Metabolic Alkalosis — NCLEX Cheat Sheet
↑ pH, ↑ HCO₃⁻Also known as: alkalosis · high pH · high bicarb · alkaline blood
Use this quick-reference guide to spot, treat, and prevent Metabolic Alkalosis on the NCLEX. Keep it handy during review and on exam day!
🩺📒 The 1-minute cheat sheet
🧪 Labs
- pH > 7.45, HCO₃ > 26
- Lungs retain CO₂ (slow/shallow)
🩺 Signs
- ↓ K → cramps, weakness
- Tetany, tingling, tremor
- Dizzy, confusion, ↑ DTRs
🚩 Report
- Dysrhythmias from ↓ K
- Seizures, tetany
⚠️ Causes
- Vomiting, NG suction
- Antacids, diuretics, ↓ K
📚 Metabolic Alkalosis — 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: high pH (over 7.45) with high HCO3 (over 26 mEq/L); the bicarbonate change drives the disorder.
- Respiratory compensation causes slow, shallow breathing to retain CO2, raising PaCO2.
- Increased neuromuscular excitability produces tingling of fingers and toes, muscle cramps, tremors, hyperactive reflexes, and tetany.
- Hypokalemia commonly accompanies metabolic alkalosis and worsens dysrhythmia risk.
- Neurologic signs include dizziness, confusion, irritability, and possible seizures.
- Vomiting and gastric suctioning are the most common causes due to loss of hydrochloric acid.
Nursing priorities
What to do, in order- Treat the cause: control vomiting, manage NG suction, and review diuretic and antacid use.
- Replace fluids with isotonic saline and replace potassium as ordered.
- Monitor ABGs, electrolytes (especially potassium and calcium), and cardiac rhythm.
- Institute safety and seizure precautions for clients with tetany or altered mental status.
- Monitor respiratory status, since compensatory hypoventilation can lower oxygenation.
Red flags — report now
Escalate immediately- Tetany, seizures, or dysrhythmias - notify provider immediately.
- Severe hypokalemia with ECG changes - report and treat urgently.
- pH above 7.55 with neuromuscular instability - escalate.
Labs & values
Numbers to know- pH normal 7.35-7.45; metabolic alkalosis pH greater than 7.45
- HCO3 normal 22-26 mEq/L; increased (over 26) in metabolic alkalosis
- PaCO2 normal 35-45 mmHg; increased with respiratory compensation; check potassium
Patient teaching
What patients must know- Do not overuse antacids or baking soda for stomach upset.
- Use diuretics exactly as prescribed and keep follow-up labs.
- Report persistent vomiting, muscle cramps, tingling, or palpitations.
❓ Metabolic Alkalosis: NCLEX FAQs
What are the priority nursing interventions for Metabolic Alkalosis?
Treat the cause: control vomiting, manage NG suction, and review diuretic and antacid use. Replace fluids with isotonic saline and replace potassium as ordered. Monitor ABGs, electrolytes (especially potassium and calcium), and cardiac rhythm. Institute safety and seizure precautions for clients with tetany or altered mental status.
What are the warning signs of Metabolic Alkalosis a nurse must report?
Tetany, seizures, or dysrhythmias - notify provider immediately. Severe hypokalemia with ECG changes - report and treat urgently. pH above 7.55 with neuromuscular instability - escalate.
What do I need to know about Metabolic Alkalosis for the NCLEX?
ABG pattern: high pH (over 7.45) with high HCO3 (over 26 mEq/L); the bicarbonate change drives the disorder. Respiratory compensation causes slow, shallow breathing to retain CO2, raising PaCO2. Increased neuromuscular excitability produces tingling of fingers and toes, muscle cramps, tremors, hyperactive reflexes, and tetany. Hypokalemia commonly accompanies metabolic alkalosis and worsens dysrhythmia risk.
What patient teaching is important for Metabolic Alkalosis?
Do not overuse antacids or baking soda for stomach upset. Use diuretics exactly as prescribed and keep follow-up labs. Report persistent vomiting, muscle cramps, tingling, or palpitations.
Quick Tip
ABG pattern: high pH (over 7.45) with high HCO3 (over 26 mEq/L); the bicarbonate change drives the disorder.
📖 Related Topics
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