Metabolic acidosis management
Metabolic acidosis can occur as renal failure due to the inability of the nephrons to secrete and expel hydrogen ions and reabsorb bicarbonate ions. Within the critically-ill patient, metabolic acidosis may be intensified due to coexisting conditions such as diabetic ketoacidosis or lactic acidosis which can subsequently increase the discharge of intracellular acids into the
circulation as a result of the high catabolic state that present with these conditions. Clinical features of metabolic acidiosis include nausea and vomiting, Kussmaul respirations (deep and rapid respirations), hyperkalaemia, tachycardia, distorted mental status. In the situation of severe metabolioc acidiosis, hypotension and bradycardia can develop due to myocardial depression and vasodilation, along with a sudden depression of consciousness level leading to a comatose state. Arterial blood gases should be monitored frequently, along with constant measuring of the patients’ oxygen saturation level with a pulse oximetry and oxygen therapy through the use of a face mask or nasal specs as applicable. Depending upon the clinical manifestations, mechanical ventilation may be required. The patient must be assessed for signs and symptoms of
pulmonary distress. The physiotherapist must be involved in the care conducting chest percussion, airway suctioning, incentive spirometer, turning the patient in the bed and if feasible mobilising out of bed to a chair (Holcome and Kern Feeley. A refractory metabolic acidosis with a pH < 7.1 would be an indicator to commence RRT