metabolic alkalosis, an abnormal condition characterized by the significant loss of acid in the body or by increased levels of base bicarbonate. Loss of acid may be caused by excessive vomiting, insufficient replacement of electrolytes, hyperadrenocorticism, or Cushing’s disease. Increased levels of base bicarbonate may have various causes, such as the ingestion of excessive amounts of bicarbonate of soda or other antacids during the treatment of peptic ulcers or the administration of excessive volumes of IV fluids containing high concentrations of bicarbonate. Severe, untreated metabolic alkalosis can lead to coma and death. Compare respiratory alkalosis. See also metabolic acidosis, respiratory acidosis. ▪ OBSERVATIONS: Signs and symptoms of metabolic alkalosis may include apnea, headache, lethargy, muscle cramps, hyperactive reflexes, tetany, shallow and slow respirations, irritability, nausea, vomiting, and atrial tachycardia. Confirmation of the diagnosis is commonly based on laboratory findings that show a blood pH greater than 7.45, a carbonic acid concentration greater than 29 mEq/L, and alkaline urine. The electrocardiogram of a patient with this condition may show atrial tachycardia with a low T wave merging with a P wave. ▪ INTERVENTIONS: Treatment seeks to eliminate the underlying cause of alkalosis. Ammonium chloride may be given intravenously to release hydrogen chloride and restore chloride levels, except in patients with liver or kidney disease. Potassium chloride and normal saline solutions usually replace fluid losses from gastric drainage but are contraindicated in patients with associated congestive heart failure. ▪ PATIENT CARE CONSIDERATIONS: Nurses closely monitor the status of the patient and cautiously administer any prescribed IV solutions. Too-rapid infusion of ammonium chloride may hemolyze red blood cells, and an excessive dosage may overcorrect alkalosis and cause acidosis. The fluid intake and output of the patient are carefully noted, and the respiration rate is regularly checked. Decreased respiratory rate indicates an effort to compensate for alkalosis and may cause respiratory acidosis.
