 What comes to nursing school explained in this video on metabolic acidosis? If you want a little bit of a refresher on how homeostasis is regulated and how the body regulates pH balance, please go ahead and watch my other video. I'll review this concept very briefly right here also. So in general, our body produces carbonic acid which is H2CO3 that can be broken down by either the respiratory or the renal systems and the respiratory system breaks it down into H2O and CO2 which is carbon dioxide and water. Whereover on the renal or also called metabolic side, the kidneys break down into HCO3- and H+, which is bicarbonate and hydrogen ion. The kidneys regulate this by excreting more or less hydrogen ion and bicarbonate and the respiratory system regulates it by increasing and decreasing the respiratory depth and rate. Normal values for pH include 7.35 through 7.45, CO2 is 35 through 45 and bicarbonate 22 through 26 and these are just normal values that you'll have to memorize. And in this acronym I always find it very helpful which is respiratory opposite metabolic equal. So in metabolic acidosis now, this all refers to the pH, so in metabolic acidosis the pH is equal or goes in the equal direction as the bicarbonate. So we know in acidosis the pH is low, so in metabolic acidosis the pH will be low and metabolic is equal, so the bicarbonate in this case will be low too, so it will be below 22. Just a quick little acronym on how to memorize this. And then over here, so causes for metabolic acidosis can either be too much hydrogen ion, so too much acid in the system or a loss of bicarbonate, so too much bicarbonate. Sorry, not enough bicarbonate which leads to acidosis. So on the hydrogen surplus side, we have significant causes which are DKA, diabetic ketoacidosis, acute kidney injury as well as chronic kidney disease. So think about it. If the renal metabolic system is supposed to regulate the pH balance and then there's something going on with the kidneys, of course it can lead to this imbalance. And for acute kidney injury we can have pre-intra or post-renal causes and I have separate videos on all of these, these orders that you can watch a little bit more details about. Also lactic acidosis which is also known as sepsis can cause metabolic acidosis and then an aerobic metabolism when the body is starved for oxygen and needs to switch over to an aerobic metabolism, it also produces lactate in exchange which then will turn into acidosis. And also starvation, think about a patient, this happens in the more western world when there's maybe an elderly patient who falls at home and does not get found until two or three days later so now their body has been starved, not only might they be injured but they also have not consumed any fluids or food for several days and so they might be in metabolic acidosis. If we look here on the opposite side if we are low in bicarbonate the causes of this can be diarrhea because whenever we lose a lot of fluids in the stool bicarbonate goes with it and then any kind of malabsorption disorders where the body cannot regulate the intestinal absorption of food and also bicarbonate then we can lose that. And signs and symptoms so because we know that the renal and respiratory systems work together now if we're in metabolic acidosis so the problem is here on the renal side the respiratory system kicks in and tries to regulate it so when we have too much acid in the body it tries to blow off the acid here the CO2 by increasing the respiratory rate and trying to get rid of some of that CO2, some of that acid that's been that's been building up. And sometimes we also refer to this as coosmal respirations and that is this kind of jagged pattern of a very fast respiratory rate that the patient is attempting to get rid of some of the CO2. Along with this comes dizziness the patient might be confused, restless and it might lead all the way to an altered level of consciousness. They are probably going to have a low blood pressure think of anybody who is in any kind of acidosis especially sepsis most likely their blood pressure is going to be low. They might be nauseous, have vomiting and or diarrhea that can also be a cause up here and then this rhythm is because of an elevated level of potassium. So let's look over here how metabolic acidosis leads to serum hyperkalemia. So in the bloodstream represented here we have this acidotic state so we have too much hydrogen ion or too little bicarbonate or basically both. So the hydrogen ion is too much there's too much of this in the bloodstream and typically on an intracellular level we have a lot of potassium. So what the body tries to do to get rid of some of this hydrogen ion in addition of course to regulating the respiratory rate it's trying to push some of that hydrogen ion into the cells but when something goes into the cell another ion has to be exchanged for it so the hydrogen ion goes into the cell and the potassium comes out in exchange and then in the serum we have this accumulation of potassium therefore in acidosis any kind of acidotic state we have serum elevated potassium levels and we always have to be aware of the potential for dysrhythmias with potassium abnormalities. For treatment and nursing care we need to treat the underlying cause so if this is diabetic ketoacidosis the patient will need lots of fluids an insulin drip maybe some anti-imidics those kind of things if it's acute kidney injury depending if it's pre-intro-opostrino we need to resolve the problem here for chronic kidney disease maybe the patient needs to go on dialysis. Lactic acidosis and sepsis, antibiotics, fluids, treatment with oxygen, any antipyretics and those kind of things and then for anaerobic metabolism and starvation we just need to treat the underlying cause and see what is going on with their electrolytes with their protein levels all those things. For diarrhea and anti-diarrheal probably fluid because they'll be dry and then malabsorption treat the underlying cause to whatever is causing that. And then for nursing care always remember your ABCs which will also help you on exam questions in general so for airway we need to protect the airway maybe the patient needs to be intubated if they are confused and restless and not cooperative they have a low blood pressure maybe they need vasopressors. B is breathing so they'll probably need some oxygen to help them in this starvation kind of acidotic mode and then for C circulation we need to make sure that we have IV good IV access probably two good lines or even a central line to be able to give the medication so that would be the insulin the antibiotics the antipyretics the things that we need to treat the underlying cause with and then certainly the patient will need to be on a cardiac monitor because we have this potential here for potassium imbalances. We want to keep a close eye on their vital signs specifically respiratory rate blood pressure and heart rate on their ABGs and check those frequently or however often they are ordered because shifts here will happen you know not super fast but they will occur within a few hours so we want to make sure that the treatment we're giving the patient we're moving them into the right direction out of this acidotic state. We want to keep a close eye on their electrolytes specifically on the potassium that we talked about and their eyes and nose and urine output because many times it is a renal cause and so we know the kidneys regular also flow it's not just electrolytes so we need to make sure that their kidneys are still functioning or if the function you know is impeded or what their urinary output is on the hourly basis and then also on their renal function their BUN and creatinine because again the underlying cause lies within the kidneys so thank you for watching this video on metabolic acidosis please also check out the videos on the other acid base imbalances i'll put them up here for you right here and thanks for watching nursing school explain see you soon