{
  "name": "Metabolic Alkalosis",
  "slug": "metabolic-alkalosis",
  "url": "https://nursingplex.com/care-plans/metabolic-alkalosis",
  "category": "Endocrine & Metabolic",
  "summary": "High pH and bicarbonate from vomiting, suction or diuretics; replace chloride and potassium.",
  "nursing_diagnoses": [
    "Risk for electrolyte imbalance",
    "Deficient fluid volume",
    "Risk for injury"
  ],
  "overview": [
    "Metabolic alkalosis is a primary rise in serum bicarbonate producing a pH above 7.45. The usual mechanisms are loss of hydrogen ion — through vomiting, nasogastric suction or diuretics — or gain of bicarbonate from antacid overuse, massive transfusion or bicarbonate administration.",
    "It is nearly always accompanied by hypokalemia and hypochloremia, because the kidney exchanges potassium for hydrogen to preserve acid. Alkalosis also increases neuromuscular irritability and lowers ionized calcium, producing tetany-like symptoms, and shifts the oxyhemoglobin curve so tissues release less oxygen.",
    "Nursing care corrects volume, chloride and potassium deficits, stops the ongoing acid loss, and monitors for arrhythmias and respiratory depression as the lungs compensate by hypoventilating."
  ],
  "key_facts": [
    {
      "label": "Values",
      "text": "pH above 7.45 with bicarbonate above 26 mEq/L; compensatory PaCO2 rises."
    },
    {
      "label": "Chloride-responsive",
      "text": "Vomiting, NG suction and diuretic causes correct with normal saline plus potassium chloride."
    },
    {
      "label": "Hypokalemia link",
      "text": "Alkalosis drives potassium into cells; expect and replace low potassium."
    },
    {
      "label": "Tetany",
      "text": "Reduced ionized calcium causes tingling, cramps and positive Chvostek and Trousseau signs."
    }
  ],
  "nursing_priorities": [
    "Stop or reduce ongoing acid loss.",
    "Restore volume, chloride and potassium.",
    "Monitor for arrhythmias and neuromuscular irritability.",
    "Support respiratory status during compensatory hypoventilation.",
    "Prevent injury from confusion, tetany or seizures."
  ],
  "assessment": {
    "subjective": [
      "Reports of tingling in fingers, toes or around the mouth",
      "Complaints of muscle cramps, weakness or dizziness",
      "History of vomiting, nasogastric suction, diuretic or antacid use",
      "Reports of confusion or irritability"
    ],
    "objective": [
      "ABG: pH above 7.45, HCO3 above 26, rising PaCO2",
      "Hypokalemia, hypochloremia, low ionized calcium",
      "Slow shallow respirations as compensation",
      "Hyperactive reflexes, tremor, positive Chvostek and Trousseau signs",
      "ECG changes: flattened T waves, U waves, ectopy"
    ],
    "related_factors": [
      "Prolonged vomiting or gastric suctioning",
      "Loop or thiazide diuretic therapy",
      "Excessive bicarbonate or antacid intake",
      "Hypokalemia and volume depletion",
      "Corticosteroid excess or hyperaldosteronism"
    ]
  },
  "goals": [
    "The client's pH and bicarbonate will return toward normal.",
    "The client will maintain potassium, chloride and calcium within normal limits.",
    "The client will maintain effective ventilation and oxygenation.",
    "The client will remain free from injury, tetany and arrhythmia."
  ],
  "interventions": [
    {
      "title": "Monitor",
      "points": [
        "Follow serial ABGs and electrolytes, especially potassium and chloride.",
        "Maintain cardiac monitoring and report ectopy or U waves.",
        "Assess respiratory rate and depth and oxygen saturation for hypoventilation.",
        "Check for tetany signs and neurologic changes each shift."
      ]
    },
    {
      "title": "Correct the cause",
      "points": [
        "Administer normal saline with potassium chloride as ordered for chloride-responsive alkalosis.",
        "Use low intermittent NG suction, irrigate with normal saline rather than water, and give antiemetics.",
        "Review and adjust diuretics and antacids with the provider.",
        "Give acetazolamide or other agents as prescribed for refractory cases."
      ]
    },
    {
      "title": "Protect the patient",
      "points": [
        "Institute seizure and fall precautions; keep the bed low and call light close.",
        "Reorient frequently and provide a calm environment.",
        "Record strict intake and output and daily weight.",
        "Encourage chloride- and potassium-rich foods when oral intake resumes."
      ]
    }
  ],
  "patient_teaching": [
    "Explain the risk of overusing antacids and baking soda remedies.",
    "Teach oral rehydration and when to seek care for prolonged vomiting.",
    "Review potassium-rich foods for patients on diuretics.",
    "Advise reporting muscle cramps, numbness or palpitations."
  ]
}