A nurse cares for a client with chronic respiratory acidosis who is placed on mechanical ventilation for an acute exacerbation of emphysema. Which acid-base abnormality will the nurse expect if the client's PaCO2 is corrected too quickly?
A) pH 7.52
B) pH 7.35
C) HCO3 18 mmoL/L
D) HCO3 24 mmoL/L
A) pH 7.52
Explanation: A) When the PaCO2, and thus carbonic acid, is quickly lowered, for example by placing the client on mechanical ventilation, the elevated bicarbonate has less acid to buffer, resulting in metabolic alkalosis. This condition is called posthypercapneic metabolic alkalosis. Because it takes the kidneys several days to decrease the amount of bicarbonate that had been retained, it is important to avoid excessively rapid normalization of the PaCO2 in individuals with chronic respiratory acidosis. A pH of 7.52 represents alkalosis and would be most likely with this client. Metabolic alkalosis manifests as an increase in HCO3 levels. Normal HCO3 levels are 22-28 mmoL/L. A decreased HCO3 level (18 mmoL/L) indicates metabolic acidosis and a HCO3 of 24 mmoL/L indicates a normal level. A pH of 7.35 is a normal pH.
B) When the PaCO2, and thus carbonic acid, is quickly lowered, for example by placing the client on mechanical ventilation, the elevated bicarbonate has less acid to buffer, resulting in metabolic alkalosis. This condition is called posthypercapneic metabolic alkalosis. Because it takes the kidneys several days to decrease the amount of bicarbonate that had been retained, it is important to avoid excessively rapid normalization of the PaCO2 in individuals with chronic respiratory acidosis. A pH of 7.52 represents alkalosis and would be most likely with this client. Metabolic alkalosis manifests as an increase in HCO3 levels. Normal HCO3 levels are 22-28 mmoL/L. A decreased HCO3 level (18 mmoL/L) indicates metabolic acidosis and a HCO3 of 24 mmoL/L indicates a normal level. A pH of 7.35 is a normal pH.
C) When the PaCO2, and thus carbonic acid, is quickly lowered, for example by placing the client on mechanical ventilation, the elevated bicarbonate has less acid to buffer, resulting in metabolic alkalosis. This condition is called posthypercapneic metabolic alkalosis. Because it takes the kidneys several days to decrease the amount of bicarbonate that had been retained, it is important to avoid excessively rapid normalization of the PaCO2 in individuals with chronic respiratory acidosis. A pH of 7.52 represents alkalosis and would be most likely with this client. Metabolic alkalosis manifests as an increase in HCO3 levels. Normal HCO3 levels are 22-28 mmoL/L. A decreased HCO3 level (18 mmoL/L) indicates metabolic acidosis and a HCO3 of 24 mmoL/L indicates a normal level. A pH of 7.35 is a normal pH.
D) When the PaCO2, and thus carbonic acid, is quickly lowered, for example by placing the client on mechanical ventilation, the elevated bicarbonate has less acid to buffer, resulting in metabolic alkalosis. This condition is called posthypercapneic metabolic alkalosis. Because it takes the kidneys several days to decrease the amount of bicarbonate that had been retained, it is important to avoid excessively rapid normalization of the PaCO2 in individuals with chronic respiratory acidosis. A pH of 7.52 represents alkalosis and would be most likely with this client. Metabolic alkalosis manifests as an increase in HCO3 levels. Normal HCO3 levels are 22-28 mmoL/L. A decreased HCO3 level (18 mmoL/L) indicates metabolic acidosis and a HCO3 of 24 mmoL/L indicates a normal level. A pH of 7.35 is a normal pH.
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