Metabolic Alkalosis

hey everyone I'm going to talk about metabolic alkalosis so let's get started metabolic alkalosis results in an elevated blood pH and an elevated bicarbonate level hc3 and this usually occurs because we've had excessive loss of acids such as hydrogen ions or we've had an increase in the amount of bases like bicarbonate that hc3 now what are some conditions that could cause either of these two things to happen well help us remember those conditions let's remember the word Alkali Alkali is a synonym for base first we have a for acid loss via the stomach your stomach acid is really rich in hydrogen ions so if we are over suctioning the patient removing too much of their GI juices or they're vomiting they're losing a lot of hydrogen ions which when we drop hydrogen ion concentration we increase that blood pH because all blood pH is is measuring the concentration of hydrogen ions in the body then we have L for low chloride level when we have a low chloride level in the body this causes our kidneys to start to decrease its excretion of byc carbonate so when we decrease excreting bicarbonate in our urine that's actually going to raise the levels in our body when we have too much bases they are going to neutralize those acids which will throw us into these Al otic conditions and then we have k for potassium loss so whenever we have hypokalemia in a patient what happens is that it really affects hydrogen ions it causes those hydrogen ions to move inside the cell so instead of being in the fluid surrounding that cell and that extracellular fluid it will start to migrate inward which will drop our hydrogen ion amounts which is going to increase our blood pH then we have a for aldosterone increase so whenever we have a condition like hyper aldosterone ISM we have a high level of aldosterone in the body it's going to do three things one thing is it's going to cause our body to keep sodium which in the end is going to cause us to waste more hydrogen ions again we're losing our hydrogen ions which raises our blood pH and keep bicarb and then we have L for Loop and thide diuretics these diuretics they increase urinary output but also in that urine will be potassium so we're at risk for hypokalemia and whenever we put a patient in hypokalemia we just learned it messes with the hydrogen ion concentration which will increase the risk of developing metabolic alkalosis and then lastly I for infusing too much sodium bicarb IV so this could happen if the patient was in let's say metabolic acidosis where they were ordered sodium bicarbonate they received too much so now we flipped them over into alkalosis because bicarbon that sodium B carb fluid acts as a base so if we give them too much of a base that will go in there neutralize too many hydrogen ions which we don't want and send them into alkalosis now to help us understand metabolic alkalosis a little bit better let's talk more in depth about bases bases are materials that once you break them down in a solution they neutralize acids by binding with the hydrogen ions so in a sense what it does is it acquires a hydrogen ion and then neutralizes it now hydrogen ions play a big role in helping us determine our blood pH because a blood pH as I pointed out earlier is the concentration of hydrogen ions and think of hydrogen ions as little acids in the body when you have a High collection of these hydrogen ions it will actually drop the blood pH and make your body more acidic but if you don't have a lot of hydrogen ions like here in metabolic alkalosis it will actually make the body too alkaline and increase the blood pH and our body likes this narrow range for its blood pH it wants it between 7.35 to 7.45 anything less than 7.35 is too acidic anything greater than 7.45 is to alkaline and the body's always trying to maintain this 20 to1 ratio between bases and acids it wants 20 bases for every acid and an important base in the body is called bicarbonate hc3 and this is actually a weak base that will help neutralize hence bind to acids like hydrogen ions and when they do this they increase the pH level now your body has these internal systems that help maintain this acid base balance the two systems I want to talk about are the respiratory and renal system with the respiratory system it works fairly fast whenever we have an acid base imbalance and how it works is that it affects carbon dioxide levels by causing you to change your respiratory rate and depth for example your respiratory system can cause you to breathe faster and deeper and whenever you're doing that think about what's happening what are you blowing off if you're breathing really fast and deep you're blowing off carbon dioxide and this is really beneficial whenever you are experiencing acidosis because carbon dioxide plays a role with the formation of carbonic acid which will affect our hydrogen ions hydrogen ions are acidic so if we can lower the amount of carbon dioxide by breathing it off we can affect in the long run hydrogen ion concentration which