hey everyone it's sarah with registered nurse Orion comm 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 the other video because I'm doing a series on acid and base in balances so in this video what I want 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 pneumonic 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 register nurse orange calm 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 and the respiratory we had respiratory issues we had co2 issues buildup 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 is 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 them has increase in the production of the male a bike our behalf which we'll go over in depth over here and you can see what's happening with each so what happens whatever 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 of 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 piece PA co2 is 35 to 45 so let's look at the causes now to help you remember the causes because on nursing school on the in cliques may throw a scenario out at you and say the patient has this condition this signs and symptoms going on what do you expect the ABG's 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 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 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 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 directs which is lasix and your thighs eyes like HC tz8 hydrochlorothiazide and what happens is that the patient just starts urinating all the time and they're wasting from all that you're in all those hydrogen ions um 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 assets and your bicarb increases okay next K remember the K and alkali ingestion this is a patients who consume way too many foods and that are very alkalotic like baking soda antacids milk things like that what happens is that they take those into their stomach and eat those weight too much and enters a bloodstream and causes it to become very alcoholic because those substances are very alcoholic themselves okay next a four Anto anticoagulant known as citrate citrate is actually used in the storage of blood the blood bags that you get for transfusions so if a patient gets a massive transfusion of blood and citrate is used as the storing agent they're 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 use 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 and loss of fluids any severe vomiting or NG suction and these fluids your 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 bicarbonate raishin 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 oh it's a sea salt of a balancing act okay so how do these patients present what do they look like to you as a nurse who are in metabolic alkalosis and one thing is that they're going to have Brady Pina if the body is trying to compensate remember but he'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 sent symptoms like tetany tremors muscle weakness tired EKG changes and remember we talked about this in the hypokalemia fluid electrolyte video and where the patient may have some depress ST segments flat inverted T waves or prominent u waves so now let's talk about the nursing interventions and work an arterial blood gas problem that you may encounter on 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 the causes so the patient's vomiting you're going to give the prescribed antiemetic like Soufan zofran vinegar in 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 inde suctioning you want to remember that cuz that's a lot of exam questions and 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 and hey next stop diuretics and because those diuretics like lasix your loop direction we remember that your thighs Ides of patience on that and there ABG's 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 what their arterial blood gases because remember they're trying to keep the po2 the carbon doll 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 braided Pina 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 an acidosis and Diamox can cause metabolic acidosis because it's one of those carbonic anhydrase inhibitors which reduces the reabsorption of h co 3 which is bicarb but um 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 in CLECs 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 we and 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 bicarbonate CO 3 is 42 the pH is seven point six 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 going to pit bicarb underbase so hco3 under here where look at our pH our pH is seven point six we know a normal pH is 7 point five to seven point four or five so this is acidic anything greater than seven point four or five 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 going to look at our PA co2 levels and they are 53 normal PA co2 is 35 to 45 so it's elevated so we're going to put it over here because it's acidic has a lot of carbon dioxide and carbon dioxide is an acid so PA co2 over here so now is the body trying to compensate absolutely so what it's done is it's slow down respirations and you're having Brady P Nia 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 um pH down to normal so if the pH was seven point four one and this was still high than 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 compensate 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 flu 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