er.alemia thatoccurs with metabolic acidosis andhy o.alemia occurs when metabolicacidosis was cured%

!y o.alemia is corrected


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Chronic Metabolic Acidosis

1ow serum calcium le(els aretreated be'ore the chronic metabolicacidosis is treated, to a(oid tetany

resultin& 'rom an increase in ! anda decreased in Ionized Calcium% Al.alyzin& a&ents may be

administered !emodialysis and -eritoneal Dialysismay include%


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Acute and ChronicMetabolic Alkalosis[Base Bicarbonate

Excess]


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Clinical Mani estations

Acute Metabolic Al.alosis Decreased calcium ionization 8 such as

tin&lin& o' the toes and :n&ers7 dizziness

and hy ertonic Muscles% Ionized 'raction o' serum calcium decreases !y ocalcemia is a redominant sym tom o'

al.alosis Res irations are de ressed, com ensatory

action by the lun&s


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Atrial Tachycardia mayoccur

As the ! increases andhy o.alemia de(elo s7(enticular disturbances

may occur% Decreased motility and

aralytic ileus may also be


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Chronic Metabolic Al.alosis

The same as the AcuteMetabolic al.alosis As otassium decreases7

're3uent remature(entricular contractions or ;

wa(es are seen on the EC0%


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Assessment and Diagnosis Findings

Arterial Blood 0ases, re(eals a !&reater than +%


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!y o.alemia may accom anymetabolic al.alosis

;rine Chloride 1e(els, may

hel identi'y the cause o'Metabolic Al.alosis


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Medical Management

Acute and Chronic Metabolic Al.alosisare both treated by correctin& theunderlyin& acid,base because o' theunderlyin& disorder) (olume de letion'rom 0I loss 7 the atient>s ?uid I@O 7must be monitored care'ully

Su cient chloride must be su lied'or the .idney to absorb sodium withchloride%


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Restorin& normal ?uid (olume byadministerin& sodium chloride ?uids

In atient with hy o.alemia7 otassium isadministered to re laced both # and Cl,losses%

Cimetidine ta&amet 7 reduce theroduction o' &astric !C1

Carbonic Anhydrase inhibitors are use'ul toatients who cannot tolerate ra id (olume

e9 ansion% e&% -atients with !eart /ailure

bicarbonates.pptx

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