Fluid and Electrolytes PDF

Chapter 10 Fluid and Electrolytes Fluid and Electrolyte Balance Necessary for life, homeostasis (internal equilibrium) Nursing role: anticipate, identify, and respond to possible imbalances Copyright © 2022 Wolters Kluwer · All Rights Reserved Fluid Approximately 60% of...

Chapter 10 Fluid and Electrolytes Fluid and Electrolyte Balance Necessary for life, homeostasis (internal equilibrium) Nursing role: anticipate, identify, and respond to possible imbalances Copyright © 2022 Wolters Kluwer · All Rights Reserved Fluid Approximately 60% of typical adult is fluid (water and electrolytes) o Varies with age, body fat, gender Intracellular fluid (fluid in cells) Loading… o 2/3 of body fluid, skeletal muscle mass Extracellular fluid (fluid outside the cells) o Intravascular (fluid within blood vessels): plasma, erythrocytes, leukocytes, thrombocytes o Interstitial (fluid that surrounds the cell): lymph o Transcellular: cerebrospinal, pericardial, synovial Copyright © 2022 Wolters Kluwer · All Rights Reserved Electrolytes Active chemicals that carry positive (cations) and negative (anions) electrical charges o Major cations: sodium, potassium, calcium, magnesium, hydrogen ions o Major anions: chloride, bicarbonate, phosphate, sulfate, negatively charged protein ions o Expressed in terms of millequivalents (mEq) per liter Electrolyte concentrations differ in ICF and ECF compartments Copyright © 2022 Wolters Kluwer · All Rights Reserved Regulation of Fluid #1 Osmosis—the diffusion of water caused by fluid and solute concentration gradients Movement of fluid through capillary walls depends on Loading… o Hydrostatic pressure: exerted on walls of blood vessels o Osmotic pressure: exerted by protein in plasma Direction of fluid movement depends on differences of hydrostatic pressure and osmotic pressure Copyright © 2022 Wolters Kluwer · All Rights Reserved Regulation of Fluid #2 Osmosis: area of low solute concentration to area of high solute concentration Diffusion: solutes move from area of higher concentration to one of lower concentration Filtration: movement of water, solutes occurs from area of high hydrostatic pressure to area of low hydrostatic pressure Active transport: Sodium–potassium pump o Maintains higher concentration of extracellular sodium, intracellular potassium Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Is the following statement true or false? Diffusion is the process by which solutes move from an area of higher concentration to one of lower concentration and requires energy. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 False Rationale: Although diffusion occurs when fluid moves from an area of higher to lower concentration, this process does not require an expenditure of energy. Copyright © 2022 Wolters Kluwer · All Rights Reserved Gains and Losses of Fluid and Electrolytes Gain o Healthy people gain fluids by drinking and eating o Daily I&O of water are equal Loss o Kidney: urine output of 1mL/kg/hr o Skin loss: sensible due to sweating and insensible due to fever, exercise, and burns o Lungs: 300 mL everyday, greater with increased respirations o GI tract: large losses due to diarrhea and fistulas Copyright © 2022 Wolters Kluwer · All Rights Reserved  Homeostatic Mechanisms Maintain body fluid within normal limits (Refer to Figures 10-5 and 10-6) o Kidney o Renin– o Heart and Blood Angiotensin– Vessels Aldosterone System o Lung o Antidiuretic o Pituitary Hormone o Adrenal o Osmoreceptors o Parathyroid o Natriuretic o Baroreceptors Peptides Copyright © 2022 Wolters Kluwer · All Rights Reserved Gerontologic Considerations Clinical manifestations of imbalance may be subtle Fluid deficit may cause delirium Decreased cardiac reserve Reduced renal function Loading… Dehydration is common Age-related thinning of the skin and loss of strength and elasticity Copyright © 2022 Wolters Kluwer · All Rights Reserved Fluid Volume Disturbances Fluid volume deficit (FVD): hypovolemia Fluid volume excess (FVE): hypervolemia Copyright © 2022 Wolters Kluwer · All Rights Reserved Fluid Volume Deficit (Hypovolemia) May occur alone or in combination with other imbalances Loss of extracellular fluid exceeds intake ratio of water o Electrolytes lost in same proportion as they exist in normal body fluids Dehydration o Not the same as FVD o Loss of water alone, with increased serum sodium levels Copyright © 2022 Wolters Kluwer · All Rights Reserved Causes of FVD Abnormal fluid losses o Vomiting, diarrhea, sweating, GI suctioning Decreased intake o Nausea, lack of access to fluids