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Difficulty: EasyPhysiological Adaptation

A nurse is caring for a client who was admitted to the medical unit with a 3-day history of severe, persistent diarrhea. Based on this clinical presentation, which acid-base imbalance is the client at greatest risk of developing?

  1. Metabolic acidosisAnswer
  2. B
    Metabolic alkalosis
  3. C
    Respiratory acidosis
  4. D
    Respiratory alkalosis

Answer

Metabolic acidosis
Intestinal fluids below the pyloric sphincter are highly alkaline because they are rich in bicarbonate. When a client experiences severe diarrhea, they lose excessive amounts of this base. The depletion of bicarbonate leaves a relative excess of hydrogen ions (acid) in the blood, causing the serum pH to drop and resulting in metabolic acidosis.

Step-by-Step Solution

1
Identify the primary source and type of fluid loss.
The client has severe diarrhea, meaning they are losing large amounts of lower gastrointestinal fluids.
Different bodily fluids have different pH levels, so the source of the fluid loss determines the resulting acid-base imbalance.
2
Determine the primary solute lost in diarrhea.
Lower intestinal fluids are highly alkaline because they contain large amounts of bicarbonate.
The pancreas secretes bicarbonate into the intestines to neutralize stomach acid.
3
Correlate the solute loss to the corresponding acid-base imbalance.
Loss of a base (bicarbonate) leads to an increasingly acidic environment in the blood, resulting in metabolic acidosis.
When bicarbonate levels drop, the ratio of acid to base increases, lowering the serum pH.

Key Concept

Acid-base imbalances related to gastrointestinal fluid loss
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Topics

Physiological Adaptation

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