Metabolic Acidosis Nursing Care Plan


Metabolic acidosis (primary base bicarbonate [HCO3] deficiency) reflects an excess of acid (hydrogen) and a deficit of base (bicarbonate) resulting from acid overproduction, loss of intestinal bicarbonate, inadequate conservation of bicarbonate, and excretion of acid, or anaerobic metabolism.

Nursing Care Plan

Here are general interventions for patients with metabolic acidosis.

Desired Outcomes

  • Display serum bicarbonate and electrolytes within normal limits (WNL).
  • Be free of symptoms of imbalance, e.g., absence of neurological impairment; vital signs WNL.
Nursing InterventionsRationale
Monitor BP.Arteriolar dilation or decreased cardiac contractility and hypovolemia occur, resulting in systemic shock, evidenced by hypotension and tissue hypoxia.
Assess LOC and note progressive changes in neuromuscular status. Note neuromuscular strength, tone, movement.Decreased mental function, confusion, seizures, weakness, flaccid paralysis can occur because of hypoxia, hyperkalemia, and decreased pH of CNS fluid.
Provide seizure or coma precautions and bed in low position, use of side rails, frequent observation.Protects patient from injury resulting from decreased mentation and convulsions.
Monitor heart rate and rhythm.Acidemia may be manifested by changes in ECG configuration and presence of brady dysrhythmias as well as increased ventricular irritability such as fibrillation (signs of hyperkalemia). Life-threatening cardiovascular collapse may also occur because of vasodilation and decreased cardiac contractility. Note: Hypokalemia can occur as acidosis is corrected, resulting in premature ventricular contractions (PVCs) and/or ventricular tachycardia.
Observe for altered respiratory excursion, rate, and depth.Deep, rapid respirations (Kussmaul’s) may be noted as a compensatory mechanism to eliminate excess acid; however, as potassium shifts out of cell in an attempt to correct acidosis, respirations may become depressed. Transient respiratory depression may be the result of overcorrection of metabolic acidosis with sodium bicarbonate.
Assess skin temperature, color, capillary refill.Evaluates circulatory status, tissue perfusion, effects of hypotension.
Auscultate bowel sounds, measure abdominal girth as indicated.In the presence of coexisting hyperkalemia, GI distress (distension, diarrhea, and colic) may occur.
Monitor I&O closely and weigh daily.Marked dehydration may be present because of vomiting, diarrhea. Therapy needs are based on underlying cause and fluid balance.
Test and monitor urine pH.Kidneys attempt to compensate for acidosis by excreting excess hydrogen in the form of weak acids and ammonia. Maximum urine acidity is pH of 4.0.
Provide oral hygiene with sodium bicarbonate washes, lemon, glycerine swabs.Neutralizes mouth acids and provides protective lubrication.
Assist with identification and treatment of underlying cause.Treatment of disorder is directed at mild correction of acidosis until organ(s) function is improved. Addressing the primary condition (DKA, liver or renal failure, drug poisoning, sepsis) promotes correction of the acid-base disorder.
Monitor and graph serial ABGs.Evaluates therapy needs and effectiveness. Blood bicarbonate and pH should slowly increase toward normal levels.
Monitor serum electrolytes, especially potassium.As acidosis is corrected, serum potassium deficit may occur as potassium shifts back into the cells.
Replace fluids, as indicated depending on underlying etiology: D5W/saline solutions.Choice of solution varies with cause of acidosis: DKA. Note: Lactate-containing solutions may be contraindicated in the presence of lactic acidosis.
Administer medications as indicated: 
Sodium bicarbonate or lactate or saline IVCorrects bicarbonate deficit, but is used cautiously to correct severe acidosis (pH less than 7.2) because sodium bicarbonate can cause rebound metabolic alkalosis.
Potassium chlorideMay be required as potassium re-enters the cell, causing a serum deficit.
PhosphateMay be administered to enhance acid excretion in presence of chronic acidosis with hypo phosphatemia.
CalciumMay be given to improve neuromuscular conduction and function.
Modify diet as indicated: low-protein, high-carbohydrate diet in presence of renal failure or American Diabetes Association (ADA) diet for the person with diabetes.Restriction of protein may be necessary to decrease production of acid waste products, whereas addition of complex carbohydrates will correct acid production from the metabolism of fats.
Administer exchange resins and/or assist with dialysis as indicated.May be desired to reduce acidosis by decreasing excess potassium and acid waste products if pH less than 7.1 and other therapies are ineffective or HF develops.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.


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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

Other nursing care plans related to endocrine system and metabolism disorders:


Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

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