When assessing a patient for metabolic alkalosis, the nurse would expect to find:
A. Low serum potassium
B. Changes in urine output
C. Hypotension
D. Increased CVP
Correct Answer: A. Low serum potassium
Decreased serum potassium is a common symptom of metabolic alkalosis. The biological effects of metabolic alkalosis are directly resultant to associated problems such as hypovolemia and potassium and chloride depletion. These changes lead to decreased myocardial contractility, arrhythmias, decreased cerebral blood flow, confusion, increased neuromuscular excitability, and impaired peripheral oxygen unloading secondary to the shift of the oxygen dissociation curve to left.
Option B: Of interest here, sodium is reabsorbed through an exchange for hydrogen in the renal collecting ducts under the influence of aldosterone. Therefore, pathologies that increase the levels of mineralocorticoids or increase the effect of aldosterone, such as Conn syndrome will lead to hypernatremia, hypokalemia, and hydrogen loss in the urine.
Option C: In general, the causes can be narrowed down to an intracellular shift of hydrogen ions, gastrointestinal (GI) loss of hydrogen ions, excessive renal hydrogen ion loss, retention or addition of bicarbonate ions, or volume contraction around a constant amount of extracellular bicarbonate known as contraction alkalosis.
Option D: As long as renal function is maintained, excess bicarbonate is excreted in the urine fairly rapidly. As a result, metabolic alkalosis will persevere if the ability to eliminate bicarbonate is impaired due to one of the following causes: hypovolemia, reduced effective arterial blood volume, chloride depletion, hypokalemia, reduced glomerular filtration rate, and/or hyperaldosteronism.
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