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Difficulty: EasyPhysiological Adaptation

A young adult client with type 1 diabetes mellitus is admitted to the emergency department with a blood glucose level of 450 mg/dL. The nurse suspects the client is experiencing diabetic ketoacidosis (DKA). Which assessment findings and laboratory values should the nurse expect? Select all that apply.

  1. Arterial blood pH of 7.28Answer
  2. Deep, rapid respiratory patternAnswer
  3. Serum bicarbonate (HCO3-) of 14 mEq/LAnswer
  4. D
    Arterial blood pH of 7.45
  5. E
    Serum bicarbonate (HCO3-) of 28 mEq/L

Answer

The expected findings are an arterial blood pH of 7.28, a deep, rapid respiratory pattern, and a serum bicarbonate (HCO3-) of 14 mEq/L.
Diabetic ketoacidosis (DKA) produces an excess of acidic ketone bodies, leading to a primary metabolic acidosis. This is confirmed by an arterial blood pH below 7.35 and a serum bicarbonate (HCO3-) level below 22 mEq/L. To compensate for the severe acid load, the respiratory center is stimulated to increase the depth and rate of breathing (known as Kussmaul respirations) to expel carbon dioxide, which acts as an acid in the body.

Step-by-Step Solution

1
Identify the underlying pathophysiology of diabetic ketoacidosis (DKA).
DKA occurs when insulin deficiency leads to the breakdown of fat for energy, producing acidic ketone bodies.
Understanding the mechanism of DKA is essential to predict the resulting systemic acid-base imbalance.
2
Determine the primary acid-base imbalance caused by ketone accumulation.
The excess acid depletes base buffers, resulting in metabolic acidosis (low pH and low bicarbonate).
This directly identifies which laboratory values are expected in the client's arterial blood gas results.
3
Evaluate the body's compensatory mechanisms for this imbalance.
The respiratory system compensates for metabolic acidosis by increasing the rate and depth of respirations (Kussmaul breathing) to blow off carbon dioxide.
Correlating lab values with physical assessment findings provides a complete clinical picture.

Key Concept

Metabolic acidosis and compensatory mechanisms in Diabetic Ketoacidosis (DKA)
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Physiological Adaptation

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