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METABOLIC ALKALOSIS (PRIMARY BASE BICARBONATE EXCESS) Metabolic alkalosis is characterized by a high pH (loss of hydrogen ions) and high plasma bicarbonate caused by excessive intake of sodium bicarbonate, loss of gastric/intestinal acid, renal excretion of hydrogen and chloride, prolonged hypercalcemia, hypokalemia, and hyperaldosteronism. Compensatory mechanisms include slow, shallow respirations to increase CO 2 level and an increase of bicarbonate excretion and hydrogen reabsorption by the kidneys. CARE SETTING This condition does not occur in isolation but rather is a complication of a broader problem that may require inpatient care in a medical-surgical or subacute unit. RELATED CONCERNS Plans of care specific to predisposing factors Fluid and electrolyte imbalances Renal dialysis Respiratory acidosis (primary carbonic acid excess) Respiratory alkalosis (primary carbonic acid deficit) Patient Assessment Database (Dependent on Underlying Cause) CIRCULATION May exhibit: Tachycardia, irregularities/dysrhythmias Hypotension Cyanosis ELIMINATION May report: Diarrhea (with high chloride content) Use of potassium-losing diuretics (Diuril, Hygroton, Lasix, Edecrin) Laxative abuse FOOD/FLUID May report: Anorexia, nausea/prolonged vomiting High salt intake; excessive ingestion of licorice Recurrent indigestion/heartburn with frequent use of antacids/baking soda NEUROSENSORY May report: Tingling of fingers and toes; circumoral paresthesia Muscle twitching, weakness Dizziness May exhibit: Hypertonicity of muscles, tetany, tremors, convulsions, loss of reflexes Confusion, irritability, restlessness, belligerence, apathy, coma Picking at bedclothes SAFETY May report: Recent blood transfusions (citrated blood) RESPIRATION May exhibit: Hypoventilation (increases P CO 2 and conserves carbonic acid), periods of apnea TEACHING/LEARNING History of Cushing’s syndrome; corticosteroid therapy Discharge plan DRG projected mean length of inpatient stay depends on underlying cause considerations: May require change in therapy for underlying disease process/condition.
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