一位病人正在經歷嚴重的嘔吐。護理師應警惕該病人可能發生哪種酸鹼失衡？
A nurse is caring for a client who is experiencing severe nausea and vomiting. Which acid-base imbalance is this client at risk for developing?
- ARespiratory Acidosis呼吸性酸中毒
- BMetabolic Acidosis代謝性酸中毒
- CMetabolic Alkalosis✓ 正解代謝性鹼中毒
- DRespiratory Alkalosis呼吸性鹼中毒
本題的核心概念是嚴重嘔吐（severe nausea and vomiting）對身體酸鹼平衡的影響。胃液中含有大量的鹽酸（hydrochloric acid, HCl），其主要成分是氫離子（H+）和氯離子（Cl-）。當病人因嚴重嘔吐而大量流失胃液時，體內的氫離子會大量減少。這種氫離子的流失會使得血漿中的碳酸氫鹽（bicarbonate, HCO3-）相對增多，導致血漿pH值升高，進而發展為代謝性鹼中毒（metabolic alkalosis）。護理師應警惕此種酸鹼失衡，因為它可能導致電解質紊亂和心律不整等併發症。
Severe vomiting leads to the loss of gastric hydrochloric acid, resulting in a decrease in hydrogen ions and a relative increase in serum bicarbonate. This metabolic shift causes metabolic alkalosis, whereas respiratory imbalances are related to ventilation issues and metabolic acidosis is often associated with conditions like diarrhea or renal failure.
在美國，ABG 判讀後護理師常依 Protocol 調整電解質；台灣則多由醫師下達具體醫囑。