Nursing Care of Patients with Altered Fluid, Electrolyte, and Acid-Base Balance PDF

Nursing Care of Patients with Altered Transport of nutrients: Water carries Fluid, Electrolyte and Acid-Base nutrients (like glucose and vitamins) Balance to cells and removes waste products...

Nursing Care of Patients with Altered Transport of nutrients: Water carries Fluid, Electrolyte and Acid-Base nutrients (like glucose and vitamins) Balance to cells and removes waste products (like carbon dioxide). HOMEOSTASIS ✨​The body’s ability to maintain a Medium for metabolic reactions: stable environment. Metabolism (chemical reactions in the ✨​It ensures everything is balanced body) happens in water. Without despite changes in the external enough water, these processes slow environment down or stop. -​ Temperature Regulation of body temperature: -​ diet Water absorbs and dissipates heat WHY IT’S IMPORTANT? through sweat to cool the body. ✨​ If something disrupts this Clinical Importance: balance, the body adjusts by ​ Dehydration: When the body changing certain processes, like loses too much water, patients sweating to cool down or can feel dizzy, have low blood retaining water when dehydrated. ✨​NURSING GOAL—When caring for pressure, and even collapse. ​ Fluid overload: Too much water patients with fluid or electrolyte can lead to swelling (edema) or imbalances, the focus is on strain on the heart. helping the body restore and ELECTROLYTES maintain balance. WHAT ARE ELECTROLYTES? ​ Electrolytes are minerals like WATER sodium (Na⁺), potassium (K⁺), ROLE OF WATER IN THE BODY: calcium (Ca²⁺), and chloride (Cl⁻) dissolved in body fluids.  ​ They carry an electrical charge ECF and are essential for various -​ Found OUTSIDE CELLS bodily functions. -​ Divided into: ROLE OF ELECTROLYTES: Interstitial Fluid: Fluid between cells in Water Balance Regulation: tissues (like a cushion for cells). Electrolytes help control how much Intravascular Fluid: Found in blood water is inside and outside cells. vessels (plasma). This fluid is essential ​ Example: Sodium (Na⁺) attracts for transporting blood cells and water; too much sodium in the blood causes water retention nutrients. (edema). Transcellular Fluid: Specialized fluids in Acid-Base Balance: Electrolytes small compartments (e.g., cerebrospinal maintain the pH of the blood (normal: fluid, joint fluid, digestive secretions). 7.35–7.45). An imbalance can lead to acidosis (too acidic) or alkalosis (too basic). Enzyme Reactions: Electrolytes act as catalysts for many chemical reactions How This Relates to Nursing in the body. Neuromuscular Activity: Potassium 1.​ Assessment: (K⁺) and calcium (Ca²⁺) are vital for ○​ Fluid Status: Check for nerve signals and muscle contractions, including the heartbeat. signs of dehydration (dry skin, low blood pressure) Intracellular and Extracellular Fluids or fluid overload (swelling, ICF difficulty breathing). -​ Found INSIDE CELLS ○​ Electrolyte Imbalance: -​ Makes up about ⅔ of total body Monitor lab results for water sodium, potassium, and -​ Essential for normal cell function calcium. Look for ( metabolism, repair and growth) symptoms like irregular  heartbeat, muscle cramps, ○​ Drinking enough water or confusion. daily. ○​ Acid-Base Imbalance: ○​ Managing salt intake. Watch for breathing ○​ Recognizing early signs of changes, confusion, or imbalance (e.g., dizziness, lethargy that might swelling). indicate acidosis or alkalosis. 2.​ Interventions: ADDITIONAL INFORMATION ABOUT ICF ○​ Hydration: Administer IV AND ECF fluids for dehydration or Intracellular Fluid (ICF): diuretics to remove excess fluid. ​ Found inside cells. ○​ Electrolyte Replacement: ​ Contains specific solutes Give supplements (e.g., (dissolved substances): potassium chloride) or ○​ Potassium (K⁺): Most restrict certain electrolytes abundant cation in the ICF, depending on the crucial for cell function, imbalance. especially nerve and ○​ Oxygen and Monitoring: muscle activity. Support patients with ○​ Magnesium (Mg²⁺): severe acid-base Important for enzyme imbalances (e.g., using activity and energy oxygen for respiratory production (ATP acidosis). synthesis). 3.​ Education:​ ○​ Phosphate (PO₄³⁻): A key Teach patients about: component in energy  storage (ATP) and bone ○​ Movement of water from structure. an area of low solute ○​ Glucose: Used as energy concentration to high for cellular metabolism. solute concentration ○​ Oxygen (O₂): Essential for across a semi-permeable cellular respiration and membrane. energy production. ○​ Goal: Balance solute concentrations on both Extracellular Fluid (ECF): sides of the membrane. ​ Found outside cells (e.g., blood ○​ Example: If sodium is plasma, interstitial fluid). higher in the ECF, water ​ Contains: moves out of the cell into ○​ Sodium (Na⁺): Main cation the ECF to balance it. in ECF; regulates water 2.​ Osmolality: balance and nerve impulse ○​ Refers to the transmission. concentration of solutes ○​ Chloride (Cl⁻): Works with in a solution. sodium to maintain fluid ○​ High osmolality: More balance and acid-base solutes, less water (e.g., in balance. dehydration). ○​ Bicarbonate (HCO₃⁻): ○​ Low osmolality: More Helps buffer blood pH, water, fewer solutes (e.g., preventing acidosis or in overhydration). alkalosis. 3.​ Osmotic Pressure: ○​ The force water applies Osmosis and Related Concepts when moving across 1.​ Osmosis: membranes.  ○​ Example: Sodium in the concentration gradient but ECF increases osmotic require a carrier protein. pressure, pulling water out ○​ Example: Glucose enters of cells. cells with the help of 4.​ Tonicity: insulin. ○​ Refers to the effect of a solution on cell volume: Filtration Isotonic: No net water movement; cell size stays the same. ​ Definition: Movement of water Hypotonic: Water enters cells; cells and solutes across a membrane swell. due to pressure differences. Hypertonic: Water leaves cells; cells shrink. ​ Forces Involved: 1.​ Hydrostatic Pressure: The 1.​ Simple Diffusion: force exerted by fluid (e.g., ○​ Movement of solutes (like blood pressure in oxygen or carbon dioxide) capillaries). from a high to low 2.