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 deficit of carbonic acid and a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. Its causes include conditions that cause overstimulation of the respiratory system:
| Cause | Description |
|---|---|
| Fever | Causes increased metabolism, resulting in overstimulation of the respiratory system. |
| Hyperventilation | Rapid respirations causing the blowing off of carbon dioxide (CO2), leading to a decrease in carbonic acid. |
| Hypoxia | Stimulates the respiratory center in the brainstem, which causes an increase in respiratory rate in order to increase oxygen (O2); this causes hyperventilation, which results in a decrease in the CO2 level. |
| Overventilation by mechanical ventilators | The administration of O2 and depletion of CO2 can occur from mechanical ventilation, causing the client to be hyperventilated. |
| Pain | Overstimulation of the respiratory center in the brain stem results in a carbonic acid deficit. |
| Severe anxiety and hysteria | Often is neurogenic and related to a psychoneurosis; however, this condition leads to vigorous breathing and excessive exhaling of CO2. |
Assessment
- Neurological: dizziness, light-headedness, confusion, headache
- Cardiovascular: low blood pressure, tachycardia, dysrhythmias
- Gastrointestinal: nausea, vomiting, diarrhea; epigastric pain
- Neuromuscular: tetany, numbness, tingling of extremities, hyperreflexia, seizures
- Respiratory: decreased respiratory rate and depth as compensation. If unable to compensate, hyperventilation occurs
Interventions
- Monitor for signs of respiratory distress.
- Provide emotional support and reassurance to the client.
- Encourage appropriate breathing patterns.
- Assist with breathing techniques and aids if needed and as prescribed; voluntary breath holding, using a rebreathing mask, CO2 breaths with rebreathing into a paper bag.
- Provide cautious care with ventilator clients so they are not forced to take breaths too deeply or rapidly.
- Prepare to administer calcium gluconate for tetany as prescribed.