{
  "name": "Metabolic Acidosis",
  "slug": "metabolic-acidosis",
  "url": "https://nursingplex.com/care-plans/metabolic-acidosis",
  "category": "Endocrine & Metabolic",
  "summary": "Low pH and bicarbonate from DKA, renal failure or diarrhea; treat the cause and monitor potassium.",
  "nursing_diagnoses": [
    "Impaired gas exchange",
    "Risk for electrolyte imbalance",
    "Decreased cardiac output"
  ],
  "overview": [
    "Metabolic acidosis is a primary fall in serum bicarbonate producing a pH below 7.35. It arises either from accumulation of acid — lactic acidosis, diabetic ketoacidosis, renal failure, toxic ingestions — or from bicarbonate loss through severe diarrhea, pancreatic fistula or renal tubular acidosis.",
    "The anion gap separates the two groups: a high gap means unmeasured acids have accumulated, while a normal gap points to bicarbonate loss with chloride retention. The lungs compensate within minutes through Kussmaul respirations blowing off carbon dioxide; the kidneys take days.",
    "Nursing care treats the cause first — fluids and insulin for ketoacidosis, perfusion restoration for lactic acidosis, dialysis for renal failure — while monitoring airway, potassium and neurologic status."
  ],
  "key_facts": [
    {
      "label": "Values",
      "text": "pH below 7.35 with bicarbonate below 22 mEq/L; PaCO2 falls with respiratory compensation."
    },
    {
      "label": "Kussmaul breathing",
      "text": "Deep, rapid respirations are compensation, not a primary respiratory problem — do not suppress them."
    },
    {
      "label": "Potassium shift",
      "text": "Acidosis pushes potassium out of cells, so serum potassium may look normal or high while total body stores are depleted; levels fall fast with treatment."
    },
    {
      "label": "Bicarbonate therapy",
      "text": "Generally reserved for severe acidemia (pH below about 7.1) or specific causes, since it can worsen intracellular acidosis."
    }
  ],
  "nursing_priorities": [
    "Identify and treat the underlying cause.",
    "Support ventilation and oxygenation.",
    "Monitor and replace potassium carefully during correction.",
    "Restore perfusion and fluid balance.",
    "Protect the patient from injury during altered mental status."
  ],
  "assessment": {
    "subjective": [
      "Reports of weakness, fatigue, nausea or vomiting",
      "Complaints of headache, drowsiness or confusion",
      "History of diabetes, renal disease, diarrhea, sepsis or ingestion",
      "Reports of abdominal pain"
    ],
    "objective": [
      "Arterial blood gas: pH below 7.35, HCO3 below 22, compensatory low PaCO2",
      "Kussmaul respirations; fruity breath odor in ketoacidosis",
      "Elevated anion gap, lactate, ketones, creatinine or glucose depending on cause",
      "Hyperkalemia initially, then falling potassium with therapy; ECG changes",
      "Hypotension, warm flushed skin, decreasing level of consciousness"
    ],
    "related_factors": [
      "Diabetic ketoacidosis or starvation ketosis",
      "Lactic acidosis from shock, sepsis or hypoxia",
      "Renal failure with retained acids",
      "Severe diarrhea or high-output intestinal losses",
      "Toxic ingestion: salicylates, methanol, ethylene glycol"
    ]
  },
  "goals": [
    "The client's arterial pH and bicarbonate will return toward normal.",
    "The client will maintain potassium within safe limits during correction.",
    "The client will maintain stable respiratory and neurologic status.",
    "The client will remain free from injury related to altered consciousness."
  ],
  "interventions": [
    {
      "title": "Monitor",
      "points": [
        "Follow serial ABGs, bicarbonate, anion gap, lactate and electrolytes.",
        "Maintain continuous cardiac monitoring for potassium-related arrhythmias.",
        "Assess respiratory rate, depth and effort; report fatigue or falling rate.",
        "Perform frequent neurologic checks and strict intake and output."
      ]
    },
    {
      "title": "Treat the cause",
      "points": [
        "For DKA: give isotonic fluids and an insulin infusion per protocol, adding dextrose as glucose falls.",
        "For lactic acidosis: restore perfusion with fluids, oxygen and treatment of sepsis or shock.",
        "For bicarbonate loss: replace fluids and electrolytes and control diarrhea.",
        "Prepare for dialysis in renal failure or toxic ingestion as ordered."
      ]
    },
    {
      "title": "Support and protect",
      "points": [
        "Administer potassium replacement as ordered once urine output is adequate, monitoring closely.",
        "Give sodium bicarbonate only as prescribed for severe acidemia.",
        "Maintain airway readiness and oxygen therapy.",
        "Institute fall and seizure precautions and reorient frequently."
      ]
    }
  ],
  "patient_teaching": [
    "Explain the cause of the imbalance in plain language and how treatment corrects it.",
    "For diabetes, review sick-day rules and ketone testing to prevent recurrence.",
    "Teach oral rehydration during prolonged diarrhea.",
    "Advise reporting deep rapid breathing, confusion or persistent vomiting."
  ]
}