Question

Difficulty: MediumPhysiological Adaptation

A nurse is evaluating a client who was recently admitted with a diagnosis of diabetic ketoacidosis (DKA). The nurse draws an arterial blood gas (ABG) sample to assess the client's acid-base balance. Which of the following ABG findings are consistent with the primary acid-base disturbance and the expected physiological compensation for this condition? Select all that apply.

  1. Arterial pH of 7.287.28Answer
  2. Bicarbonate (HCO3−HCO_3^-) level of 1414 mEq/LAnswer
  3. Partial pressure of carbon dioxide (PaCO2PaCO_2) of 2828 mm HgAnswer
  4. D
    Arterial pH of 7.467.46
  5. E
    Partial pressure of carbon dioxide (PaCO2PaCO_2) of 4848 mm Hg

Answer

The expected findings include an arterial pH of 7.28, a bicarbonate level of 14 mEq/L, and a PaCO2 of 28 mm Hg.
The correct findings represent a state of partially compensated metabolic acidosis, which is expected in diabetic ketoacidosis. The accumulation of ketoacids decreases the arterial pH (acidemia) and consumes bicarbonate, resulting in a low bicarbonate level. The body adapts to this metabolic acidosis via respiratory compensation. The lungs attempt to blow off excess acid in the form of carbon dioxide through deep, rapid breathing (Kussmaul respirations). This compensatory hyperventilation lowers the partial pressure of carbon dioxide below the normal range of 35-45 mm Hg.

Step-by-Step Solution

1
Identify the primary acid-base disturbance caused by diabetic ketoacidosis.
The primary disturbance is metabolic acidosis.
The accumulation of ketones (acids) in the bloodstream lowers the blood pH and depletes bicarbonate buffers.
2
Determine the expected ABG values for metabolic acidosis.
An arterial pH less than 7.35 and a bicarbonate level less than 22 mEq/L.
Normal arterial pH ranges from 7.35 to 7.45, and normal bicarbonate ranges from 22 to 26 mEq/L. Both values are decreased in metabolic acidosis.
3
Identify the body's compensatory mechanism for metabolic acidosis.
The respiratory system compensates by increasing the rate and depth of breathing (Kussmaul respirations).
Hyperventilation helps blow off excess acid in the form of carbon dioxide.
4
Determine the expected ABG value resulting from the compensatory mechanism.
A partial pressure of carbon dioxide (PaCO2) less than 35 mm Hg.
Normal PaCO2 is 35 to 45 mm Hg. Hyperventilation effectively lowers this value to reduce the overall acidic load in the blood.

Key Concept

Diabetic ketoacidosis leads to metabolic acidosis with compensatory respiratory alkalosis.
Estimated Time:1m 30s
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