Nurse Nacole ◂ Nursing Resources

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Fri, 19 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
Acetazolamide is a carbonic anhydrase inhibitor promoting the renal excretion of bicarbonate and has been demonstrated to be effective in treating metabolic alkalosis in ICU patients. A single dose of 500 mg is recommended.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Thu, 18 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
The first therapeutic maneuver in patients with a metabolic alkalosis is to replace any volume deficit with normal saline and correct electrolyte deficiencies. Aggressive potassium supplementation is warranted to achieve a K+ > 4.5 mEq/L.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Wed, 17 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
Correction of metabolic alkalosis increases minute ventilation, increases arterial and mixed venous oxygen tensions and decreases oxygen consumption. It is therefore important to correct metabolic alkalosis in majority of patients.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Tue, 16 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
Citrate in transfused blood is metabolized to bicarbonate and may cause metabolic alkalosis. Type II respiratory failure promotes compensatory retention of bicarbonate that may result in a metabolic alkalosis when ventilation is normalized.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Mon, 15 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
Metabolic alkalosis is usually the result of therapeutic interventions. Nasogastric drainage, diuretic-induced intravascular volume depletion, hypokalemia and the use of corticosteroids are common causes of metabolic alkalosis.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Sun, 14 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
During critical illness, the source of lactate is often believed to be ischemic anaerobically metabolizing tissues. In addition to ischemia, the Warburg effect with dysregulated glycolysis is a major nonischemic cause for lactatemia.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Sat, 13 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
Bicarbonate is frequently administered to “correct the acidosis” in patients with diabetic ketoacidosis (DKA). However, paradoxically, bicarbonate has been demonstrated to increase ketone and lactate production.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Fri, 12 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
Infusion of bicarbonate can lead to a variety of problems in patients with acidosis, including fluid overload, hypernatremia and metabolic alkalosis. Studies suggest that alkali therapy may only transiently raise the plasma bicarbonate concentration.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Thu, 11 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
Bicarbonate increases hemoglobin-oxygen affinity, known as the Bohr effect, leading to potential tissue hypoxemia, hypertonic state and low plasma calcium concentrations because of albumin chelation.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Wed, 10 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
The treatment of metabolic acidosis involves treatment of the underlying disorder. Except in specific circumstances, there is no scientific evidence to support treating a metabolic or respiratory acidosis with sodium bicarbonate.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Tue, 09 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
The first reported in children and then recognized also in adults, prolonged high-dose propofol (>100 μg/kg/min) is associated with the “propofol infusion syndrome” characterized by rhabdomyolysis, metabolic acidosis and renal/cardiac failure.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Mon, 08 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
Long-term use of lorazepam can result in the accumulation of propylene glycol, resulting in AKI, metabolic acidosis and altered mental status. Propylene glycol toxicity is typically observed after prolonged, high-dose lorazepam infusion.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Sun, 07 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
In patients with an unexplained anion gap metabolic acidosis, drugs such as salicylates, methanol or ethyleneglycol toxicity should be considered. Accumulation of 5-oxoproline related to the use of acetaminophen is also a rare cause.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Sat, 06 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
Severe metabolic acidosis requires an aggressive approach to treat the underlying causes. In most patients, the causes are obvious, with lactic acidosis (tissue hypoxia or sepsis), ketoacidosis and acute kidney injury being the most common.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Fri, 05 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
Severe metabolic acidosis results in myocardial depression with a reduction in cardiac output, blood pressure and decreased hepatic and renal blood flows. The cardiovascular system also becomes less responsive to vasopressor agents.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Thu, 04 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
It is possible for a patient to have an acid-base disorder with normal pH, PaCO2 and HCO3-, with the only clue to an acid-base disorder being an increased anion gap (AG). If the AG is > 15 mEq/L, the patient most likely has a metabolic acidosis.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Wed, 03 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
In non anion gap metabolic acidosis, H+ is accompanied by Cl- (a measured anion). Therefore, there is no change in anion gap. Acid-base disorders may present as two or three coexisting disorders.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Tue, 02 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
In high anion gap metabolic acidosis, acid dissociates into H+ and an unmeasured anion. H+ is buffered by HCO3-, and the unmeasured anion accumulates in the serum, resulting in an increase in anion gap.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Mon, 01 Jun 2026 12:00:00 +0000

Category: Critical Care Nursing
Any alteration in acid-base equilibrium sets into motion a compensatory response by either the lungs or kidneys. The compensatory response attempts to return the ratio between PaCO2 and HCO3- to normal with subsequent normalization of pH.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Sun, 31 May 2026 12:00:00 +0000

Category: Critical Care Nursing
Patients with chronic obstructive pulmonary disease could have chronic respiratory acidosis because of CO2 accumulation counterbalanced by metabolic alkalosis, resulting in a normal pH.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Sat, 30 May 2026 12:00:00 +0000

Category: Critical Care Nursing
The history and physical examination can often give clues as to the underlying acid-base disorder. For example, severe diarrhea could lead to loss of HCO3- with subsequent non-anion gap metabolic acidosis.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Fri, 29 May 2026 12:00:00 +0000

Category: Critical Care Nursing
In electrochemical neutrality, total cations must equal total anions. With this, a number is derived from the difference. When cations are in excess, mathematically, this “gap” (anion gap) is filled with anions to preserve electrochemical neutrality.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Thu, 28 May 2026 12:00:00 +0000

Category: Critical Care Nursing
Arterial oxygen tension decreases with age. For example, at age 60 years, with an FiO2 of 21%, and 1 atmospheric pressure, the PaO2 is 85-90 mm Hg. This value decreases to 80-85 mm Hg at the age of 80 years.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Wed, 27 May 2026 12:00:00 +0000

Category: Critical Care Nursing
Because the normal PaO2 in an adult breathing room air is 80-100 mm Hg, the normal value for PaO2/FiO2 ranges between 400-500 mm Hg. A PaO2/FiO2 ratio of less than 200 indicates a shunt of greater than 20% of total cardiac output.

Nursing Tip of the Day! - Critical Care Nursing

noreply@blogger.com (Nurse Nacole) — Tue, 26 May 2026 12:00:00 +0000

Category: Critical Care Nursing
Clinically, the P/F ratio (PaO2/FiO2) is most commonly used to approximately quantitate the degree of venous admixture, composed of ventilation/perfusion mismatching (V/Q) and true shunt.