​ Osmotic Pressure: The concentration without pull exerted by solutes, energy or assistance. especially proteins, to ○​ Example: Oxygen moves retain water. from blood (high ​ Example: In the kidneys, filtration concentration) into tissues removes waste from blood into (low concentration). urine. 2.​ Facilitated Diffusion: ○​ Solutes (like glucose) move down their Active Transport  ​ Definition: Movement of solutes can cause against their concentration confusion or gradient using energy (ATP). seizures). ​ Sodium-Potassium Pump: ○​ Check hydration status, ○​ Pumps 3 sodium ions out signs of edema, or of the cell and 2 dehydration. potassium ions into the 2.​ Intervention: cell. ○​ Administer IV fluids: ○​ Maintains the high sodium ​ Isotonic (e.g., 0.9% concentration in the ECF NaCl) to maintain and high potassium balance. concentration in the ICF. ​ Hypertonic or ○​ Example: Essential for hypotonic solutions nerve impulse for specific transmission and muscle imbalances. contractions. ○​ Correct electrolyte levels: ​ Potassium supplements for How This Relates to Nursing Practice hypokalemia. ​ Sodium restriction 1.​ Assessment: for hypernatremia. ○​ Monitor lab values: 3.​ Education: ​ Potassium: 3.5–5.0 ○​ Teach patients to mEq/L (imbalances recognize symptoms of can cause imbalances, like dizziness, arrhythmias). swelling, or muscle ​ Sodium: 135–145 cramps. mEq/L (imbalances  ○​ Encourage balanced fluid ❖​ Renin: Released by kidneys, intake and monitor converts angiotensinogen to conditions like kidney angiotensin I. disease. ❖​ Angiotensin II: Constricts blood vessels to raise blood pressure FLUID REGULATION and stimulates aldosterone THIRST: release. ❖​ Aldosterone: Promotes sodium ❖​ Primary regulator of water intake and water reabsorption in ❖​ Triggered by increased osmolality kidneys. (too many solutes) or decreased blood volume. ❖​ Controlled by the hypothalamus, which signals the body to drink water. Kidneys: ❖​ Regulate fluid volume and osmolality by filtering blood. ❖​ Adjust water and electrolyte Antidiuretic Hormone (ADH) excretion based body's needs. ❖​ Released by the pituitary gland Renin-Angiotensin-Aldosterone System when osmolality is high (RAAS): ❖​ Promotes water reabsorption in kidneys, reducing urine output ❖​ Activated when blood pressure or Atrial Natriuretic Peptide (ANP) blood volume is low  ❖​ Released by the heart’s atrial ○​ Environmental factors: cells in response to fluid Heat exposure causing overload. excessive sweating. ❖​ Opposes RAAS by promoting ○​ Trauma or hemorrhage: sodium and water excretion, Loss of blood volume. lowering blood volume and ○​ Third Spacing: Fluid shifts pressure. from the vascular space into unusable areas (e.g., Fluid Volume Deficit (Dehydration) abdomen during ascites), Definition reducing available circulating volume. ​ Dehydration: Loss of water alone. ​ Often used interchangeably with fluid volume deficit, but the latter Clinical Manifestations of Fluid Volume includes loss of electrolytes too. Deficit Pathophysiology 1.​ Signs and Symptoms: ​ Causes a decrease in ○​ Weight loss: Rapid and intravascular, interstitial, or significant. intracellular fluid, leading to ○​ Skin turgor: Poor skin hypovolemia (low blood volume). elasticity, especially on the ​ Can result from: sternum or back of the ○​ Fluid losses: Vomiting, hand. diarrhea, gastrointestinal ○​ Urine output: Decreased, suctioning, fistulas, or dark-colored urine. diuretics. ○​ Tachycardia: Fast heartbeat as  compensation for low ​ Urine Specific Gravity and blood volume. Osmolality: High levels indicate ○​ Low blood pressure concentrated urine. (hypotension): Decreased Fluid Management systolic and venous pressures. 1.​ Oral Rehydration: ○​ Pale skin: Indicates poor ○​ First-line treatment for perfusion. mild deficits. 2.​ Severe Consequences: ○​ Encourages safe and ○​ Hypovolemic shock: Can effective fluid progress to organ failure if replacement. not treated promptly. 2.​ IV Therapy: ○​ Used in severe cases or when oral intake isn’t Interprofessional Care possible. ○​ Isotonic solutions (e.g., Diagnosis 0.9% NaCl) restore fluid ​ Serum Electrolytes: To assess volume. imbalances (e.g., sodium, ○​ Hypotonic solutions (e.g., potassium). 0.45% NaCl) are used to ​ Serum Osmolality: High rehydrate cells. osmolality suggests dehydration. ​ Hemoglobin and Hematocrit: Elevated in dehydration due to Health Promotion and Education hemoconcentration. 1.​ Teaching:  ○​ Encourage adequate ○​ Risk for Injury: Prevent hydration based on activity falls or complications from level and environment. dizziness. ○​ Recognize early signs of 3.​ Continuity of Care: fluid deficit (e.g., thirst, ○​ Assess patient’s dizziness). understanding of the fluid 2.​ Monitoring: deficit's cause. ○​ Careful intake and output ○​ Provide resources for (I&O) documentation. hydration education and ○​ Track weight daily to follow-up care. monitor fluid changes. Fluid Volume Excess (Hypervolemia) Pathophysiology Priorities of Care 1.​ Causes: 1.​ Restoration of Adequate Fluid ○​ Heart failure: Reduced Volume: cardiac output leads to ○​ Ensure hydration through fluid retention. appropriate methods (oral ○​ Renal failure: Impaired or IV). excretion of fluids and 2.​ Nursing Diagnoses and electrolytes. Interventions: ○​ Cirrhosis of the liver: ○​ Deficient Fluid Volume: Decreased albumin Administer fluids and production reduces monitor response. oncotic pressure, causing ○​ Ineffective Tissue fluid retention. Perfusion: Monitor vital ○​ Adrenal disorders: Excess signs and capillary refill. aldosterone increases  sodium and water ​ Congestive Heart Failure (CHF): retention. Excess fluid strains the heart. ○​ Corticosteroids: Promote ​ Pulmonary Edema: Fluid sodium retention. accumulation in the lungs impairs ○​ Stress conditions: Trigger gas exchange. ADH and aldosterone Interprofessional Care for Fluid Volume release. Excess ○​ Excessive sodium intake: Leads to water retention. Diagnosis ○​ Medications: E.g., certain ​ Labs: IV fluids or drugs causing ○​ Serum electrolytes and sodium retention. osmolality: Evaluate Manifestations sodium and fluid status. ○​ Hematocrit and ​ Extracellular: hemoglobin: Often ○​ Hypovolemia: Signs of decreased due to circulatory overload. hemodilution. ○​ Interstitial: ○​ Renal and liver function ​ Peripheral edema: tests: Identify organ Swelling in dysfunction. extremities. ​ Generalized edema: Medications Total body swelling 1.