metabolic acidosis and need to monitor I&O

[unsaint77]

It seems to me any kind of acidosis warrants close monitoring of I&O. Obviously, I&O imbalance can cause acidosis. What if a diabetic just developed signs of DKA (SOB, confusion, abd pain, etc) and the pt had no fluid imbalance problem prior to the DKA episode? In that case should I still monitor I&O? To put it directly, does acidosis cause fluid loss or retention?

Thank you.

[nurseprnRN, BSN, RN]

not necessarily true either way; it is not at all "obvious" that "i&o imbalance" causes acidosis. people who make no urine at all (renal failure) are acidotic, because their kidneys are gone and no longer doing their work of regulating ph, so they're at risk for fluid excess. people with diabetic keto[color=#ffa07a]acidosis are usually putting out liters, because of the high blood sugar involved, and they get dehydrated in a hurry. you can have a good whopping lactic acidosis due to tissue hypoxia and have normal urine output. well, at least until you get septic and experience circulatory failure, at which point your kidneys will probably poo oout on ya.

(you monitor i&o in all of these, even though the crf guy isn't making urine-- he may have diarrhea or vomitus, and of course he's still getting intake of some sort, probably.)

look a little more closely as to why the patient is making a lot/little bit of urine; don't just stop at acid/base balance. it's just not the clue it looks like you hope it would be. did you have a particular question in mind?

[unsaint77]

Great! I am a student and I was studying PIE charting , and it had signs of DKA as the P (problem), and I&O monitoring as one of the I (intervention). I didn't quite link the polyuria with hyperglycemic condition of the DKA. Now it makes sense. Thank you also for correcting me; not all acidosis will increase the urine output. Thank you so much, Guide.