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Difficulty: EasyPhysiological Adaptation

A client admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD) has the following arterial blood gas (ABG) results: pH 7.26, PaCO₂ 58 mm Hg, and HCO₃⁻ 24 mEq/L. Based on these physiological values, which acid-base imbalance is the client experiencing?

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

Answer

Uncompensated respiratory acidosis
The client is experiencing uncompensated respiratory acidosis. The pH is 7.26, which is below the normal range (7.35-7.45) and indicates acidemia. The PaCO2 is 58 mm Hg, which is above the normal range (35-45 mm Hg) and acts as an acid, identifying the respiratory system as the source of the acidosis. The HCO3- is 24 mEq/L, which falls within the normal range (22-26 mEq/L), indicating that the kidneys have not yet initiated compensation by retaining bicarbonate.

Step-by-Step Solution

1
Analyze the pH value.
The pH is 7.26 (normal is 7.35 to 7.45). Since it is below 7.35, the primary imbalance is acidosis.
Determining the pH establishes whether the overall state is acidotic or alkalotic.
2
Analyze the PaCO2 value.
The PaCO2 is 58 mm Hg (normal is 35 to 45 mm Hg). Because it is elevated and goes in the opposite direction of the pH, the cause is respiratory.
PaCO2 represents the respiratory component. An elevated PaCO2 causes acidosis.
3
Analyze the HCO3- value.
The HCO3- is 24 mEq/L (normal is 22 to 26 mEq/L). Since it is within the normal range, no metabolic compensation is occurring.
HCO3- represents the metabolic (renal) component. A normal value indicates the kidneys have not compensated for the respiratory problem.

Key Concept

Arterial Blood Gas (ABG) Interpretation
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Topics

Physiological Adaptation

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