will help increase that blood pH back to normal on the flip side your respiratory system can cause you to breathe slower so think about it whenever you're breathing slower what are you keeping more of you're keeping more of carbon dioxide and this is very beneficial whenever you have alkalosis going on where you're too basic because keeping carbon dioxide is going to cause you to create more hydrogen ions so a lot of times whenever you have a patient in an alkalic state you will see that they have braad dnia where their respirations are slow they're having hypoventilation and the whole purpose of this is to keep that carbon dioxide because when we keep the carbon dioxide that stays in our blood that carbon dioxide is going to bind with water when it binds with water it's going to form carbonic acid carbonic acid is a weak acid and it breaks apart when it breaks apart it increases hydrogen ions those hydrogen ions will go in there and neutralize the bicarbonate whenever we neutralize the bicarbonate that is going to help bring down that blood pH to normal and then the renal system will come into play now I like to think of the renal system as the slow and steady system it's like the turtle it's slow but once it gets going it does its thing so with this system what's going to happen is it is going to help retain hydrogen ions so why do we need hydrogen ions because because they're going to help make things more acidic which is really needed when we have metabolic alkalosis so those hydrogen ions will go and neutralize that bicarbonate plus the kidneys can start to excrete extra bicarb which again will help lower that blood pH now one of the ways you can tell that your patients in metabolic alkalosis is that you can look at their arterial blood gas results their abgs so what are abgs going to look like in a person with metabolic alkalosis well there's three things you got to look at we got to look at the blood pH the bicarbonate level and the P2 so the blood pH again a normal was what 7.35 to 7.45 with this the blood pH is going to be greater than 7.45 it's going to be on the alkaline side the bicarbonate which represents our metabolic system a normal is 22 to 26 mil equivalents per liter and with this it's going to be elevated so it's going to be greater than 26 it's going to be on the alkaline side and then our P2 which represents our respiratory system it can be one of two things it could be normal or it could be elevated so a normal level is 35 to 45 mm of mercury if the body isn't trying to compensate that respiratory the pac2 is going to be normal because our body hasn't decreased our respirations yet in Hope of retaining that CO2 so it'll just be within that 35 to 45 range however if it was trying to compensate like partially compensate it would start to cause your respiratory system to keep that CO2 so you would start to see the CO2 levels rise and they would be greater than 45 now let's analyze an arterial blood gas problem so this problem here actually comes from my workbook called ABG interpretation so if you need more practice or explanation on this topic you can get a copy of this book so our problem says we have a pH of 7.53 a p 2 of 49 and a bicarb hc3 of 28 so how I'm going to solve this is I'm going to use the Tic Tac Toe method you could use Rome or whatever you prefer so we're going to set up our grid we have acid over there on the left normal in the middle and then base here on the right first let's Analyze That pH a normal is 7.35 to 7.45 we're at 7.53 that is alkaline so we're going to put pH under base the P CO2 is 49 and normal is 35 to 45 this is elevated so we're going to put the P2 under acid it's on the acid side then our by carb is 28 normals 22 to 26 this is elevated so we are going to put our hco3 under base now what we're looking for with this Tic Tac Toe method is a vertical three in a row and we do have one now sometimes you won't have a vertical three in a row and that tips you off that you're dealing with full compensation so we can go ahead and Mark that off because we do not have that here so so we look over here at our vertical three in a row under base we have pH and our hc3 which again represents metabolic so we have metabolic alkalosis now that we've determined that we have to figure out do we have partial compensation or is it uncompensated so the answer is it's partial compensation now how do I know that well how I know that is that I look at the respiratory system because the respiratory system is that system that should be trying to compensate for the alkalic conditions it should cause our respiratory system to retain CO2 which will hopefully decrease our blood pH and that is exactly what a respiratory system is doing it's trying to retain hence increase that CO2 level because it is elevated at 49 now would be uncompensated meaning the respiratory system is not trying to compensate at all if that pac2 was within normal range so if it was between 35 to 45 we would say it was uncompensated now that we know what a