Metabolic Acidosis with aspiration pneumonia?

Esme12, ASN, BSN, RN · Dec 5, 2012

Metabolic acidosis is a clinical disturbance characterized by an increase in plasma acidity. Metabolic acidosis should be considered a sign of an underlying disease process. Identification of the underlying condition is essential to initiate appropriate therapy.

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First.......Why do you feel a pneumonia patient would have to have metabolic alkalosis?

Look at the ABG's.....Look at the PCO2 and the PO2......the patient doesn't hyperventilate to blow off acidosis......the body will hyperventilate to correct the acidosis caused by.....What? What are the patients other co-morbidities? How much O2 is the patient on? What is the O2 Sat? What is the Resp Rate? What are the vital signs? What is your assessment?

What are the causes of acidosis? Is this patient trying to increase their PO2 and blow off the PCO2 in an attempt to correct the metabolic acidosis? Can hypoxia cause acidosis? Is this patient so de-compensated that the have lactic acidosis from hypoxia or sepsis?

Tell me more about your patient......so we can talk about the acidosis.

Tonks57 · Dec 5, 2012

The patient has several other issues: hypoxic encephalopathy, tracheostomy, history of MRSA in her sputum, 104 degree fever, WBC count of 17 x 10^9, HR is 122, RR is 31, O2 sat is 90%, chest x ray with infiltration, serum albumin level of 27, thick green foul smell sputum, and c. diff. I believe yes, that the patient is breathing fast to blow of the CO2 and I also think that hypoxia can result in metabolic acidosis.

Thank you for helping me! I am just trying to understand the process of metabolic acidosis in this patient.

Esme12, ASN, BSN, RN · Dec 5, 2012

So this is a very sick patient with acidosis......probably from Sepsis, hypoxia and lactic acidosis. The patient is hypoxic from the fulminate pneumonia and is septic from the pneumonia. They are tachypnec from the hypoxia and acidosis. The hypoxia causes lactic acidosis.

In basic terms, lactic acid is the normal endpoint of the anaerobic breakdown of glucose in the tissues. The lactate exits the cells and is transported to the liver, where it is oxidized back to glucose. In the setting of decreased tissue oxygenation, lactic acid is produced as the anaerobic cycle is utilized for energy production. With a persistent oxygen debt and overwhelming of the body's buffering abilities (whether from chronic dysfunction or excessive production), lactic acidosis ensues. lactic acidosis medscape requires registration I strongly suggest you register to see this information.

Metabolic acidosis is a clinical disturbance characterized by an increase in plasma acidity. Metabolic acidosis should be considered a sign of an underlying disease process. Identification of this underlying condition is essential to initiate appropriate therapy. Metabolic Acidosis.

Metabolic acidosis occurs when the body produces too much acid, or when the kidneys are not removing enough acid from the body. There are several types of metabolic acidosis. The main causes are best grouped by their influence on the anion gap.

It bears noting that the anion gap can be spuriously normal in sampling errors of the sodium level, e.g. in extreme hypertriglyceridemia. The anion gap can be increased due to relatively low levels of cations other than sodium and potassium (e.g. calcium or magnesium).http://www.anaesthesiamcq.com/AcidBaseBook/ab5_2.php

Increased anion gap Main article: High anion gap metabolic acidosis

Causes include:

lactic acidosis
ketoacidosis
chronic renal failure (accumulation of sulfates, phosphates, urea)
intoxication:
- organic acids (salicylates, ethanol, methanol, formaldehyde, ethylene glycol, paraldehyde, INH)
- sulfates, metformin (Glucophage)
[*]massive rhabdomyolysis

Because this patient is in decompensated metabolic acidosis.....the patient will require Bicarb to correct the acidosis after the hypoxia is corrected better. If the patient is trached they should be returned pt the vent and I on the vent the settings need to be adjusted. If this has been done and the patient is on 100% O2...they are critical and not doing well.

Tonks57 · Dec 6, 2012

Thank you so much! You have made it so much easier to understand. I really appreciate it.

Esme12, ASN, BSN, RN · Dec 6, 2012

:) anytime!!!!