Metabolic Acidosis — NCLEX Cheat Sheet
↓ pH, ↓ HCO₃⁻Also known as: acidosis · low pH · acid blood · low bicarb
Use this quick-reference guide to spot, treat, and prevent Metabolic Acidosis on the NCLEX. Keep it handy during review and on exam day!
🩺📒 The 1-minute cheat sheet
🧪 Labs
- pH < 7.35, HCO₃ < 22
- Lungs blow off CO₂ (compensate)
🩺 Signs
- Kussmaul breathing (deep/fast)
- Confusion, drowsy, warm flush
- ↑ K (hyperkalemia)
🚩 Report
- Dysrhythmias from ↑ K
- Coma, fatal if untreated
⚠️ Causes
- DKA, lactic acidosis, renal fail
- Diarrhea, shock
📚 Metabolic Acidosis — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Key points
Understand these first- ABG pattern: low pH (under 7.35) with low HCO3 (under 22 mEq/L); the bicarbonate change drives the disorder.
- Respiratory compensation produces deep, rapid Kussmaul respirations to exhale CO2 and a low PaCO2.
- Neurologic signs include headache, confusion, drowsiness, and progression to lethargy and coma.
- Acidosis shifts potassium out of cells, so hyperkalemia is often present and causes cardiac dysrhythmias.
- Cardiovascular effects include hypotension, bradycardia, and decreased cardiac contractility.
- GI symptoms include nausea, vomiting, and abdominal pain; warm flushed skin may be seen.
Nursing priorities
What to do, in order- Treat the underlying cause (insulin and fluids for DKA, restore perfusion for lactic acidosis, dialysis for renal failure).
- Monitor ABGs, potassium, and cardiac rhythm closely.
- Support airway and breathing; do not suppress the compensatory Kussmaul respirations.
- Administer IV fluids and prepare to give sodium bicarbonate only for severe acidosis per order.
- Monitor potassium during treatment, as correcting acidosis can shift potassium back into cells and cause hypokalemia.
Red flags — report now
Escalate immediately- Dysrhythmias from hyperkalemia - obtain ECG and notify provider immediately.
- Decreasing level of consciousness, profound hypotension, or pH below 7.20 - escalate urgently.
- During correction, watch for a sudden drop in potassium that can also cause dysrhythmias.
Labs & values
Numbers to know- pH normal 7.35-7.45; metabolic acidosis pH less than 7.35
- HCO3 normal 22-26 mEq/L; decreased (under 22) in metabolic acidosis
- PaCO2 normal 35-45 mmHg; decreased with respiratory compensation
Patient teaching
What patients must know- Diabetic clients should monitor glucose and ketones and seek care for persistent high glucose or vomiting.
- Take chronic kidney disease medications and attend dialysis as prescribed.
- Report increasing fatigue, confusion, deep rapid breathing, or persistent diarrhea.
❓ Metabolic Acidosis: NCLEX FAQs
What are the priority nursing interventions for Metabolic Acidosis?
Treat the underlying cause (insulin and fluids for DKA, restore perfusion for lactic acidosis, dialysis for renal failure). Monitor ABGs, potassium, and cardiac rhythm closely. Support airway and breathing; do not suppress the compensatory Kussmaul respirations. Administer IV fluids and prepare to give sodium bicarbonate only for severe acidosis per order.
What are the warning signs of Metabolic Acidosis a nurse must report?
Dysrhythmias from hyperkalemia - obtain ECG and notify provider immediately. Decreasing level of consciousness, profound hypotension, or pH below 7.20 - escalate urgently. During correction, watch for a sudden drop in potassium that can also cause dysrhythmias.
What do I need to know about Metabolic Acidosis for the NCLEX?
ABG pattern: low pH (under 7.35) with low HCO3 (under 22 mEq/L); the bicarbonate change drives the disorder. Respiratory compensation produces deep, rapid Kussmaul respirations to exhale CO2 and a low PaCO2. Neurologic signs include headache, confusion, drowsiness, and progression to lethargy and coma. Acidosis shifts potassium out of cells, so hyperkalemia is often present and causes cardiac dysrhythmias.
What patient teaching is important for Metabolic Acidosis?
Diabetic clients should monitor glucose and ketones and seek care for persistent high glucose or vomiting. Take chronic kidney disease medications and attend dialysis as prescribed. Report increasing fatigue, confusion, deep rapid breathing, or persistent diarrhea.
Quick Tip
ABG pattern: low pH (under 7.35) with low HCO3 (under 22 mEq/L); the bicarbonate change drives the disorder.
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