patient's arterial blood gases will look like with metabolic alkalosis how will they be presenting with their signs and symptoms a big one you're going to see is braad dnia that's those slow respirations now that's a compensatory mechanism but it can become really severe where it leads to respiratory failure and the patient can have drimia so you really want to pay attention to their ECG because this is arising from hypoc calmia where we have a low pottassium level so whenever a patient has a low potassium level you want to look specifically at that ST segment with a low potassium level it will be depressed and you'll want to look at their t-wave which could be inverted like flipped upside down now normally after the t-wave is a flat line but whenever you have hypokalemia where it's severe you can actually have what's called a uwave after that t-wave also arising from this low potassium level could be tetany trimmers muscle cramping they can feel tired and irritable what are some nursing interventions for the patient with metabolic alkalosis well of course we want to monitor that ECG the respiratory status and neuros Status we also want to keep an eye on their electrolyte levels particularly pottassium due to hypoa and that chloride level which could be hypochloremia so the healthcare provider May order supplementation that you will be administering to the patient and if the patient is vomiting we want to address that because remember those GI juices are really rich in hydrogen ions and we need to keep those nren ions in this condition so an antiemetic may be ordered also certain diuretics may need to be held particularly those Loop and thoi diuretics and the reason for that is because they drop our potassium level and when we drop our potassium level way too low it affects hydrogen ion concentration making alkalosis worse and sometimes a medication can be ordered called acetazolamide which brand name is Diamox and this is a Carbonic and hydr inhibitor and it's actually a diuretic and what it does is it decreases the reabsorption of bicarb so we're not keeping more bicarb instead it's going to help us excrete it via the urine which is really helpful when we're in alkalosis okay so that wraps up this review on metabolic alkalosis and if you'd like to watch more videos in this series you can access the link in the description below

hey everyone I&#39;m going to talk about metabolic alkalosis so let&#39;s get started metabolic alkalosis results in an elevated blood pH and an elevated bicarbonate level hc3 and this usually occurs because we&#39;ve had excessive loss of acids such as hydrogen ions or we&#39;ve had an increase in the amount of bases like bicarbonate that hc3 now what are some conditions that could cause either of these two things to happen well help us remember those conditions let&#39;s remember the word Alkali Alkali is a synonym for base first we have a for acid loss via the stomach your stomach acid is really rich in hydrogen ions so if we are over suctioning the patient removing too much of their GI juices or they&#39;re vomiting they&#39;re losing a lot of hydrogen ions which when we drop hydrogen ion concentration we increase that blood pH because all blood pH is is measuring the concentration of hydrogen ions in the body then we have L for low chloride level when we have a low chloride level in the body this causes our kidneys to start to decrease its excretion of byc carbonate so when we decrease excreting bicarbonate in our urine that&#39;s actually going to raise the levels in our body when we have too much bases they are going to neutralize those acids which will throw us into these Al otic conditions and then we have k for potassium loss so whenever we have hypokalemia in a patient what happens is that it really affects hydrogen ions it causes those hydrogen ions to move inside the cell so instead of being in the fluid surrounding that cell and that extracellular fluid it will start to migrate inward which will drop our hydrogen ion amounts which is going to increase our blood pH then we have a for aldosterone increase so whenever we have a condition like hyper aldosterone ISM we have a high level of aldosterone in the body it&#39;s going to do three things one thing is it&#39;s going to cause our body to keep sodium which in the end is going to cause us to waste more hydrogen ions again we&#39;re losing our hydrogen ions which raises our blood pH and keep bicarb and then we have L for Loop and thide diuretics these diuretics they increase urinary output but also in that urine will be potassium so we&#39;re at risk for hypokalemia and whenever we put a patient in hypokalemia we just learned it messes with the hydrogen ion concentration which will increase the risk of developing metabolic alkalosis and then lastly I for infusing too much sodium bicarb IV so this could happen if the patient was in let&#39;s say metabolic acidosis where they were ordered sodium bicarbonate they received too much so now we flipped them over into alkalosis