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Thursday, February 12, 2015

Metabolic Acidosis Study Guide

ABGs, Acid-Base Imbalance, Metabolic, Acidosis, Nurse, Nursing school, RN, NCLEX, Boards, Bicarb

Metabolic Acidosis

Metabolic Acidosis is an acid-base imbalance in which the pH and the bicarbonate are both low. Being able to interpret and understand acid-base imbalances will not only show up on NCLEX but will also show up frequently in the hospital setting. This is a post over the signs and symptoms, causes, and treatments of Metabolic Acidosis.

You might like to go back and review this post on ABGs: The Ultimate Beginners Guide.

Metabolic Acidosis happens by either gaining hydrogen ions or losing bicarb. The pH is below 7.35 and the bicarb is below 22 mEq/L. Here's a table for a quick review:

ROME: Respiratory Opposite. Metabolic Equal.

Remember Metabolic Acidosis is from the ass (diarrhea). Just think, it puts the ass in acidosis. Hey, whatever helps me remember things, right?

Metabolic Alkalosis is from the mouth (vomiting)

I'm a little twisted. I know.

ABGs, Arterial Blood Gases, nurse, lab draws, respiratory alkalosis, respiratory acidosis, metabolic alkalosis, metabolic acidosis, pH, Acid-Base Imbalances


  • Diarrhea
  • **Excessive administration of isotonic saline or ammonium chloride**
  • Diabetic Ketoacidosis
  • Renal Failure
  • Toxins
    • Methanol
    • Ethylene Glycol
    • Salicylates

Signs and Symptoms

  • Headache
  • Confusion
  • Nausea / Vomiting
  • Drowsiness
  • Increased Respiratory Rate
Respirations will increase to compensate. The patient begins to hyperventilate because the body is trying to decrease the CO2.


Like everything else I ever post about, treatment depends on the cause. If the patient has renal failure, we can treat this with dialysis. If the patient is in Diabetic Ketoacidosis we treat with fluid replacement and insulin. 

Some providers might order sodium bicarb. Which means as the nurse you're observing for hypernatremia. (Which I've already posted about. YAY! Super Fantastic Handy Dandy Post on Hypernatremia) Bicarb will be ordered when the cause of the metabolic acidosis is diarrhea. It could possibly be used in treating toxin poisonings too.

There you have it. Metabolic Acidosis in a nut shell!!

Here are the other posts in this series on acid-base imbalances:

ABGs: The Ultimate Beginners Guide
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis

I didn't go into too many details on this post, so if you'd like more information I have an ebook on for $3.99 that explains everything so much better. I also work through practice problems with you- step by step. I know how confusing this can be. It took me four different teachers, and four different classes until I FINALLY learned acid-base imbalances the correct way. So check it out! Easy Guide to Interpret Acid-Base Imbalances. It's cheaper than your lunch, and you don't even need to have a kindle to read it!! Thanks!!

What topics would you be interested in learning more about?? (Please don't say care plans, ha!) 

Leave me a comment below with your burning questions!!




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