In this video, we will talk about metabolic acidosis. So we'll talk about what lab values you will see with uncompensated metabolic acidosis, partially compensated metabolic acidosis, and fully compensated metabolic acidosis. We will also cover the causes of metabolic acidosis, what symptoms you may see in your patient, and treatment options for metabolic acidosis. All right.
So when we look at the pH, if it is under 7.35, then we know we have acidosis present. And we just have to figure out who's to blame. When we look at PaCO2 here, if it's in the normal range between 35 and 45, then we can't blame that acidosis on the respiratory system.
When we go over here to HCO3, which is bicarb, which represents the metabolic system, we can see it's low. It's under 22, which means that we have metabolic acidosis and that it is uncompensated because this respiratory system is not doing anything to try to save the day. It's not trying to fix the situation. It's just chilling out in its normal range.
So we have uncompensated metabolic acidosis. Then if we go to the second row here, again, if the pH is under 7.35. we have acidosis.
Who's to blame? If we look at PaCO2, it is under 35, which means it's basic. So we definitely know that the respiratory system is not to blame for the acidosis.
However, with HCO3, we see that it is low, under 22. So the metabolic system is to blame for the acidosis, and the respiratory system is trying to fix the situation, right? It's becoming more basic. to help counteract this acidosis.
So we have partially compensated metabolic acidosis. The metabolic system is to blame for the acidosis. Respiratory system is trying to save the day, but hasn't done so completely because that pH is still out of range. Then if we go down to this last row, if we have a pH that is within the normal range, so it's between and 7.45, but it's a little on the low side, like if it's 7.35 or 7.36, then you can guess there may be some compensation that is occurring. And sure enough, if we look here at PaCO2, we'll see that's basic.
It is under 35. And if we look at HCO3, it is acidic. It is under 22. So we can deduce that we had metabolic acidosis. that was fully compensated by the respiratory system because our pH is in normal range. So again, the metabolic system caused the acidosis, they're to blame, and the respiratory system came in and fixed the situation, got that pH in the normal range.
Alright, let's talk about some of the causes of metabolic acidosis. One big cause is something called diabetic ketoacidosis, or DKA. This is a life-threatening complication for typically type 1 diabetic patients that we see fairly regularly in the hospital. So with DKA, these type 1 diabetic patients, they don't produce enough insulin or any insulin. And so the glucose can't get from the patient's bloodstream into their cells.
It can't get in there because it needs insulin to get in there. So these cells feel like they're starving to death. right? So they start breaking down protein and fat to try to get energy.
And with that breakdown of protein and fat, we get an accumulation of acid in the body, including ketones, and that's what causes the metabolic acidosis. Other causes of metabolic acidosis include kidney failure. So it's another really common cause, as well as starvation for kind of the same reasons as DKA, right?
If your cells are starving. Dr. Amy Moore they can't get glucose in, they start breaking down that muscle and fat, the protein and fat, which is how we have that accumulation of acid. Other causes include diarrhea. So one way to remember that diarrhea causes metabolic acidosis is that you lose bicarb out the butt.
Another tip that someone gave me is that with diarrhea, you have diarrhea out the acidosis. So if either of those little tricks help you, that's great. Other causes include dehydration, pancreatitis, liver failure, and then anything that causes hypermetabolism.
So this could be something such as a fever, seizures, or like heavy exercising. And then in terms of symptoms, symptoms of metabolic acidosis include hypotension, tachycardia, weak pulses, GI upset such as nausea and vomiting, dysrhythmias, Because we often have hyperkalemia or too high of our potassium levels when it comes to metabolic acidosis. It happens almost all the time.
So when you think of metabolic acidosis, I want you to think of hyperkalemia. And when you think of hyperkalemia, I want you to know that there is a high risk of life threatening dysrhythmias when a patient's potassium levels are out of whack. Other signs and symptoms can include Kussmaul respirations.
So you would see this with a diabetic patient who has like DKA. They have this deep, rapid breathing due to respiratory compensation for that metabolic acidosis. So just like we were talking before, the metabolic system is to blame for the acidosis, and the respiratory system often tries to compensate. And it will do that by increasing the depth and the rate of breathing.
So you have this really deep, rapid breathing that you see with Kussmaul respirations. Other things include a fruity odor or breath. So that's definitely a sign of DKA and of metabolic acidosis.
And then warm, flush skin. In terms of treatment, we can provide the patient with sodium bicarbonate. So again, we're trying to eliminate the acid, trying to balance, you know, create a balance, acid-base balance, so we can give them bicarbonate. We can also give them IV fluids as well as insulin for DKA. So by giving them insulin, we can get that glucose into the cells so that the cells will stop trying to break down that fat and that protein.
And then if a patient has renal failure, like kidney failure, then hemodialysis is another option. Okay. So that is it with metabolic acidosis.
I spent a little more time on the the causes, signs and symptoms, and treatment, just because it's really important for you to know as a nursing student and as a nurse. So last, in my next video, we'll go over metabolic alkalosis, all of that same information, and we're on the homestretch. So stick with me.
We're almost there.