If the lungs cannot get rid of the excess carbon dioxide, then the kidneys are going to go to work to try to correct the problem. The kidneys goal right now is to get the pH back into normal range. The kidneys use bicarbonate (base) and hydrogen (acid) in an effort to correct the pH. In this instance, when there is too much CO2 (acid), the kidneys will kick in and secrete bicarbonate into the blood and excrete hydrogen out of the body. _ If the lungs are getting rid of too much CO2 (acid), as with hyperventilation, then the patient will become alkalotic. Now, the pH is out of range so the kidneys will try to correct it with the same two chemicals, bicarb and hydrogen. Since the kidneys are trying to correct alkalosis, they will excrete bicarb from the body and retain hydrogen. If the kidneys are sick, which organ/organs are going to compensate for the malfunctioning kidneys? The lungs! The lungs are going to compensate by either blowing off the excess carbon dioxide (by increasing respirations) or retaining carbon dioxide (by slowing respirations). How the respiration will change, depends on whether the client is experiencing metabolic acidosis or alkalosis.
Acidosis = Hypercalcemia
Alkalosis: Alkalosis causes calcium to bind with plasma proteins. Therefore, alkalosis causes serum calcium to go down! Since, calcium (sedative) is low - Hypocalcemia, the muscles will not be relaxed; instead, the muscles will be tight and begin to twitch. Hypocalcemia = Trousseaus sign and Chvosteks sign
Hyperkalemia - Acidosis causes K_ to increase in the blood. To compensate for the respiratory acidosis, H_ (acid) moves out of the blood into the cell where K_ is now living. Now the blood is less acid. However, K_ does not want to live with H_ inside the cell, so K_ moves into the bloodstream causing the serum K_ to go up In respiratory acidosis the client is breathing too slowly, too shallow, or not breathing at all. In all 3 situations, the client is retaining CO2. Think hypoventilation first!
_ Administer drugs to open up the airways and thin out secretions so they can be coughed up. _ Increase fluids to liquefy secretions so they can be coughed up more easily. _ Oxygen therapy. _ Respiratory therapy: breathing treatments. _ Elevate head of bed (HOB) for lung expansion. _ Monitor ABGs. _ Monitor for electrolyte imbalances. _ Monitor pulse oximetry. _ Administration of Pulmocare: a tube feeding sometimes used to decrease CO2 retention.
Hypoxia may be the first sign of respiratory acidosis. The early signs of hypoxia are restlessness and tachycardia. Early hypoxia: restlessness, tachycardia. Hypoxia causes the heart rate to increase to pump what little oxygen is left to the vital organs. Bradycardia occurs because the heart is not receiving enough oxygen. Late hypoxia: cyanosis, bradycardia.
Dont forget anything leading to respiratory problems or heart attack or shock and also look for decrease in LOC. Acute respiratory acidosis causes hyperkalemia. With chronic respiratory acidosis, the Kmay be normal as the kidneys have time to readjust and get the Kback into the normal range
Respiratory alkalosis
What is it?
Respiratory alkalosis is an acidbase imbalance where the PCO2 is less than 35 mm Hg and the pH is greater than 7.45. Basically, the pH is increased and the CO2 is decreased. As in respiratory acidosis, the lungs are the cause of the problem in respiratory alkalosis. _ The only way the PCO2 can decrease in the blood is through excessive exhalationhyperventilation. _ When the lungs are impaired, the kidneys compensate with their own chemicalsbicarbonate and H. _ The kidneys will retain Hbecause this is acid. We want to keep acid in order to replace the acid being lost from the hyperventilation. _ The kidneys will excrete bicarbonate because this is base. This
excretion of the base will help raise acid levels and restore the body to a normal pH. _ Respiratory alkalosis means that the client has lost excessive CO2 (acid), thus making the client alkalotic.
DEFINE TIME Hypocapnia occurs when the CO2 is low; hypercapnia occurs when the CO2 is high. Hyperapnia is hyperventilation.
You can get hypokalemia (low potassium) Hypokalemia H_ ions move out of the cell into the bloodstream to decrease alkalinity. K_ moves into the cells trying
to get away from H_, which decreases serum K_ The name respiratory tips you off to the fact that a lung problem exists Since it is a lung problem, the problem chemical is the acid carbon dioxide (CO2) Excessive exhalation causes PCO2 to decrease in the blood. Acid is lost When the lungs are impaired, the kidneys compensate with their own chemicalsbicarbonate and H. The kidneys will retain Hbecause this is acid. We want to keep acid since the body is losing acid from the excessive exhalation. The kidneys will excrete bicarbonatea basein order to create a more acidic environment and return the pH to normal Respiratory alkalosis means that the client has lost excessive CO2 (acid), thus making the client alkalotic
Metabolic acidosis
What is it?
Metabolic acidosis is an acidbase imbalance where the pH is less than 7.35 and the bicarbonate level is less than 22 mEq/L. Acid (Hions) builds up in the body, or too much bicarbonate has been lost from the body. Basically, the pH is decreased and the bicarbonate level is decreased. The less bicarb you have in the body, the more acid you will be. _ In metabolic disorders, the problem is not with the lungs but with the kidneys. _ Which chemicals are associated with the kidneys? Bicarbonate and H. _ The decrease in the alkaline substances (bases) causes a build up of acids in the body, causing acidosis. _ Which organ will compensate? The lungs will compensate by increasing respirations in an effort to blow off excess CO2 (acid) and therefore increase pH. _ The lungs will start compensating in just few minutes, but its not enough to correct the imbalance at this point.
Metabolic alkalosis
What is it?
Metabolic alkalosis is an acidbase imbalance where the pH is greater than 7.45 and the bicarbonate level is greater than 26 mEq/L. There is an excess of base in the body and a loss of acid. Basically, pH is increased and bicarbonate is increased. _ The lungs did not cause the problem; that is why it is a metabolic problem and not a respiratory one. _ Metabolic means the kidneys, which involve bicarbonate and H. _ The lungs compensate by retaining CO2 by means of hypoventilation. This compensates for the alkalosis and helps the pH go down into normal range. Causes
The two most common causes of metabolic alkalosis are loss of stomach acid and diuretics.
Hypokalemia Vomiting may have caused initial imbalance. As Kmoves into the cells, serum Kdrops. Hmoves into the bloodstream, increasing serum acidity
The ABGs of metabolic alkalosis will look like: pH greater than 7.45 and HCO3 greater than 26 mEq/L. If compensation has begun, PCO2 will increase.
Acidosis: Think hyperkalemia and hypercalcemia. Alkalosis: Think hypokalemia and hypocalcemia. Recap of metabolic alkalosis The problem is with the kidneys, not the lungs Bicarbonate (base) and H(acid) are associated with the kidneys Metabolic alkalosis can be caused by increased bicarbonate through diuretic therapy, prolonged nasogastric suctioning, and excessive vomiting, resulting in pH levels
The lungs compensate by retaining CO2 by means of hypoventilation. This compensates for the alkalosis