When caring for a client with metabolic alkalosis, which clinical manifestation should the nurse specifically monitor?

Monitoring for bicarbonate excess is crucial when caring for a client with metabolic alkalosis. In this condition, the body experiences an increased pH due to elevated levels of bicarbonate or a significant loss of hydrogen ions. This alteration in acid-base balance can lead to symptoms such as tetany, muscle twitching, and in severe cases, cardiac arrhythmias. By specifically monitoring for bicarbonate excess, the nurse can assess the severity of the alkalosis and the effectiveness of interventions aimed at restoring normal acid-base balance.

In metabolic alkalosis, it's not typical to see decreased bicarbonate, as the condition is characterized by increased bicarbonate levels. While volume overload could potentially occur in the context of fluid management, it is not a primary clinical manifestation directly related to metabolic alkalosis itself. Thus, monitoring for bicarbonate levels remains a primary focus in managing and understanding metabolic alkalosis. Severe fatigue might be a symptom experienced by the client, but it is not as directly indicative of the underlying metabolic derangement as monitoring bicarbonate levels would be.