Third-space fluid shifts o Due to burns, ascites Additional causes o Diabetes insipidus, adrenal insufficiency, hemorrhage Copyright © 2022 Wolters Kluwer · All Rights Reserved Clinical Manifestations, Assessment and Diagnostic Findings of FVD Can develop rapidly Severity depends on degree of loss See Table 10-4 for clinical signs and symptoms and laboratory findings Copyright © 2022 Wolters Kluwer · All Rights Reserved Gerontologic Considerations for FVD Assessment o Cognition o Ambulation o ADLs o Gag Reflex Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical Management of FVD Oral route is preferred IV for acute or severe losses Types of Solutions o Isotonic o Hypotonic o Hypertonic o Colloid o Refer to Table 10-5 Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Is the following statement true or false? An isotonic solution, such as 0.9% NaCl (Normal Saline), is the only intravenous solution that may be administered with blood products. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 True Rationale: Tonicity is the tension that osmotic pressure of a solution with impermeable solutes exerts on cell size because of water movement across the cell membrane. Normal saline has nearly the same tonicity as plasma. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Management of FVD I&O at least every 8 hours, sometimes hourly Daily weight Vital signs closely monitored Skin and tongue turgor, mucosa, urine output, mental status Measures to minimize fluid loss Administration of oral fluids Administration of parenteral fluids Copyright © 2022 Wolters Kluwer · All Rights Reserved Fluid Volume Excess (Hypervolemia) Expansion of the ECF caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF Secondary to an increase in the total-body sodium content Copyright © 2022 Wolters Kluwer · All Rights Reserved Causes of FVE Due to fluid overload or diminished homeostatic mechanisms Heart failure, kidney injury, cirrhosis of liver Contributing factors: Consumption of excessive amounts of table salt or other sodium salts Excessive administration of sodium-containing fluids Copyright © 2022 Wolters Kluwer · All Rights Reserved Clinical Manifestations, Assessment and Diagnostic Findings of FVE Edema Distended neck veins Crackles BUN HCT See Table 10-4 for signs and symptoms and laboratory findings Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical Management of FVE Pharmacologic o Diuretics Dialysis Nutritional o Dietary restrictions of sodium Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Management of FVE I&O and daily weights; assess lung sounds, edema, other symptoms Monitor responses to medications—diuretics and parenteral fluids Promote adherence to fluid restrictions, patient teaching related to sodium and fluid restrictions Monitor, avoid sources of excessive sodium, including medications Promote rest Copyright © 2022 Wolters Kluwer · All Rights Reserved Electrolyte Imbalances Sodium: hyponatremia, hypernatremia Potassium: hypokalemia, hyperkalemia Calcium: hypocalcemia, hypercalcemia Magnesium: hypomagnesemia, hypermagnesemia Phosphorus: hypophosphatemia, hyperphosphatemia Chloride: hypochloremia, hyperchloremia Copyright © 2022 Wolters Kluwer · All Rights Reserved Hyponatremia Serum sodium less than 135 mEq/L Acute o Result of fluid overload of a surgical patient Chronic o Seen outside of hospital setting, longer duration, less serious neurologic sequelae Exercise associated o More common in women of small stature, extreme temperatures, excessive fluid intake, prolonged exercise Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #1 Hyponatremia o Pathophysiology: Imbalance of water, losses by vomiting, diarrhea, sweating, diuretics, adrenal insufficiency, certain medications, SIADH o Clinical manifestations: poor skin turgor, dry mucosa, headache, decreased salivation, decreased blood pressure, nausea, abdominal cramping, neurologic changes o Serum sodium levels o Refer to Table 10-6 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hyponatremia Treat underlying condition Sodium replacement Water restriction Medication Loading… Assessment: I&O, daily weight, lab values, CNS changes Encourage dietary sodium Monitor fluid intake Effects of medications (diuretics, lithium) Copyright © 2022 Wolters Kluwer · All Rights Reserved Hypernatremia Serum sodium greater than 145 mEq/L Occurs in patients with normal fluid volume, FVD, FVE Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings Hypernatremia o Pathophysiology: fluid deprivation, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions o Clinical