References:
- Saunders Comprehensive Review for the NCLEX-RN Examination, 9th Edition, ISBN 978-032-37-9530-2, by Linda Anne Silvestri, Angela E. Silvestri, and Jessica Grimm (Ch. 8, pp. 106-115)
A total concentration of buffer base that is lower than normal, with a relative increase in the hydrogen ion concentration, resulting from loss of too much base and/or retention of too much acid. Its causes include:
| Cause | Description |
|---|---|
| Diabetes Mellitus | An insufficient insulin supply increases fat metabolism, leading to an excess accumulation of ketones or other acids; the bicarbonate ends up being depleted. |
| Excessive ingestion of acetylsalicylic acid | Increase in the hydrogen ion concentration. |
| High-fat diet | Rapid accumulation of the waste products of fat metabolism leads to a buildup of ketones and acids. |
| Insufficient metabolism of carbohydrates | When the oxygen supply is not sufficient for the metabolism of carbohydrates, lactic acid is produced, leading to acidosis. |
| Malnutrition | Improper metabolism causes fat catabolism, which produces ketones and acids. |
| Renal insufficiency, acute kidney injury, or chronic kidney disease | Increased retention of waste products of protein metabolism; acids increase, and bicarbonate is unable to compensate. |
| Severe diarrhea | The alkaline intestinal and pancreatic secretions are lost, leading to acidosis. |
Assessment
- Neurological: lethargy, confusion, dizziness, headache, coma (same as with its respiratory counterpart)
- Cardiovascular: decreased blood pressure; dysrhythmias (from hyperkalemia during compensation); and cold, clammy skin (only skin presentation varies from its respiratory counterpart)
- Gastrointestinal: nausea, vomiting, diarrhea, abdominal pain
- Neuromuscular: muscle weakness, seizures
- Respiratory: deep, rapid respirations (compensatory action by the lungs) known as Kussmaul’s respirations.
Interventions
- Monitor for signs of respiratory distress.
- Monitor intake and output and assist with fluid and electrolyte replacement as prescribed.
- Prepare to administer solutions intravenously as prescribed to increase the buffer base.
- For diabetes mellitus and diabetic ketoacidosis (DKA), give insulin as prescribed to decrease ketosis, monitor for circulator collapse caused by polyuria (osmotic diuresis), and administer fluid volume resuscitation for DKA; monitor electrolytes, glucose, and urinary output during administration.
- For kidney disease, dialysis may be necessary to remove waste products. A diet low in protein and high in calories decreases the resulting amount of protein waste products.