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Difficulty: EasyPhysiological Adaptation

A client presents to the emergency department experiencing an acute panic attack with a respiratory rate of 38 breaths per minute. The client reports lightheadedness and tingling in the extremities. Arterial blood gas (ABG) analysis reveals a pH of 7.52, a PaCO2 of 26 mm Hg, and an HCO3- of 24 mEq/L. Based on these findings, which acid-base imbalance is occurring?

  1. Uncompensated respiratory alkalosisAnswer
  2. B
    Uncompensated respiratory acidosis
  3. C
    Uncompensated metabolic alkalosis
  4. D
    Partially compensated respiratory alkalosis

Answer

The client is experiencing uncompensated respiratory alkalosis.
The client is hyperventilating due to a panic attack, leading to excessive exhalation of carbon dioxide. The arterial blood gas results confirm this: the elevated pH (7.52) defines alkalosis, and the decreased PaCO2 (26 mm Hg) identifies the respiratory system as the cause. Because the bicarbonate (HCO3-) remains within the normal range of 22-26 mEq/L, the kidneys have not yet begun to compensate for the imbalance, making it uncompensated.

Step-by-Step Solution

1
Analyze the pH to determine the primary acid-base state.
The pH is 7.52.
Normal pH is 7.35 to 7.45. A pH of 7.52 is elevated, indicating an alkalotic state.
2
Evaluate the PaCO2 to determine if there is a respiratory component.
The PaCO2 is 26 mm Hg.
Normal PaCO2 is 35 to 45 mm Hg. A value of 26 mm Hg is low (hypocapnia). Because CO2 acts as an acid, a low PaCO2 causes alkalosis, which matches the pH.
3
Evaluate the HCO3- to determine metabolic involvement or compensation.
The HCO3- is 24 mEq/L.
Normal HCO3- is 22 to 26 mEq/L. A value of 24 mEq/L is normal, indicating no primary metabolic issue and no renal compensation occurring yet.
4
Combine the findings to classify the imbalance.
Uncompensated respiratory alkalosis.
The matching pH and PaCO2 define the primary respiratory alkalosis, and the normal HCO3- confirms it is uncompensated.

Key Concept

Arterial Blood Gas (ABG) Interpretation
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Topics

Physiological Adaptation

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