manifestations: thirst; elevated temperature o Serum osmolality greater than 300 mOsm/kg o Increased urine specific gravity and osmolality Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hypernatremia Gradual lowering of serum sodium level via infusion of hypotonic electrolyte solution Diuretics Assessment for abnormal loss of water and low water intake Assess for over-the-counter sources of sodium Monitor for CNS changes Copyright © 2022 Wolters Kluwer · All Rights Reserved Hypokalemia Below-normal serum potassium Less than 3.5 mEq/L May occur with normal potassium levels: when alkalosis is present a temporary shift of serum potassium into cells occurs Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #2 Hypokalemia o Pathophysiology: GI losses, medications, prolonged intestinal suctioning, recent ileostomy, tumor of the intestine, alterations of acid–base balance, poor dietary intake, hyperaldosteronism o Clinical manifestations: ECG changes, dysrhythmias, dilute urine, excessive thirst, fatigue, anorexia, muscle weakness, decreased bowel motility, paresthesia o ECG changes o Refer to Table 10-7 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hypokalemia Potassium replacement: Increased dietary potassium, oral potassium supplements or IV potassium for severe deficit (unless oliguria present) Monitor ECG for changes Monitor ABGs Monitor patients receiving digitalis for toxicity Monitor for early signs and symptoms Administer IV potassium only after adequate urine output has been established Copyright © 2022 Wolters Kluwer · All Rights Reserved Hyperkalemia Serum potassium greater than 5.0 mEq/L Seldom occurs in patients with normal renal function Increased risk in older adults Cardiac arrest is frequently associated Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #3 Hyperkalemia o Pathophysiology: Impaired renal function, rapid administration of potassium, hypoaldosteronism, medications, tissue trauma, acidosis o Clinical manifestations: Cardiac changes and dysrhythmias, muscle weakness, paresthesias, anxiety, GI manifestations o ECG changes o Metabolic or respiratory acidosis o Refer to Table 10-7 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hyperkalemia Monitor ECG, heart rate (apical pulse) and blood pressure, assess labs, monitor I&O, obtain apical pulse Limitation of dietary potassium and dietary teaching Administration of cation exchange resins (sodium polystyrene sulfonate) Emergent care: IV calcium gluconate, IV sodium bicarbonate, IV regular insulin and hypertonic dextrose IV, beta-2 agonists, dialysis Administer IV slowly and with an infusion pump Copyright © 2022 Wolters Kluwer · All Rights Reserved Hypocalcemia Serum level less than 8.6 mg/dL, must be considered in conjunction with serum albumin level Serum calcium level controlled by parathyroid hormone and calcitonin Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #4 Hypocalcemia o Pathophysiology: hypoparathyroidism, malabsorption, osteoporosis, pancreatitis, alkalosis, transfusion of citrated blood, kidney injury, medications o Clinical manifestations: tetany, circumoral numbness, paresthesias, hyperactive DTRs, Trousseau sign, Chvostek sign, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, anxiety o Ionized calcium levels o Refer to Table 10-8 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hypocalcemia IV of calcium gluconate for emergent situations (monitor for risk of extravasation) Seizure precautions Oral calcium and vitamin D supplements Exercises to decrease bone calcium loss Patient teaching related to diet and medications Copyright © 2022 Wolters Kluwer · All Rights Reserved Hypercalcemia Serum level greater than 10.4 mg/dL Mild and moderate hypercalcemia usually asymptomatic. Hypercalcemia crisis has high mortality Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #5 Hypercalcemia o Pathophysiology: malignancy and hyperparathyroidism, bone loss related to immobility, diuretics o Clinical manifestations: polyuria, thirst, muscle weakness, intractable nausea, abdominal cramps, severe constipation, diarrhea, peptic ulcer, bone pain, ECG changes, dysrhythmias o Refer to Table 10-8 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hypercalcemia Treat underlying cause (Cancer) Administer IV fluids, furosemide, phosphates, calcitonin, bisphosphonates Increase mobility Encourage fluids Dietary teaching, fiber for constipation Ensure safety Copyright © 2022 Wolters Kluwer · All Rights Reserved Hypomagnesemia Serum level less than 1.8 mg/dL Associated with hypokalemia and