because bicarbon that sodium B carb fluid acts as a base so if we give them too much of a base that will go in there neutralize too many hydrogen ions which we don&#39;t want and send them into alkalosis now to help us understand metabolic alkalosis a little bit better let&#39;s talk more in depth about bases bases are materials that once you break them down in a solution they neutralize acids by binding with the hydrogen ions so in a sense what it does is it acquires a hydrogen ion and then neutralizes it now hydrogen ions play a big role in helping us determine our blood pH because a blood pH as I pointed out earlier is the concentration of hydrogen ions and think of hydrogen ions as little acids in the body when you have a High collection of these hydrogen ions it will actually drop the blood pH and make your body more acidic but if you don&#39;t have a lot of hydrogen ions like here in metabolic alkalosis it will actually make the body too alkaline and increase the blood pH and our body likes this narrow range for its blood pH it wants it between 7.35 to 7.45 anything less than 7.35 is too acidic anything greater than 7.45 is to alkaline and the body&#39;s always trying to maintain this 20 to1 ratio between bases and acids it wants 20 bases for every acid and an important base in the body is called bicarbonate hc3 and this is actually a weak base that will help neutralize hence bind to acids like hydrogen ions and when they do this they increase the pH level now your body has these internal systems that help maintain this acid base balance the two systems I want to talk about are the respiratory and renal system with the respiratory system it works fairly fast whenever we have an acid base imbalance and how it works is that it affects carbon dioxide levels by causing you to change your respiratory rate and depth for example your respiratory system can cause you to breathe faster and deeper and whenever you&#39;re doing that think about what&#39;s happening what are you blowing off if you&#39;re breathing really fast and deep you&#39;re blowing off carbon dioxide and this is really beneficial whenever you are experiencing acidosis because carbon dioxide plays a role with the formation of carbonic acid which will affect our hydrogen ions hydrogen ions are acidic so if we can lower the amount of carbon dioxide by breathing it off we can affect in the long run hydrogen ion concentration which will help increase that blood pH back to normal on the flip side your respiratory system can cause you to breathe slower so think about it whenever you&#39;re breathing slower what are you keeping more of you&#39;re keeping more of carbon dioxide and this is very beneficial whenever you have alkalosis going on where you&#39;re too basic because keeping carbon dioxide is going to cause you to create more hydrogen ions so a lot of times whenever you have a patient in an alkalic state you will see that they have braad dnia where their respirations are slow they&#39;re having hypoventilation and the whole purpose of this is to keep that carbon dioxide because when we keep the carbon dioxide that stays in our blood that carbon dioxide is going to bind with water when it binds with water it&#39;s going to form carbonic acid carbonic acid is a weak acid and it breaks apart when it breaks apart it increases hydrogen ions those hydrogen ions will go in there and neutralize the bicarbonate whenever we neutralize the bicarbonate that is going to help bring down that blood pH to normal and then the renal system will come into play now I like to think of the renal system as the slow and steady system it&#39;s like the turtle it&#39;s slow but once it gets going it does its thing so with this system what&#39;s going to happen is it is going to help retain hydrogen ions so why do we need hydrogen ions because because they&#39;re going to help make things more acidic which is really needed when we have metabolic alkalosis so those hydrogen ions will go and neutralize that bicarbonate plus the kidneys can start to excrete extra bicarb which again will help lower that blood pH now one of the ways you can tell that your patients in metabolic alkalosis is that you can look at their arterial blood gas results their abgs so what are abgs going to look like in a person with metabolic alkalosis well there&#39;s three things you got to look at we got to look at the blood pH the bicarbonate level and the P2 so the blood pH again a normal was what 7.35 to 7.45 with this the blood pH is going to be greater than 7.45 it&#39;s going to be on the alkaline side the bicarbonate which represents our metabolic system a normal is 22 to 26 mil equivalents per liter and with this it&#39;s going to be elevated so it&#39;s going to be greater than 26 it&#39;s going to be on the alkaline side and then our P2 which represents our respiratory system it can be one of two things it could be normal or it could be elevated so a normal level is 35 to 45 mm of mercury if the body isn&#39;t trying to compensate that