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Hypochloremia (chloride Hypoventilation 1. Chloride produce in the hyperexcitability of Blood test Normal saline/.45% Monitor intake and
deficit) respiratory acidosis stomach muscle Chloride level sodium chloride output, arterial blood
low sodium intake 2. Chloride combines with tetany Sodium and potassium Diet Modification gas values
vomiting hydrogen to form HCl hyperactive deep level Ammonium chloride
diarrhea 3. Small amount of tendon reflexes Arterial blood gas Monitor serum
chloride combines with weakness Urine exam electrolytes levels
the feces twitching and muscle
4. Diarrhea and excessive crumps Assess patients
vomiting will cause consciousness and
hypochloremia muscle strength
Encourage to eat
foods with high
chloride intake
Hyperchloremia Head trauma 1. Loss of bicarbonate Tachypnea Blood test Hypotonic IV solution monitor vital signs,
(Chloride excess) increased perspiration ions via the kidney or Weakness Serum pH, serum Lactated Ringer’s arterial blood gas
excess adrenocortical GI tract Lethargy chloride, serum sodium solution values
hormone production 2. Chloride ions increases deep rapid respiration Urine exam IV sodium bicarbonates
decrease glomerular 3. Chloride ions in the diminished cognitive diuretics monitor intake and
filtration form of acidifying salt ability output
accumulate hypertension
4. acidosis asses respiratory,
neurologic and
cardiac functions
encourage to
maintain adequate
hydration
Acute Metabolic Acidosis Uremia Headache Arterial blood gas Bicarbonate Monitor intake and
(Base bicarbonate Diabetic Ketoacidosis Confusion sampling replacement output
deficit) lactic acidosis Drowsiness blood pH alkalizing agent
ketoacidosis increased respiratory Blood Serum
chronic renal failure rate ECG
diarrhea nausea and vomiting
vomiting decreased cardiac
output
Chronic Metabolic Asymptomatic until
Acidosis (Base bicarbonate is
bicarbonate deficit) approximately
15mEq/L or less
Acute metabolic alkalosis Vomiting or gastric 1.-kidneys conserve tingling of the fingers ABG administering sodium Monitor intake and
(Base bicarbonate suction with loss of potassium thus and toes serum bicarbonate chloride fluids output
Excess) hydrogen and chloride increasing the excretion dizziness and urine chloride levels administer KCl
ions of H+ hypertonic muscles (potassium chloride)
Pyloric stenosis 2.cellular potassium depressed respirations H2 Receptor
diuretic therapy moves out of the cells atrial tachycardia antagonists (Tagamet)
excessive into the ECF in attempt decreased motility and carbonic anhydrase
adrenocorticoid to maintain near-normal paralytic ileus inhibitors
hormones serum levels
excessive alkali ingestion 3.ionized fraction of
from antacids containing serum calcium
bicarbonate during decreases as more
cardiopulmonary calcium combines with
resuscitation protein
Chronic metabolic long-term diuretic
alkalosis (Base therapy
bicarbonate Excess) villous adenoma
external drainage of
gastric fluids
significant potassium
depletion
cystic fibrosis
chronic ingestion of milk
and calcium bicarbonate
Acute Respiratory acute pulmonary edema 1.inadequate ventilation sudden hypercapnia ABG analysis mproving ventilation monitor respiratory
Acidosis (Carbonic Acid severe pneumonia 2.elevated plasma CO2 increase respiratory serum electrolyte bronchodilators rate
Excess) acute respiratory concentration rate levels antibiotics place patient in a semi-
Chronic Respiratory distress syndrome 3.increased levels of increase intracranial chest x-ray thrombolytics or fowler’s position
Acidosis (Carbonic Acid Atelectasis carbonic acid pressure ECG anticoagulants (if
Excess) Pneumothorax 4.elevated PaCo2 , hyperkalemia drug screen (if caused pulmonary emboli (+))
overdose of sedatives hypoventilation causes a by overdose) clear respiratory tract of
chronic empysema and decrease in PaO2 mucus and purulent
bronchitis drainage
obesity adequate hydration
supplemental oxygen
mechanical ventilation
Acute Respiratory hyperventilation 1. hyperventilation light-headedness ABG analysis sedative to relieve monitor respiratory
Alkalosis (Carbonic Acid extreme anxiety 2. excessive “blowing off” inability to concentrate serum electrolytes hyperventilation rate
Deficit) hypoxemia of the CO2 numbness and tingling toxicology screen instruct patient to
Chronic Respiratory gram-negative 3. decrease in plasma tinnitus breath slowly
Alkalosis (Carbonic Acid bacteremia carbonic acid loss of consciousness
Deficit) chronic hypocapnia concentration