​ Diuretics: (anasarca). ○​ Loop diuretics: E.g., Complications furosemide, act on the loop of Henle for rapid fluid removal.  ○​ Thiazide diuretics: Pathophysiology Effective for ​ Caused by: mild-to-moderate fluid ○​ Excessive sodium loss: retention. Via GI tract, kidneys, skin, ○​ Potassium-sparing or third spacing. diuretics: Help maintain ○​ Water gains: From potassium levels while systemic diseases like removing fluid. heart failure or SIADH. Treatments Manifestations ​ Fluid restriction: Limits intake to ​ Depend on severity: manage volume. ○​ Mild: Nausea, vomiting, ​ Sodium restriction: Reduces headache. water retention. ○​ Severe: Confusion, seizures, coma, and risk of cerebral edema. Care ​ Diagnosis: ○​ Serum sodium, osmolality, and 24-hour urine specimen. ​ Management: ○​ Sodium-containing fluids: Oral, enteral, or IV (e.g., Sodium Imbalances isotonic saline). Hyponatremia (Sodium < 135 mEq/L)  ○​ Dietary adjustments: ​ Severe symptoms: High-sodium foods and ○​ Altered mental status, fluids. seizures, coma, or death. ○​ Health promotion: Care ​ Teach signs of imbalance. ​ Diagnosis: ​ Encourage ○​ Serum sodium and electrolyte osmolality tests. replacement in ​ Management: high-heat or ○​ Fluid replacement: Oral, excessive sweating enteral, or IV (e.g., situations. hypotonic solutions like 0.45% NaCl). ○​ Health promotion: Hypernatremia (Sodium > 145 mEq/L) ​ Encourage adequate hydration. Pathophysiology ​ Teach sodium ​ Excess water loss: management, ○​ Sweating, diarrhea, or especially in inadequate intake. patients on tube ​ Excess sodium intake: feedings or with ○​ High-sodium diets or high risk of hypertonic IV fluids. imbalance. Manifestations Assessment and Nursing Priorities ​ Early signs: Assessment: ○​ Thirst, dry mucous membranes.  ​ Health history: Ask about fluid ○​ Manage edema and intake, output, diet, and prevent skin breakdown. symptoms (e.g., thirst, swelling, ○​ Monitor intake and output, confusion). weight, and diuretic ​ Physical exam: effectiveness. ○​ Weight changes: A rapid 2.​ Hyponatremia: gain or loss indicates fluid ○​ Prevent cerebral edema. imbalances. ○​ Restore sodium levels ○​ Vital signs: Monitor for safely. tachycardia, hypertension ○​ Monitor neurologic (hypervolemia), or function. hypotension 3.​ Hypernatremia: (hypovolemia). ○​ Prevent complications like ○​ Circulatory signs: Edema, seizures or coma. distended neck veins ○​ Ensure adequate fluid (hypervolemia). intake. ○​ Lung sounds: Crackles ○​ Educate on suggest pulmonary sodium-restricted diets. edema. ○​ Neurologic status: Confusion or seizures Nursing Diagnoses and Interventions (sodium imbalances). 1.​ Fluid Volume Excess: Priorities of Care: ○​ Intervention: Administer diuretics, restrict fluids, 1.​ Fluid Volume Excess: monitor for complications. ○​ Support cardiovascular 2.​ Risk for Impaired Skin Integrity: and respiratory function.  ○​ Intervention: Reposition potassium into cells and sodium frequently, assess for skin out) breakdown. ​ The kidneys regulate potassium 3.​ Hyponatremia: levels via excretion, influenced by ○​ Risk for Ineffective aldosterone. Cerebral Tissue Perfusion: Hypokalemia (Potassium < 3.5 mEq/L) Safely increase sodium levels. Pathophysiology 4.​ Hypernatremia: ​ Causes: ○​ Risk for Injury: Educate on ○​ Inadequate intake: Poor hydration and prevent dietary potassium or seizures. prolonged fasting. POTASSIUM OVERVIEW ○​ Excessive losses: ​ Normal serum potassium levels: ​ Renal: Diuretics, 3.5-5.3 mEq/L hyperaldosteronism ​ Functions:. ➔​ Key in generating nerve ​ Intestinal: Diarrhea, impulses vomiting, or fistulas. ➔​ Regulates cardiac rhythms ​ Skin: Sweating. for proper heart function ○​ ICF to ECF shift: Insulin or ➔​ Facilitates muscle alkalosis can cause contraction, including potassium to move into cardiac and skeletal cells. muscles. Manifestations Regulation: ​ Maintained by the 1.​ Neuromuscular: sodium-potassium pump (moves  ○​ Muscle weakness, cramps, ○​ IV potassium precautions: and fatigue. Never give undiluted 2.​ Cardiac: potassium IV push; always ○​ Irregular heartbeats, dilute and infuse at a decreased cardiac output. controlled rate. 3.​ Renal: 2.​ Nutrition: ○​ Polyuria (excessive ○​ Encourage potassium-rich urination). foods like bananas, 4.​ GI: oranges, potatoes, ○​ Nausea and vomiting. spinach, and avocados. 3.​ Health Promotion: Diagnosis ○​ Replace potassium during ​ Serum potassium: Confirms fluid losses with balanced hypokalemia. electrolyte solutions. ​ Electrolytes and arterial blood gases (ABGs): To identify related imbalances (e.g., alkalosis). Hyperkalemia (Potassium > 5.3 mEq/L) ​ Renal function tests: Evaluate Pathophysiology potassium excretion. ​ Causes: Interventions ○​ Inadequate excretion: Due 1.​ Medications: to renal failure or ○​ Potassium supplements: hypoaldosteronism. Oral or IV (administer IV ○​ Excessive intake: From slowly to avoid supplements or rapid IV complications like administration. arrhythmias).  ○​ Tissue damage: Acidosis, ​ Serum potassium: Confirms trauma, or chemotherapy hyperkalemia. releases intracellular ​ Electrolytes and ABGs: Acidosis potassium. can exacerbate hyperkalemia. ○​ Starvation: Causes ​ Renal function studies: Assess potassium to leak from potassium clearance. cells into the bloodstream. Interventions Manifestations 1.​ Medications: 1.​ Neuromuscular: ○​ Calcium gluconate: ○​ Muscle weakness and Stabilizes the heart by tremors. reducing the excitability of 2.​ GI: cardiac cells. ○​ Abdominal cramping and ○​ Insulin with glucose: discomfort. Drives potassium into cells 3.​ Cardiac: temporarily. ○​ ECG changes: Peaked T ○​ Sodium bicarbonate: waves, widened QRS Corrects acidosis and complex. lowers potassium. ○​ Dysrhythmias: ○​ Diuretics: Increase renal Bradycardia, ventricular potassium excretion. fibrillation. ○​ Sodium polystyrene ○​ Risk of cardiac arrest in sulfonate (Kayexalate): severe cases. Removes potassium through the GI tract. Diagnosis  ○​ Dialysis: Used in ○​ GI: Observe for nausea, emergencies or severe vomiting, or abdominal renal failure. discomfort. 2.​ Health Promotion: Nursing Priorities ○​ Educate about the risks of potassium-rich diets in 1.