Definition: metabolic alkalosis is a clinical disturbance characterized by a high pH (decrease H+ concentration) and a high plasma bicarbonate concentration
It can be produced by a gain of bicarbonate or a loss of H+ (khanna and khurtzman 2001) Probably the most common cause of metabolic alkalosis is vomiting or gastric function with loss of hydrogen and chloride ions
This order also occurs in pyloric stenosis, in which only gastric fluid is lost Gastric fluid has an acid pH (usually 1-3)
Therefore loss of highly acidic fluid increase the alkalinity of body fluids Other loss of K+ such as diuretic therapy that promotes excretion of K+ (furosemide)
Hypokalemia produces alkalosis In two ways
- The kidney conservative potassium
- Cellular K+ moves out of the cell into ECF
Chronic metabolic alkalosis can occur with long term diuretic therapy, villous adenoma, external drainage of gastric fluids, cystic fibrosis and chronic ingestion of milk and calcium carbonate
- Primary symptoms related to decreased calcium ionization such as tingling of the finger and toes, dizziness, and hypertonic muscles Serum Ca+ level decreased in alkalosis as more Ca+ combines with serum proteins
- Respirations are depressed as compensatory action by the lungs
- Arterial tachycardia may occur As pH increases above 7.6 and hypokalemia develops Ventricular disturbance may occur
- Decreased motility and paralytic ileus may also occur Symptoms of chronic metabolic alkalosis are same as for acute metabolic alkalosis
- ABG’s – pH greater than 7.45 and serum bicarbonate concentration greater than 20mEq/L Serum electrolytes – decreased Ca+ + K+
- Treatment aimed at reversing the underlying disorder
- Sufficient chloride must be supplied for kidney to absorb sodium with chloride Restoring normal fluids by Na+Cl fluids
- To maintain alkalosis Administer K+CL
- Histamine – 2 – receptor antagonists (cimitidine)
- Management of chronic metabolic alkalosis is aimed to correct underlying acid- base disorder
Health Perception–Health Management
• How is your energy level compared with 1 yr ago?
• Do you notice any visual changes?*
• Have you ever smoked? If yes, how many packs per day?
• How is your appetite?
• Has your weight changed over the past yr?*
• Do you take vitamins, herbs, or any other supplements?*
• How much and what kinds of fluids do you drink daily?
• How many dairy products and how much meat do you eat?
• Do you drink coffee? Colas? Tea?
• Do you eat chocolate?
• Do you spice your food heavily?*
• Are you able to sit through a 2-hr meeting or ride in a car for 2 hr without urinating?
• Do you awaken at night with the desire to urinate? If so, how many times does this occur during an average night?
• Do you ever notice blood in your urine?* If so, at what point in the urination does it occur?
• Do you ever pass urine when you do not intend to? When?
• Do you use special devices or supplies for urine elimination or control?*
• How often do you move your bowels?
• Do you ever experience constipation?
• Do you frequently experience diarrhea? Do you ever have problems controlling your bowels? If so, do you have problems controlling the passage of gas? Watery or liquid stool? Solid stool?
• Have you noticed any changes in your ability to do your usual daily activities?*
• Do certain activities aggravate your urinary problem?*
• Has your urinary problem caused you to alter or stop any activity or exercise?*
• Do you require assistance in moving or getting to the bathroom?*
• Do you awaken at night from an urge to urinate?*
• Do you awaken at night from pain or other problems and urinate as a matter of routine before returning to sleep?*
• Do you experience daytime sleepiness and fatigue as a result of nighttime urination?*
• Do you ever have pain when you urinate?* If so, where is the pain?
• How does your urinary problem make you feel about yourself?
• Do you perceive your body differently since you have developed a urinary problem?
• Does your urinary problem interfere with your relationships with family or friends?*
• Has your urinary problem caused a change in your job status or
affected your ability to carry out job-related responsibilities?*
• Has your urinary problem caused any change in your sexual pleasure or performance?*
• Do you have hygiene problems related to sexual activities that cause you concern?*
• Do you feel able to manage the problems associated with your urinary problem? If not, explain.
• What strategies are you using to cope with your urinary problem?
• Has your present illness affected your belief system?*
• Are your treatment decisions related to your urinary problem in conflict with your value system?*