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Respiratory/Metabolic Acidosis/Alkalosis | 마이메르시 MyMerci
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Respiratory/Metabolic Acidosis/Alkalosis

NCLEX Review Guide: Fluid, Electrolyte & Acid-Base Balance

Acid-Base Balance Fundamentals

Normal Values & Compensation

  • Normal arterial pH: 7.35-7.45 - Values below 7.35 indicate acidosis, above 7.45 indicate alkalosis
  • Normal PaCO2: 35-45 mmHg - Respiratory component controlled by lungs through ventilation
  • Normal HCO3-: 22-26 mEq/L - Metabolic component controlled by kidneys through retention/excretion
  • Compensation occurs when one system attempts to correct imbalances caused by the other system

Memory Aid: ROME

Respiratory Opposite - pH and CO2 move in opposite directions
Metabolic Equal - pH and HCO3- move in same direction

Key Points

  • Respiratory compensation is fast (minutes to hours)
  • Metabolic compensation is slow (hours to days)
  • Full compensation rarely occurs - pH returns to normal range

Respiratory Acidosis & Alkalosis

Respiratory Acidosis (pH <7.35, CO2 >45)

  • Hypoventilation leads to CO2 retention, causing carbonic acid buildup and decreased pH
  • Common causes: COPD exacerbation, pneumonia, respiratory depression from opioids, airway obstruction
  • Signs/symptoms: confusion, drowsiness, headache, warm flushed skin, muscle twitching

Respiratory Alkalosis (pH >7.45, CO2 <35)

  • Hyperventilation leads to excessive CO2 elimination, causing increased pH
  • Common causes: anxiety, fever, pain, mechanical ventilation, high altitude, salicylate poisoning
  • Signs/symptoms: lightheadedness, tingling, muscle cramps, tetany, seizures

Clinical Scenario

Patient with COPD presents with pH 7.30, CO2 55, HCO3- 28. This indicates respiratory acidosis with partial metabolic compensation (kidneys retaining bicarbonate).

Metabolic Acidosis & Alkalosis

Metabolic Acidosis (pH <7.35, HCO3- <22)

  • Caused by loss of bicarbonate or gain of acids from non-respiratory sources
  • Common causes: diabetic ketoacidosis, renal failure, diarrhea, lactic acidosis, methanol/ethylene glycol poisoning
  • Compensation: Kussmaul respirations - deep, rapid breathing to blow off CO2

Metabolic Alkalosis (pH >7.45, HCO3- >26)

  • Caused by loss of acids or gain of bicarbonate from non-respiratory sources
  • Common causes: prolonged vomiting, nasogastric suction, diuretic use, excessive antacid use
  • Compensation: shallow, slow respirations to retain CO2 (limited by hypoxia)

Memory Aid: MUDPILES (Metabolic Acidosis Causes)

Methanol, Uremia, DKA, Paraldehyde, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates

Commonly Confused Concepts

Condition pH Primary Change Compensation Key Signs
Respiratory Acidosis ↓ (<7.35) ↑ CO2 (>45) ↑ HCO3- Confusion, drowsiness
Respiratory Alkalosis ↑ (>7.45) ↓ CO2 (<35) ↓ HCO3- Tingling, tetany
Metabolic Acidosis ↓ (<7.35) ↓ HCO3- (<22) ↓ CO2 Kussmaul breathing
Metabolic Alkalosis ↑ (>7.45) ↑ HCO3- (>26) ↑ CO2 Shallow breathing

Common Pitfalls

  • Don't confuse compensation with correction - compensation doesn't normalize the primary disorder
  • Always identify the primary disorder first, then look for compensation
  • Remember: the body never overcompensates beyond normal pH range

Nursing Interventions

  1. Assess respiratory status - rate, depth, pattern, oxygen saturation
  2. Monitor vital signs - especially neurological changes and cardiac rhythm
  3. Position appropriately - semi-Fowler's for respiratory issues, side-lying for vomiting
  4. Administer oxygen as prescribed for hypoxemia (avoid high concentrations in COPD)
  5. Monitor electrolytes - especially potassium, which shifts with pH changes

Priority Nursing Actions

For respiratory acidosis: improve ventilation, clear airway, position for optimal breathing. For metabolic acidosis: treat underlying cause, monitor for dysrhythmias, prepare for possible bicarbonate administration.

Quick Assessment Checklist

  • ☐ Can you identify the primary disorder from ABG values?
  • ☐ Do you understand the difference between respiratory and metabolic causes?
  • ☐ Can you recognize signs of compensation?
  • ☐ Do you know priority nursing interventions for each type?
  • ☐ Can you identify high-risk medications and conditions?

Quick Check: ABG Interpretation Steps

  1. Look at pH - acidosis or alkalosis?
  2. Look at CO2 - does it match the pH? (respiratory cause)
  3. Look at HCO3- - does it match the pH? (metabolic cause)
  4. Check for compensation - is the other system trying to correct?

Remember: Understanding acid-base balance is crucial for safe nursing practice. Master the basics, practice ABG interpretation daily, and always consider the whole patient picture. You've got this! 💪

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