​ Cardiac Function: kidney disease. ○​ Monitor ECG changes for ○​ Ensure adequate hydration signs of dysrhythmias. to support renal excretion. ○​ Administer medications to stabilize cardiac rhythms. 2.​ Muscle Function: Assessment and Nursing Priorities ○​ Assess neuromuscular activity and manage Assessment weakness. 1.​ Health History: 3.​ Prevent Complications: ○​ Diet and medication use ○​ Hypokalemia: Prevent (e.g., diuretics, potassium respiratory failure and supplements). arrhythmias. ○​ History of renal or ○​ Hyperkalemia: Prevent endocrine disorders. cardiac arrest and 2.​ Physical Examination: acidosis-related ○​ Neuromuscular: Assess complications. for muscle weakness and cramps. ○​ Cardiac: Monitor pulse and Nursing Diagnoses and Interventions ECG for irregularities. 1.​ Hypokalemia: ○​ Decreased Cardiac Output:  ​ Intervention: ○​ Recommended diet: High Monitor ECG, potassium for administer hypokalemia, low potassium potassium for supplements, and hyperkalemia. assess for ○​ Use of salt substitutes: improved heart Many are high in function. potassium. ○​ Activity Intolerance: ○​ Importance of adhering to ​ Intervention: prescribed medications or Promote rest and treatments. gradually increase ​ Monitoring: physical activity. ○​ Schedule routine serum 2.​ Hyperkalemia: potassium checks, ○​ Risk for Injury: especially for patients with ​ Intervention: chronic conditions or on Implement fall diuretics. precautions due to muscle weakness. ○​ Impaired Gas Exchange: ​ Intervention: Address underlying acidosis if present. Continuity of Care ​ Education: Hyperkalemia (Serum Potassium > 5.3 ​ Starvation: Lack of nutrients and mEq/L) electrolyte imbalance can cause potassium to shift inappropriately Pathophysiology between compartments of the ​ Inadequate renal excretion of body. potassium: The kidneys are unable Manifestations to excrete potassium effectively, leading to its accumulation in the ​ Neuromuscular: blood. ○​ Muscle weakness: ​ Rapid IV administration: Potassium is crucial for Potassium infused too quickly proper muscle contraction. through an intravenous (IV) line Low or high levels can can overwhelm the body’s ability impair muscle function. to regulate it. ○​ Tremors: Uncontrolled ​ Acidosis: A condition where the shaking or trembling due blood becomes too acidic, to neuromuscular leading to potassium shifting instability. from cells into the bloodstream. ○​ GI discomfort: Potassium ​ Tissue trauma: When tissues are imbalance can cause damaged (e.g., from burns or nausea, vomiting, and injuries), potassium is released abdominal cramping. from cells into the blood. ​ Cardiac: ​ Chemotherapy: Treatment for ○​ ECG changes: cancer that can cause cell death, Electrocardiogram (ECG) releasing potassium into the alterations, such as bloodstream. peaked T waves or  widened QRS, indicating Medications electrical disturbances. ​ Calcium gluconate: Used to stabilize ○​ Dysrhythmias: Irregular the heart's electrical activity heart rhythms, which can during hyperkalemia. be life-threatening. ​ Calcium chloride: Similar to ○​ Cardiac arrest: A severe calcium gluconate, used for complication where the managing severe hyperkalemia. heart stops pumping ​ Insulin and glucose: Insulin effectively, often due to drives potassium into cells, while severe potassium glucose helps prevent imbalance. hypoglycemia. Diagnosis ​ Hypertonic dextrose: Used alongside insulin to manage ​ Serum electrolytes: Blood test that potassium levels. measures levels of potassium ​ Sodium bicarbonate: Corrects and other electrolytes in the acidosis and may reduce blood. potassium levels. ​ ABGs (Arterial Blood Gases): ​ Sodium polystyrene sulfonate: A Measures the levels of oxygen, resin used to remove excess carbon dioxide, and pH in the potassium from the body via the blood to assess acid-base gastrointestinal tract. balance. ​ Dialysis: A procedure to remove ​ ECG: A test that records the waste products and excess electrical activity of the heart, potassium from the bloodstream, useful for detecting abnormal used in severe cases. rhythms caused by electrolyte imbalances. Health Promotion  ​ Reading food labels: Helps patients ​ Risk for Activity Intolerance: Due avoid foods with high potassium to muscle weakness, patients content, especially those at risk may not be able to tolerate for hyperkalemia. normal activities. Assessment Continuity of Care ​ Health history: Reviewing patient’s ​ Diet restrictions: Educate patients medical background, including on limiting potassium-rich foods conditions affecting potassium to avoid further increases in regulation. serum potassium. ​ Physical assessment: Observing the patient for signs like muscle weakness or abnormal heart Calcium Imbalances rhythms. Normal Serum Calcium Level: 9–11 mg/dL Priorities of Care Calcium plays an essential role in ​ Electrical conduction and contractility stabilizing cell membranes, muscle of the heart: Monitoring and contraction and relaxation, cardiac supporting the heart’s function, function, and blood clotting. It is as potassium imbalance affects regulated by parathyroid hormone heart rhythms. (PTH), calcitriol (vitamin D), calcitonin, and acid-base balance. Diagnoses, Outcomes, and Interventions ​ Risk for Decreased Cardiac Output: Hyperkalemia can lead to Hypocalcemia (Serum Calcium < 9 decreased heart function. mg/dL) Risk Factors  ​ Parathyroidectomy: Removal of the proteins, reducing its free (active) parathyroid glands, leading to form. calcium imbalances. ​ Malabsorption disorders: ​ Older women: Higher risk due to Conditions that impair the gut's osteoporosis and decreased ability to absorb calcium, such as calcium absorption. celiac disease. ​ Lactose intolerance: Reduced Manifestations calcium intake from dairy products. ​ Tetany: Muscle spasms or cramps ​ Alcoholism: Can lead to poor due to increased neuromuscular nutrition and altered calcium excitability. metabolism. ​ Convulsions: Seizures may occur due to extreme calcium Pathophysiology deficiency. ​ Pancreatitis: Inflammation of the Diagnosis pancreas can lead to calcium binding and lowering serum ​ Serum calcium: Direct measure of calcium levels. calcium in the blood. ​ Hypoparathyroidism: Decreased ​ Albumin: A protein that binds production of PTH, which calcium, with low albumin leading normally raises calcium levels. to a falsely low calcium reading. ​ Other electrolyte imbalances: ​ Magnesium: Low magnesium Imbalances in magnesium or levels can cause hypocalcemia. phosphate can affect calcium ​ Phosphate: High phosphate regulation. levels often accompany low ​ Alkalosis: An increased blood pH calcium. can cause calcium to bind with  ​ Parathyroid hormone (PTH): To managing complications like assess the function of the tetany. parathyroid glands. ​ ECG: Heart rhythm abnormalities associated with calcium Hypercalcemia (Serum Calcium > 11.0 imbalances. mg/dL) Medications Pathophysiology ​ Oral or IV supplements: Calcium ​ Hyperparathyroidism: Excessive supplements are given if levels production of PTH increases are low. calcium levels. ​ Malignancies: Cancer, especially Nutrition bone metastases, releases ​ Diet high in calcium-rich foods: Dairy calcium into the bloodstream. products, leafy greens, and ​ Prolonged immobility: Reduced fortified cereals. movement leads to bone Health Promotion resorption and calcium release. ​ Excessive calcium or vitamin D ​ Risk factors: Educating on calcium intake: Overconsumption can intake and the risks associated lead to elevated calcium levels. with aging and female gender. Manifestations and Complications Priorities of Care ​ Subtle symptoms in mild cases, but ​ Neuromuscular irritability: Monitoring can cause decreased for muscle spasms or seizures. neuromuscular excitability, CNS ​ Risk for muscle spasm and symptoms (confusion, lethargy), convulsions: Preventing and  and cardiac effects (e.g., arrhythmias). Diagnosis ​ Serum PTH levels: To assess parathyroid function. ​ ECG: To detect cardiac rhythm abnormalities. ​ Bone density test: To assess the effects of prolonged hypercalcemia on bones. Medications Magnesium Imbalances ​ Loop diuretics: Help excrete calcium through urine. Normal Serum Concentration: 1.8–3.0 mg/dL ​ Bisphosphonates: Medications Magnesium is essential for intracellular that inhibit bone resorption and processes, neuromuscular reduce calcium levels. transmission, and cardiovascular ​ Sodium phosphate: Used to function. It helps regulate muscle reduce calcium in the blood. function, nerve transmission, and heart ​ Glucocorticoids: Corticosteroids rhythms, among other functions. that help lower calcium levels. Magnesium is found primarily inside Fluid Management cells, and its balance with other electrolytes (like potassium and ​ Isotonic saline: Administered to calcium) is important for maintaining dilute calcium levels and promote proper physiological function. renal excretion.  ​ Relates to hypokalemia and hypocalcemia: Low magnesium Hypomagnesemia (Serum Magnesium < levels often occur alongside 1.8 mg/dL) deficiencies in potassium and Risk Factors calcium because these electrolytes work together in ​ Alcoholism: Chronic alcohol use various cellular processes. can impair magnesium absorption and increase renal Manifestations and Complications excretion. ​ Tremors: Shaking or involuntary ​ Protein-calorie malnutrition: muscle movements due to Poor nutrition can lead to neuromuscular irritability. magnesium deficiency. ​ Hyperreactive reflexes: ​ Diabetic ketoacidosis: High blood Overactive reflex responses when sugar levels can cause testing with a reflex hammer, magnesium to be lost through commonly seen in magnesium urine. deficiency. ​ Kidney disease: Impaired kidney ​ Positive Chvostek sign: A clinical function can affect the body’s sign where tapping the facial ability to maintain normal nerve leads to twitching of the magnesium levels. facial muscles, indicating ​ Medications: Diuretics, some neuromuscular excitability. antibiotics, and proton pump ​ Positive Trousseau sign: A inhibitors can deplete clinical sign of latent tetany magnesium levels. where inflating a blood pressure Pathophysiology cuff above systolic pressure for a few minutes causes carpal  spasm (flexing of the wrist and ​ Urine magnesium levels: Can be fingers), another indicator of low measured to determine if magnesium. magnesium is being lost ​ Tetany: A condition characterized excessively through urine. by muscle spasms and cramps Medications due to low magnesium, which affects neuromuscular ​ Magnesium sulfate: Administered transmission. orally or IV to correct magnesium ​ Paresthesias: Abnormal deficiency. Magnesium sulfate is sensations like tingling or typically used in acute situations, numbness, particularly around such as in the treatment of the mouth or in the extremities. seizures or preeclampsia. ​ Seizures: Severe magnesium ​ Magnesium oxide: A commonly deficiency can lead to seizures used oral supplement for chronic due to impaired neuromuscular magnesium deficiency. and neuronal function. Nutrition Diagnosis ​ Diet high in magnesium-rich foods: ​ Serum magnesium levels: A blood Include foods such as leafy green test to measure the concentration vegetables, nuts, seeds, whole of magnesium. grains, and legumes. ​ Serum potassium and calcium: Health Promotion These electrolytes are often measured alongside magnesium, ​ Avoiding excessive alcohol: as imbalances often occur Educating patients about the together. risks of alcohol use and its impact on magnesium levels.  ​ Promoting adequate nutrition: ​ Risk for Injury: Due to the increased Encouraging a balanced diet that risk of seizures and muscle includes magnesium-rich foods. spasms, preventing falls and injuries is a key concern. Assessment ​ Continuity of care: Teaching ​ Health history: Reviewing the patients about medications, patient’s history for risk factors dietary changes, and lifestyle such as alcohol use, kidney adjustments to prevent disease, or malnutrition. recurrence of magnesium ​ Physical assessment: Checking imbalances. for signs like tremors, muscle spasms, and abnormal reflexes. Priorities of Care Hypermagnesemia (Serum Magnesium > 3.0 mg/dL) ​ Neuromuscular irritability: The Pathophysiology primary concern with hypomagnesemia is ​ Renal failure: The kidneys are the neuromuscular disturbances, so primary organs responsible for monitoring for signs like muscle excreting magnesium. In kidney weakness, spasms, or seizures