hypocalcemia Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #6 Hypomagnesemia o Pathophysiology: alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood o Clinical manifestations: Chvostek and Trousseau signs, apathy, depressed mood, psychosis, neuromuscular irritability, ataxia, insomnia, confusion, muscle weakness, tremors, ECG changes and dysrhythmias o Ionized serum magnesium level o Refer to Table 10-9 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hypomagnesemia Magnesium sulfate IV is administered with an infusion pump; monitor vital signs and urine output Calcium gluconate or hypocalcemic tetany or hypermagnesemia Oral magnesium Monitor for dysphagia Seizure precautions Dietary teaching (green, leafy vegetables; beans, lentils, almonds, peanut butter) Copyright © 2022 Wolters Kluwer · All Rights Reserved Hypermagnesemia Serum level greater than 2.6 mg/dL Rare electrolyte abnormality, because the kidneys efficiently excrete magnesium Falsely elevated levels with a hemolyzed blood sample Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #7 Hypermagnesemia o Pathophysiology: kidney injury, diabetic ketoacidosis, excessive administration of magnesium, extensive soft tissue injury o Clinical manifestations: hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias, and cardiac arrest o Refer to Table 10-9 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hypermagnesemia IV calcium gluconate Ventilatory support for respiratory depression Hemodialysis Administration of loop diuretics, sodium chloride, and LR Avoid medications containing magnesium Patient teaching regarding magnesium-containing over-the-counter medications Observe for DTRs and changes in LOC Copyright © 2022 Wolters Kluwer · All Rights Reserved Hypophosphatemia Serum level below 2.7 mg/dL Hypophosphatemia can occur when total-body phosphorus stores area normal Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #8 Hypophosphatemia o Pathophysiology: alcoholism, refeeding of patients after starvation, pain, heat stroke, respiratory alkalosis, hyperventilation, diabetic ketoacidosis, hepatic encephalopathy, major burns, hyperparathyroidism, low magnesium, low potassium, diarrhea, vitamin D deficiency, use of diuretic and antacids o Clinical manifestations: neurologic symptoms, confusion, muscle weakness, tissue hypoxia, muscle and bone pain, increased susceptibility to infection o 24-hour urine collection o Elevated PTH levels o Refer to Table 10-10 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hypophosphatemia Prevention is the goal Oral or IV phosphorus replacement (only for patients with serum phosphorus levels less than 1 mg/dL not to exceed 3 mmol/hr), Burosumab, correct underlying cause Monitor IV site for extravasation Monitor phosphorus, vitamin D and calcium levels Encourage foods high in phosphorus (milk, organ meats, beans nuts, fish, poultry), gradually introduce calories for malnourished patients receiving parenteral nutrition Copyright © 2022 Wolters Kluwer · All Rights Reserved Hyperphosphatemia Serum level above 4.5 mg/dL Can occur with increased intake, decreased excretion, or shifting of phosphate from intracellular to extracellular spaces Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #9 Hyperphosphatemia o Pathophysiology: kidney injury, excess phosphorus, excess vitamin D, acidosis, hypoparathyroidism, chemotherapy o Clinical manifestations: few symptoms; soft tissue calcifications, symptoms occur due to associated hypocalcemia o X-rays show abnormal bone development o Decreased PTH levels o BUN o Creatinine o Refer to Table 10-10 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hyperphosphatemia Treat underlying disorder Vitamin D preparations, calcium-binding antacids, phosphate-binding gels or antacids, loop diuretics, IV fluids (Normal Saline), dialysis Monitor phosphorus and calcium levels Avoid high-phosphorus foods Patient teaching related to diet, phosphate- containing substances, signs of hypocalcemia Copyright © 2022 Wolters Kluwer · All Rights Reserved Hypochloremia Serum level less than 97 mEq/L Aldosterone impacts reabsorption Bicarbonate has an inverse relationship with chloride Chloride mainly obtained from the diet Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #10 Hypochloremia o Pathophysiology: Addison disease, reduced chloride intake, GI loss, diabetic ketoacidosis, excessive sweating, fever, burns, medications, metabolic alkalosis o Loss of chloride occurs with loss of other electrolytes, potassium, sodium o Clinical manifestations: agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma o ABG o