| Respiratory Acidosis | Metabolic Acidosis | Respiratory Alkalosis | Metabolic Alkalosis | |
| Causes | Depression of the respiratory center (brainstem trauma, over-sedation), respiratory muscle paralysis, disorders of the chest wall, disorders of the lung parenchyma, hypoventilation | Lactic acidosis, renal failure, diabetic ketoacidosis, diarrhea | High altitudes, hypermetabolic states such as fever, anemia and thyrotoxicosis, early salicylate intoxication, anxiety or panic disorder, improper use of mechanical ventilations | Prolonged vomiting, gastric suctioning, excessive HCO3- intake, hyperaldosteronism with hypokalemia, diuretic therapy |
| pH | < 7.35 | < 7.35 | > 7.45 | > 7.45 |
| CO2 | Hypercapnia | Hypocapnia, CO2 < 38mmHg | ||
| HCO3- | HCO3- < 24 mEq/L | HCO3- > 26 mEq/L | ||
| Compensation | Not as effective since kidneys take time, but conserve bicarbonate and eliminate H+ | Hyperventilation and renal excretion of excess acids | Kidneys decrease H+ excretion and HCO3- absorption | Hypoventilation, kidneys conserve H+ and eliminate HCO3- |
| Manifestations | Headache, restlessness, blurred vision, apprehension, lethargy, muscle twitching, tremors, convulsions, coma | Headache, lethargy, Kussmaul respirations | Dizziness, confusion, tingling extremities, convulsions, coma with sigs of hypocalcemia | Weakness, muscle cramps, hyperactive reflexes, hypocalcemia |
| Treatment | Restore adequate ventilation, mechanical ventilation may be required, IV lactate | HCO3-, lactate (converted to HCO3- in the liver), treat underlying causes | Paper bag, treat hypoxemia and hypermetabolic states | NaCl, K+, Chloride IV (Cl replaces HCO3-) |
Source: Medical-Surgical Nursing : Assessment and Management of Clinical Problems, 10th Ed (Lewis)💎
Brilliant Nurse NCLEX-RN® Test Prep! 💎
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