is failure, magnesium can critical. accumulate in the blood. ​ Risk for muscle spasm and ​ Excessive magnesium intake: convulsions: Magnesium’s role in Overuse of neuromuscular function means magnesium-containing that deficiency can lead to severe medications (like antacids or complications, including seizures. laxatives) or supplements can Diagnoses, Outcomes, and Interventions lead to toxicity. Manifestations and Complications ​ Calcium gluconate: Used to counteract the effects of elevated ​ Neuromuscular: Weakness, lethargy, magnesium on the heart and or drowsiness, which may muscles. progress to paralysis if left ​ Loop diuretics: Used to increase untreated. urinary excretion of magnesium. ​ Cardiac: Heart rhythm ​ Dialysis: In severe cases of abnormalities, including hypermagnesemia, especially in bradycardia (slow heart rate), patients with renal failure, dialysis hypotension, and possibly cardiac may be required to remove arrest. excess magnesium. ​ Respiratory: Depressed respiratory function due to Fluid Management neuromuscular weakness ​ Isotonic saline: Helps to dilute the affecting respiratory muscles. magnesium concentration and ​ CNS symptoms: Drowsiness, promote renal excretion. confusion, or in severe cases, coma. Health Promotion Diagnosis ​ Avoiding excessive magnesium supplements: Educating patients on ​ Serum magnesium levels: Blood test the risks of taking too many to confirm elevated magnesium. magnesium-containing ​ Serum calcium levels: Often supplements or antacids. monitored, as elevated ​ Promoting renal health: magnesium can lead to a Encouraging adequate hydration decrease in calcium levels. and kidney function monitoring, Medications  especially in patients with magnesium-containing pre-existing renal conditions. medications and supplements. ​ Encourage increasing fluid Priorities of Care intake: Promoting hydration to ​ Safety: The patient is at risk of help with kidney function and falls and injuries due to magnesium excretion. neuromuscular weakness and PHOSPHATE IMBALANCES possible cardiac arrhythmias. ​ Risk for Fluid Volume Excess: As ✱​ Normal Serum Phosphate Level: magnesium toxicity can cause 2.5 - 4.5 mg/dL renal impairment, fluid ✱​ Phosphate plays an important management and monitoring are role in producing ATP (adenosine essential. triphosphate), which is essential for cellular energy. It also Diagnoses, Outcomes, and Interventions supports the function of red ​ Risk for Injury: Due to the potential blood cells, the nervous system for cardiac arrhythmias and and muscles. neuromuscular weakness. ✱​ Phosphate is involved in ​ Risk for Fluid Volume Excess: metabolism and acid-base Because of possible kidney balance, making it crucial for dysfunction associated with maintaining overall physiological hypermagnesemia. stability. Continuity of Care Hypophosphatemia (Serum ​ Educate on limiting intake: Educating Phosphate < 2.5 mg/dL) patients on how to safely use Risk Factors  ​ Malnutrition: Inadequate dietary ​ Phosphate is primarily stored in intake can result in low bones, with smaller amounts phosphate levels. circulating in the blood. When ​ Chronic alcoholism: Alcohol phosphate levels fall, cellular impairs the absorption of function is impaired, affecting phosphate in the gastrointestinal energy production and metabolic tract and can lead to deficiencies. processes. The musculoskeletal ​ Hyperparathyroidism: Elevated system, nervous system, and red parathyroid hormone (PTH) levels blood cells are especially can increase phosphate excretion impacted by low phosphate through the kidneys. levels. ​ Vitamin D deficiency: This Manifestations and Complications vitamin is important for phosphate absorption, and its ​ Muscle weakness: Reduced ATP deficiency can cause low availability can lead to muscle phosphate levels. dysfunction. ​ Diabetic ketoacidosis: The ​ Respiratory failure: Severe condition causes phosphate to hypophosphatemia can weaken be lost through urine. respiratory muscles, impairing ​ Refeeding syndrome: Refeeding breathing. after a period of starvation can ​ Hemolysis: Low phosphate can cause a rapid shift of phosphate damage red blood cells, leading into cells, leading to a deficiency to their breakdown. in the blood. ​ Rhabdomyolysis: Muscle breakdown caused by inadequate Pathophysiology cellular energy and muscle injury.  ​ Irritability: Due to impaired ​ Phosphate-rich foods: Encouraging neuronal function. the consumption of dairy products, meat, fish, nuts, and Diagnosis legumes can help restore ​ Serum phosphate levels: A blood phosphate levels. test to measure the concentration Health Promotion of phosphate. ​ Serum calcium levels: Often ​ Balanced diet: Ensure adequate measured because phosphate intake of nutrients, particularly and calcium are tightly regulated phosphorus and vitamin D, to and inversely related. support bone and cell function. ​ Electrolyte panels: Other ​ Monitor alcohol use: Educating electrolytes such as potassium patients about the risks of and magnesium may also be excessive alcohol consumption measured. and its effect on phosphate levels. Medications Assessment ​ Phosphate supplements: Oral or IV supplements are used to treat ​ Health history: Asking about diet, moderate to severe cases of alcohol use, chronic illnesses, hypophosphatemia. and medications can help identify ​ Vitamin D: If deficiency is a risk factors. contributing factor, vitamin D ​ Physical assessment: Checking supplementation may be for signs of muscle weakness, necessary to help with phosphate respiratory difficulty, and absorption. irritability can help identify hypophosphatemia early. Nutrition Priorities of Care phosphate, and impaired kidney function can lead to phosphate ​ Safety: Protecting the patient retention. from injury due to muscle ​ Hyperparathyroidism: Increased weakness and the risk of falls. PTH levels can interfere with ​ Neuromuscular function: phosphate excretion, leading to Monitoring for changes in muscle elevated phosphate levels in the strength and respiratory function. blood. Diagnoses, Outcomes, and Interventions ​ Excessive phosphate intake: This can occur with the use of ​ Risk for Injury: Due to muscle phosphate-containing weakness and poor