 What comes in nursing school explain in this video on metabolic alkalosis? If you want a little bit more of a review about the physiology behind acid-base imbalances, please go check out my other videos that is titled just as such, but I'll also give you a brief review here. In general, our body produces carbonic acid, which is H2CO3, and it can be broken down and excreted by either the respiratory or the renal, that's always sometimes called the metabolic system. So the respiratory system breaks this bicarbonate acid down into H2O and CO2, and we kind of regulate it by the increasing or decreasing respiratory rate and depth. On the metabolic or renal side, the kidneys break carbonic acid down into bicarbonate, HCO3- and hydrogen ion H+, which are the acid and the base. And depending on what's needed, the kidneys either excrete or reabsorb either one or the other to have a normal pH balance. And normal pH is 7.35 through 7.45, normal CO2 35 through 45, normal bicarbonate 22 through 26. These are just numbers that you'll have to memorize. And then this acronym, Respiratory Opposite Metabolic Equal, Rome, I find it very helpful because it tells us a little bit which way the pH and either the CO2 or the bicarbonate move. So in our case in metabolic alkalosis, the pH will be high because the body is more in a basic state, and because we know that metabolic is equal, so the bicarbonate will also be elevated, so it'll be greater than 26. And watch my other video about ABG interpretation to really get into the nitty gritty of this and then how it's balanced or compensated. Now as for causes of metabolic alkalosis, this can either be too much loss of hydrogen ion, so loss of the acid, or buildup of the base, which is the bicarbonate in our system. The loss of hydrogen ion is much more common than the increase in the bicarbonate. So we can lose hydrogen ion through the GI tract and just think about that our stomach contains a lot of stomach acid, and if that stomach acid is excreted somehow, we lose that acid leaving us in an alkalotic state. So that can be due to prolonged vomiting to whatever the underlying cause for that might be, or if the patient has an NG tube and there is suctioning to that NG tube, that acid gets sucked out on a regular basis out of the stomach, leaving the patient or potentially leaving the patient in an alkalotic state. Now when there's something going on with the kidneys where they are all of a sudden excreting too much of the hydrogen ion, will be left with the bicarbonate excess. Any kind of cause for serum hypokalemia will cause alkalosis metabolically. Also diuretics, remember the diuretics affect the kidney and the RAS, the renal angiotensin and aldosterone system, in regulating our electrolytes and the way they are absorbed and exchanged. So if we give the patient too many diuretics or they are not balanced in their potassium specifically, this might cause an imbalance. And then also a condition called hyperaldosteronism might lead to melabolic alkalosis. And then less common causes that would lead to an increase in the bicarbonate buildup in the body would be lactate administration during dialysis. So if there's something maybe misinterpreted or the solution is not the right one for the patient, it can leave the patient in an alkalotic state. And then certainly also the ingestion of an anti-acid. So think about it. We're given the patient or the patient is taking anti-acids for whatever their stomach concerns are. So now we're balancing out or we're minimizing their acid in their stomach, which will leave them more in an alkalotic state. Signs and symptoms because the body is trying to regulate this imbalance on the metabolic side here, we're trying to keep more acid in the system because we're in this alkalotic state. Therefore, the respiratory rate will go down. So the patient will be hypoventilating. They might be altered, which can also lead to seizures. They might complain of a headache, be anorexic because of all these GI things we talked about here. There might be tetanis or involuntary muscle contractions as well as tremors and muscle cramps. And then this rythmias, which can lead to low serum potassium. So either it can lead to low serum potassium or the cause can be serum low potassium. So just both of them, the potassium is low, but it can either be a symptom or a cause. And let's look at this here. So in a metabolic, the alkalotic state will have too much bicarbonate and not enough of the acid, the hydrogen ion. So in our bloodstream here, we have in green, the bicarbonate in excess, but a little bit only of the hydrogen ion because it's a low concentration. Now what the body tries to do, it tries to get more of that hydrogen ion into the bloodstream to balance out this alkalotic state. But if we pull something out of the cell, which in this case is the hydrogen ion, something else has to be moved into the cell. And in this case, it's exchanged for potassium. So the potassium moves into the cell, hydrogen ion comes out of it and into the bloodstream, which then leaves the patient's bloodstream with low potassium levels, so hypokalemia. And so in an alkalotic state, will lead to serum hypokalemia and we always have to be aware of possible dysrhythmias when we have potassium imbalances. For nursing care and treatment, we want to treat the underlying cause. So if the patient is vomiting, most likely they're going to be dehydrated, so they'll need IV fluids, and they also need anti-ametics to stop the vomiting. If the cause is because of the NG tube suctioning, maybe the suctioning is not functioning properly, maybe the suctioning needs to be paused. It all depends on the specific patient care scenario. If there's renal excretion that's increased, then we need to find out what is causing that. If there are diuretics that the patient is taking, maybe too many of them, and for some reason it leaves them in an alkalotic state, then we need to find the underlying cause and find out why the patient might be having not taken the appropriate diuretic and then go from there. If this is happening due to an excess of the bicarbonate, then certainly we'll have to review the paperwork and the fluids that the patient is receiving during dialysis and then find out why is the patient taking so many antacids, what is the cause that causes them the GI discomfort. And then we always come back to our A, Bs, and Cs. So A is we have to protect their airway, maybe they need to be intubated. If they're vomiting so much that they can't protect their airway, or if there's something going on with their NG tube. Certainly O2 and monitoring the respiratory rate very carefully is indicated for breathing. C, circulation, we want to make sure we have good IV access in this patient so we can give them the fluids and the anti-ametics and any kind of other maybe serum potassium that they'll need. Certainly they'll need to be on a cardiac monitor because of the hypokalemia we talked about here. And we wanted to monitor them very closely in terms of their vital signs, specifically their respiratory rate and depth, as well as their ABGs because things might shift fairly quickly here as the respiratory system is adjusting. We wanted to monitor their electrolytes, specifically their potassium, their eyes and nose and urine output because in all of these cases we are talking about kidney and potential for dehydration, so we want to keep an eye on that, as well as their renal function because if there's something going on with the kidneys and underlying cause, we need to find out what it was and what can we do to balance that. Thank you for watching this video on metabolic alkalosis. Please also check out the other videos in the acid-base imbalances playlist where I go into all the different other disorders that pertain to pH balance. Thanks for watching Nursing School Explained, see you soon.