Refer to Table 10-11 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hypochloremia Replace chloride-IV NS or 0.45% NS Ammonium chloride Monitor I&O, ABG values and electrolyte levels Assess for changes in LOC Educate about foods high in chloride (tomato juice, bananas, eggs, cheese, milk) and avoid drinking free water (water without electrolytes) Copyright © 2022 Wolters Kluwer · All Rights Reserved Hyperchloremia Serum level more than 107 mEq/L Hypernatremia, bicarbonate loss, and metabolic acidosis can occur Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #11 Hyperchloremia o Pathophysiology: usually due to iatrogenically induced hyperchloremic metabolic acidosis o Clinical manifestations: tachypnea; lethargy; weakness; rapid, deep respirations; hypertension; cognitive changes o Normal serum anion gap o Potassium Levels o ABGs o Urine Chloride Level o Refer to Table 10-11 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Hyperchloremia Correct the underlying cause and restore electrolyte and fluid balance Hypertonic IV solutions Lactated Ringers Sodium bicarbonate, diuretics Monitor I&O, ABG Focused assessments of respiratory, neurologic, and cardiac systems Patient teaching related to diet and hydration Copyright © 2022 Wolters Kluwer · All Rights Reserved Maintaining Acid–Base Balance Normal plasma pH 7.35 to 7.45: hydrogen ion concentration Major extracellular fluid buffer system; bicarbonate–carbonic acid buffer system Kidneys regulate bicarbonate in ECF Lungs, under control of medulla, regulate CO2, and thus the carbonic acid in ECF Refer to Table 10-12 Other buffer systems o ECF: inorganic phosphates, plasma proteins o ICF: proteins, organic, inorganic phosphates o Hemoglobin Copyright © 2022 Wolters Kluwer · All Rights Reserved Acute and Chronic Metabolic Acidosis Low pH 26 mEq/L Hypokalemia will produce alkalosis Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #13 Metabolic Alkalosis o Pathophysiology: Most commonly due to vomiting or gastric suction, may also be due to medications, especially long-term diuretic use, hyperaldosteronism, Cushing’s syndrome, and hypokalemia will produce alkalosis o Clinical manifestations: symptoms related to decreased calcium, respiratory depression, tachycardia, symptoms of hypokalemia including tingling of toes, fingers, dizziness and tetany, ECG changes, decreased GI motility o Urine chloride levels o Refer to Table 10-13 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Metabolic Alkalosis Correct the underlying acid–base disorder Restore fluid volume with sodium chloride solutions Monitor I&O Monitor for ECG and neurologic changes Copyright © 2022 Wolters Kluwer · All Rights Reserved Acute and Chronic Respiratory Acidosis Low pH 42 mm Hg Always due to respiratory problem with inadequate ventilation, resulting in elevated plasma levels of CO2 Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology, Clinical Manifestations, Assessment and Diagnostic Findings #14 Respiratory Acidosis o Pathophysiology: Pulmonary edema, overdose, atelectasis, pneumothorax, severe obesity, pneumonia, COPD, muscular dystrophy, multiple sclerosis, myasthenia gravis o Clinical Manifestations: With chronic respiratory acidosis, body may compensate, may be asymptomatic. With acute respiratory acidosis may see sudden increased pulse, respiratory rate, and BP; mental changes; feeling of fullness in head (intracranial pressure), and increased conjunctival vessels. o Refer to Table 10-13 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical and Nursing Management of Respiratory Acidosis Improve ventilation Bronchodilators, antibiotics, anticoagulants Pulmonary physiotherapy Adequate hydration Mechanical ventilation if necessary Monitor respiratory status, I&O Copyright © 2022 Wolters Kluwer · All Rights Reserved Acute and Chronic Respiratory Alkalosis High pH >7.45 PaCO2 94% Base excess/deficit ±2 mEq/L Refer to Chart 10-3 Copyright © 2022 Wolters Kluwer · All Rights Reserved  Question #3 Which is the correct interpretation of this arterial blood gas (ABG)? pH = 7.5 PaCO2 = 37 HCO3 = 30 A. Respiratory Acidosis B. Respiratory Alkalosis C. Metabolic Acidosis D. Metabolic Alkalosis Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 D. Metabolic Alkalosis Rationale: The pH is above the normal range indicating alkalosis. The CO2 is within normal range indicating no respiratory involvement. The HCO3 is above normal range indicating alkalosis. When the body absorbs too much bicarbonate, this creates a metabolic imbalance. Copyright © 2022 Wolters Kluwer · All Rights Reserved