A client manages peptic ulcer disease with excessive amount of oral antacids. The client is at risk for which acid-base imbalance?

Appeared in: DHS 2018 shift 1st

Explanation

Antacids are alkaline (basic) substances used to neutralize stomach acid.
Excessive ingestion of antacids, particularly absorbable ones like sodium bicarbonate, introduces a large amount of base into the bloodstream.
This leads to an increase in serum bicarbonate (HCO₃⁻) concentration and a rise in blood pH above the normal range (greater than 7.45).
This condition, characterized by a primary excess of bicarbonate, is defined as metabolic alkalosis.

Option A: Metabolic acidosis is caused by an accumulation of acid or a loss of base. Ingesting antacids (bases) does the opposite.
Option C: Respiratory acidosis is a primary respiratory problem caused by the lungs retaining too much carbon dioxide (CO₂), leading to an excess of carbonic acid. It is not caused by metabolic factors like ingesting medication.
Option D: Respiratory alkalosis is a primary respiratory problem caused by the lungs eliminating too much CO₂. The cause in the question is metabolic, not respiratory.

Clinical Relevance

Nursing practice connection: Use the key finding related to Acid-base imbalance caused by medication side effects to guide bedside assessment, documentation, and the next nursing action.
Nurses must educate patients on the correct dosage and frequency of over-the-counter antacids to prevent complications like metabolic alkalosis and milk-alkali syndrome.
It is crucial to monitor for signs of metabolic alkalosis (e.g., confusion, muscle twitching, tingling, slow breathing) in patients with high antacid intake or those receiving bicarbonate infusions.
What if? If the client had severe diarrhea instead of taking antacids, they would be at risk for metabolic acidosis due to the significant loss of bicarbonate-rich intestinal fluid.

How to Approach the Question

First, identify the key substance in the question: 'oral antacids'.
Recall the chemical nature of antacids: they are alkaline substances, or bases, used to neutralize acid.
Analyze the effect of 'excessive' intake. Ingesting too much of a base will increase the body's overall alkalinity.
Determine the type of imbalance. An excess of base causes 'alkalosis'. Since the cause is ingestion and absorption through the gut (a metabolic process), the imbalance is 'metabolic'.
Combine these parts to arrive at 'metabolic alkalosis'.
Eliminate the respiratory options because the primary problem is not with the lungs. Eliminate metabolic acidosis because that would be caused by a gain of acid or loss of base, which is the opposite of what is happening.

Concept Tested & Keywords

Concept Tested: Acid-base imbalance caused by medication side effects
Stem keywords: peptic ulcer disease, excessive amount, oral antacids, acid-base imbalance
Lead-in keywords: at risk for which

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E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 82-84

E6 Nursing Fundamentals Taylor p. 780-782

E6 Biochemistry U Satyanarayana— Part 2 (pp 421-820 of 840) p. 99-101

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.