respiratory the pac2 is going to be normal because our body hasn&#39;t decreased our respirations yet in Hope of retaining that CO2 so it&#39;ll just be within that 35 to 45 range however if it was trying to compensate like partially compensate it would start to cause your respiratory system to keep that CO2 so you would start to see the CO2 levels rise and they would be greater than 45 now let&#39;s analyze an arterial blood gas problem so this problem here actually comes from my workbook called ABG interpretation so if you need more practice or explanation on this topic you can get a copy of this book so our problem says we have a pH of 7.53 a p 2 of 49 and a bicarb hc3 of 28 so how I&#39;m going to solve this is I&#39;m going to use the Tic Tac Toe method you could use Rome or whatever you prefer so we&#39;re going to set up our grid we have acid over there on the left normal in the middle and then base here on the right first let&#39;s Analyze That pH a normal is 7.35 to 7.45 we&#39;re at 7.53 that is alkaline so we&#39;re going to put pH under base the P CO2 is 49 and normal is 35 to 45 this is elevated so we&#39;re going to put the P2 under acid it&#39;s on the acid side then our by carb is 28 normals 22 to 26 this is elevated so we are going to put our hco3 under base now what we&#39;re looking for with this Tic Tac Toe method is a vertical three in a row and we do have one now sometimes you won&#39;t have a vertical three in a row and that tips you off that you&#39;re dealing with full compensation so we can go ahead and Mark that off because we do not have that here so so we look over here at our vertical three in a row under base we have pH and our hc3 which again represents metabolic so we have metabolic alkalosis now that we&#39;ve determined that we have to figure out do we have partial compensation or is it uncompensated so the answer is it&#39;s partial compensation now how do I know that well how I know that is that I look at the respiratory system because the respiratory system is that system that should be trying to compensate for the alkalic conditions it should cause our respiratory system to retain CO2 which will hopefully decrease our blood pH and that is exactly what a respiratory system is doing it&#39;s trying to retain hence increase that CO2 level because it is elevated at 49 now would be uncompensated meaning the respiratory system is not trying to compensate at all if that pac2 was within normal range so if it was between 35 to 45 we would say it was uncompensated now that we know what a patient&#39;s arterial blood gases will look like with metabolic alkalosis how will they be presenting with their signs and symptoms a big one you&#39;re going to see is braad dnia that&#39;s those slow respirations now that&#39;s a compensatory mechanism but it can become really severe where it leads to respiratory failure and the patient can have drimia so you really want to pay attention to their ECG because this is arising from hypoc calmia where we have a low pottassium level so whenever a patient has a low potassium level you want to look specifically at that ST segment with a low potassium level it will be depressed and you&#39;ll want to look at their t-wave which could be inverted like flipped upside down now normally after the t-wave is a flat line but whenever you have hypokalemia where it&#39;s severe you can actually have what&#39;s called a uwave after that t-wave also arising from this low potassium level could be tetany trimmers muscle cramping they can feel tired and irritable what are some nursing interventions for the patient with metabolic alkalosis well of course we want to monitor that ECG the respiratory status and neuros Status we also want to keep an eye on their electrolyte levels particularly pottassium due to hypoa and that chloride level which could be hypochloremia so the healthcare provider May order supplementation that you will be administering to the patient and if the patient is vomiting we want to address that because remember those GI juices are really rich in hydrogen ions and we need to keep those nren ions in this condition so an antiemetic may be ordered also certain diuretics may need to be held particularly those Loop and thoi diuretics and the reason for that is because they drop our potassium level and when we drop our potassium level way too low it affects hydrogen ion concentration making alkalosis worse and sometimes a medication can be ordered called acetazolamide which brand name is Diamox and this is a Carbonic and hydr inhibitor and it&#39;s actually a diuretic and what it does is it decreases the reabsorption of bicarb so we&#39;re not keeping more bicarb instead it&#39;s going to help us excrete it via the urine which is really helpful when we&#39;re in alkalosis okay so that wraps up this review on metabolic alkalosis and if you&#39;d like to watch more videos in this series you can access the link in the description below

Transcript for:Metabolic Alkalosis

Transcript for:
Metabolic Alkalosis