The nurse would monitor a patient using sodium bicarbonate to treat gastric hyperacidity for signs and symptoms of:A. Metabolic alkalosis
A. Metabolic alkalosis
B. Metabolic acidosis
C. Hyperkalemia
D. Hypercalcemia
Correct Answer: A. Metabolic alkalosis
Solutions containing sodium bicarbonate (a base) can cause metabolic alkalosis. Serum K and serum calcium would decrease with alkalosis, not increase. Due to rapid alkalotic effects, sodium bicarbonate is contraindicated in those with signs/symptoms or laboratory values indicating underlying metabolic or respiratory alkalosis due to the potential for exacerbation of symptoms.
Option B: Sodium bicarbonate is indicated for acute metabolic acidosis. If pH is less than 7.1 or pH less than 7.1 to 7.2 in patients with severe acute kidney injury (oliguria or 2-fold or larger increase in serum creatinine level). It is also indicated for chronic metabolic acidosis. 50-100 mEq oral tablet can be initiated and titrated according to the ongoing evaluation of acid-base balance.
Option C: When patients with severe hyperkalemia (serum potassium level of more than 6 mEq/L or more than 5.5 mEq/L with arrhythmia or EKG changes) have metabolic acidosis, sodium bicarbonate should be administered. The dose needed is empirical and is unpredictable. Initially, 150 mEq of sodium bicarbonate can be given in 1 liter of 5% dextrose over 4 hours. More can be given if acidosis does not correct with this regimen.
Option D: Sodium bicarbonate administration in a rapid infusion or as large boluses can result in acute metabolic alkalosis resulting in reduced serum ionized calcium. This acute shift in ionized calcium can result in tetany. This severe alkalosis is potentially treatable with ammonium chloride. Hypocalcemia may be addressed with calcium gluconate. An addition of 0.9 % NS infusion and potassium supplementation may also be indicated.
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