coordination. medications or excessive dietary ​ Imbalanced Nutrition: Less than intake. body requirements, especially if ​ Cellular release: Conditions such the patient is malnourished or as tumor lysis syndrome or has an underlying eating disorder. rhabdomyolysis cause ​ Continuity of care: Ensuring phosphate to be released from appropriate phosphate cells, raising blood phosphate supplementation and dietary levels. modifications. Manifestations and Complications ​ Soft tissue calcification: Elevated Hyperphosphatemia (Serum phosphate levels can lead to Phosphate > 4.5 mg/dL) calcium-phosphate deposits in Pathophysiology soft tissues, including the skin, blood vessels, and kidneys, ​ Renal failure: The kidneys are responsible for excreting  potentially causing organ ​ Loop diuretics: These may be damage. used to increase urinary excretion ​ Hypocalcemia: High phosphate of phosphate in certain cases. levels can cause a decrease in Fluid Management calcium levels due to their inverse relationship. ​ Dialysis: In cases of severe ​ Pruritus (itching): Phosphate hyperphosphatemia due to kidney buildup can irritate the skin. failure, dialysis may be required to remove excess phosphate Diagnosis from the bloodstream. ​ Serum phosphate levels: A blood Health Promotion test will confirm the phosphate concentration. ​ Avoid excessive ​ Serum calcium levels: Since high phosphate-containing foods: phosphate levels can lead to low Educating patients with kidney calcium, both should be disease or hyperparathyroidism monitored together. on avoiding foods that are high in phosphate, such as dairy Medications products and certain processed ​ Phosphate binders: These foods. medications (e.g., calcium ​ Monitor kidney function: For acetate, sevelamer) help to patients with renal disease, reduce phosphate absorption regular kidney function tests are from the digestive tract, essential to prevent phosphate commonly used in patients with buildup. chronic kidney disease. Priorities of Care  ​ Safety: Preventing complications which is crucial for maintaining normal like soft tissue calcification and cellular function. They are involved in managing associated several physiological processes, hypocalcemia. including metabolism and enzyme ​ Fluid balance: Ensuring proper activity. hydration and monitoring kidney ​ Acids: Release hydrogen ions function. (H⁺) when dissolved in water. The Diagnoses, Outcomes, and Interventions more hydrogen ions released, the stronger the acid. ​ Risk for Injury: Due to potential ○​ Example: Carbonic acid soft tissue calcification or bone (H₂CO₃) produced in the demineralization. body as a result of carbon ​ Risk for Fluid Volume Excess: dioxide (CO₂) dissolving in Especially in renal failure, water. phosphate imbalances can affect ​ Bases (Alkalis): Accept hydrogen fluid balance. ions (H⁺). The more hydrogen Continuity of Care ions a base accepts, the stronger the base. ​ Education on diet: Ensuring the ○​ Example: Bicarbonate patient understands the (HCO₃⁻) is an important importance of limiting foods high base in the blood that in phosphate and following helps neutralize acids. prescribed treatments. Acids and Bases pH and Its Regulation Acids and bases are essential for regulating the pH balance in the body,  ​ pH measures the acidity or excess of hydrogen ions (H⁺). This alkalinity of a solution. The scale disrupts normal cellular functions and ranges from 0 to 14, with 7 being can lead to serious health problems if neutral. not corrected. ○​ Normal body pH range: Causes of Acidosis 7.35–7.45. Maintaining this range is essential for ​ Respiratory acidosis: Caused by normal metabolic hypoventilation (decreased functions, enzyme activity, breathing), which leads to CO₂ and cellular processes. buildup in the blood, forming ​ pH of 7: Neutral (neither acidic carbonic acid. nor alkaline). ○​ Common in chronic ​ Acidic pH (7): Fewer hydrogen syndrome. ions (H⁺), leading to alkalosis. ​ Metabolic acidosis: Occurs when there is an accumulation of The body uses buffer systems to nonvolatile acids (like lactic acid regulate pH, which involves volatile or ketoacids) or a loss of acids (like carbonic acid) and bicarbonate (HCO₃⁻), leading to a nonvolatile acids (like phosphoric acid). decrease in pH. ○​ Diabetic ketoacidosis (DKA): The body produces Acidosis (pH < 7.35) ketoacids due to insulin deficiency, leading to Acidosis occurs when the blood acidosis. becomes too acidic, meaning there is an  ○​ Renal failure: The kidneys ​ Serum electrolytes: To assess for can't excrete acids imbalances in bicarbonate, properly, causing them to potassium, and sodium. accumulate. ​ Lactate levels: In cases of lactic ○​ Lactic acidosis: Buildup of acidosis. lactic acid from anaerobic Management metabolism, often due to shock, sepsis, or severe ​ Respiratory acidosis: Improve hypoxia. ventilation (e.g., via mechanical ventilation for patients with Manifestations of Acidosis respiratory failure). ​ Respiratory: Rapid, shallow ​ Metabolic acidosis: Treat the breathing (compensatory underlying cause (e.g., insulin for mechanism to expel CO₂). DKA, sodium bicarbonate for ​ Cardiac: Dysrhythmias, severe acidosis). decreased cardiac output. ​ Neurological: Confusion, lethargy, stupor, and potentially coma. Alkalosis (pH > 7.45) ​ Musculoskeletal: Muscle Alkalosis occurs when the blood weakness, fatigue. becomes too alkaline, meaning there is ​ GI: Nausea, vomiting, abdominal a deficiency of hydrogen ions (H⁺). pain. Causes of Alkalosis Diagnosis ​ Respiratory alkalosis: Caused by ​ ABGs (Arterial Blood Gases): A hyperventilation, which expels primary test to assess pH and too much CO₂, decreasing CO₂ levels. carbonic acid in the blood.  ○​ Common causes: anxiety, ​ Electrolytes: To check for low pain, fever, or hypoxia. potassium (hypokalemia) or ​ Metabolic alkalosis: Occurs when calcium (hypocalcemia), which there is an excess of bicarbonate are often associated with (HCO₃⁻) or a loss of acid (H⁺). alkalosis. ○​ Common causes: Management vomiting, nasogastric suction, excessive diuretic ​ Respiratory alkalosis: Encourage use, or ingestion of slow, deep breathing or use paper alkaline substances (e.g., bags to re-breathe CO₂ (in case of antacids). anxiety-induced hyperventilation). ​ Metabolic alkalosis: Address the Manifestations of Alkalosis underlying cause (e.g., replace ​ Respiratory: Slowed breathing lost potassium or chloride in (compensatory mechanism to cases of vomiting or diuretic retain CO₂). use). ​ Cardiac: Tachycardia, dysrhythmias. ​ Neurological: Irritability, seizures, Phosphate Imbalances and pH confusion, muscle twitching. Regulation ​ GI: Nausea, vomiting, and abdominal discomfort. Phosphate is involved in both acid-base balance and cellular metabolism, so Diagnosis phosphate imbalances can contribute to ​ ABGs: To assess the pH, changes in pH. bicarbonate (HCO₃⁻), and CO₂ ​ Hypophosphatemia can worsen levels. metabolic acidosis because  phosphate is a buffer that helps ○​ Signs and symptoms of regulate pH. acidosis or alkalosis, so ​ Hyperphosphatemia can also they can seek help early if affect calcium metabolism, symptoms develop. contributing to metabolic The body maintains a delicate balance alkalosis in certain conditions of acids and bases to keep the pH within (e.g., kidney failure). a normal range (7.35–7.45), which is essential for proper cellular function. Several systems, particularly the lungs Interprofessional Care and Nursing and kidneys, regulate acid-base balance. Considerations ​ Carbonic acid regulation: The ​ Identify at-risk patients: Patients lungs regulate the levels of with chronic kidney disease, carbonic acid by eliminating or diabetic ketoacidosis, respiratory retaining carbon dioxide (CO₂), disorders, or alcoholism should which combines with water (H₂O) be carefully monitored for to form carbonic acid (H₂CO₃). acid-base imbalances. ○​ The kidneys also play a ​ Patient Education: Teach patients crucial role in long-term about the importance of: regulation by eliminating ○​ Balanced diet: To avoid excess non-volatile acids acid-base disturbances. and adjusting bicarbonate ○​ Avoiding excessive intake (HCO₃⁻) levels in the of antacids or extracellular fluid (ECF). phosphate-containing solutions in certain conditions. Arterial Blood Gas (ABG) Analysis ABGs help assess the acid-base balance ○​ Metabolic acidosis: and the respiratory system’s Caused by a decrease in effectiveness in regulating pH. Key bicarbonate (HCO₃⁻) or an parameters measured include: accumulation of metabolic acids. ​ PaCO₂: Partial pressure of carbon ○​ Respiratory acidosis: dioxide, indicating respiratory Caused by an increase in function and carbonic acid carbonic acid due to CO₂ regulation. retention. ​ PaO₂: Partial pressure of oxygen, ​ Alkalosis: A condition where reflecting the efficiency of gas hydrogen ion concentration is exchange in the lungs. below normal (pH > 7.45), leading ​ Serum bicarbonate (HCO₃⁻): to excess alkalinity in the blood. Indicates the metabolic ○​ Metabolic alkalosis: component of acid-base balance. Caused by an increase in ​ Base excess/deficit: Measures bicarbonate (HCO₃⁻) or a the amount of excess or loss of hydrogen ions (H⁺). insufficient base in the blood, ○​ Respiratory alkalosis: which reflects metabolic Caused by a decrease in disorders. carbonic acid due to excessive CO₂ elimination. Acidosis and Alkalosis ​ Acidosis: A condition where Metabolic Acidosis hydrogen ion concentration is Pathophysiology: above normal (pH < 7.35), leading to excess acidity in the blood.  ​ Accumulation of metabolic acids mechanism to reduce CO₂ and (e.g., lactic acid, ketoacids) or raise pH. excess loss of bicarbonate can ​ GI: Anorexia, nausea, vomiting. decrease the pH of the blood. Diagnosis: ​ Conditions that can lead to metabolic acidosis include: ​ ABGs: pH < 7.35, low bicarbonate ○​ Tissue hypoxia (due to (< 22 mEq/L), and potentially low shock or cardiac arrest) PaCO₂ (compensatory). ○​ Diabetic ketoacidosis ​ Serum electrolytes: To evaluate (DKA) potassium and chloride levels. ○​ Renal failure (acute or ​ Blood glucose: For diabetic chronic) ketoacidosis (DKA). ○​ Gastrointestinal losses, ​ Renal function: To assess for such as diarrhea or renal failure. intestinal suction Management: Manifestations: ​ Sodium bicarbonate (for severe ​ Neurological: Headache, acidosis) to buffer hydrogen ions weakness, fatigue, confusion, and and raise pH. decreased level of ​ IV insulin and fluids for diabetic consciousness. ketoacidosis (DKA). ​ Cardiovascular: Dysrhythmias, ​ Saline solutions and glucose for hypotension, cardiac arrest. fluid replacement and to prevent ​ Respiratory: Rapid and deep further ketoacid formation. respirations (Kussmaul Health Promotion: breathing), a compensatory  ​ Managing underlying diseases ​ Neurological: Tetany (muscle like diabetes mellitus, renal spasms), confusion, dizziness, failure, or GI disorders. and irritability. ​ Encouraging fluid and electrolyte ​ Cardiovascular: Depressed balance through proper hydration respirations, possible respiratory and dietary changes. failure, and arrhythmias. ​ Muscular: Weakness and cramping. Metabolic Alkalosis Diagnosis: Pathophysiology: ​ ABGs: pH > 7.45, high ​ Metabolic alkalosis results from bicarbonate (> 26 mEq/L). an increase in bicarbonate ​ Serum electrolytes: Low (HCO₃⁻) or loss of hydrogen ions potassium and calcium levels, (H⁺), leading to a pH > 7.45. which can contribute to muscle ​ Causes include: spasms. ○​ Loss of hydrogen ions ​ Urine pH: To assess for (e.g., from vomiting, bicarbonate excretion. gastric suction, or diuretic ​ ECG: To detect arrhythmias use). associated with electrolyte ○​ Excessive bicarbonate imbalances. intake (e.g., from antacid Management: overuse). ​ Potassium chloride and sodium Manifestations: chloride to replenish electrolytes and improve kidney function.  ​ Acidifying solutions like bicarbonate (HCO₃⁻) as a ammonium chloride or compensatory mechanism. hydrochloric acid (in rare cases) ​ Management: Improve ventilation may be used for severe alkalosis. using mechanical ventilation or non-invasive positive pressure Health Promotion: ventilation (NIPPV). ​ Preventing excessive loss of hydrogen ions by avoiding prolonged vomiting, excessive Respiratory Alkalosis use of diuretics, and overuse of Respiratory alkalosis occurs when there antacids. is excessive elimination of CO₂ due to ​ Fluid replacement with sodium hyperventilation. chloride to maintain elec