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Difficulty: EasyPhysiological Adaptation

A nurse is caring for a client with type 1 diabetes mellitus in the emergency department. The client has a blood glucose level of 450 mg/dL, deep and rapid respirations, and a fruity breath odor. Which of the following acid-base imbalances is this client most likely experiencing?

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

Answer

Metabolic acidosis
The client's presentation of severe hyperglycemia, deep and rapid respirations (Kussmaul respirations), and a fruity breath odor are classic and unmistakable indicators of diabetic ketoacidosis (DKA). In DKA, a severe lack of insulin forces the body to break down fats for energy, a process that produces acidic ketone bodies. The subsequent accumulation of these ketones in the bloodstream directly results in metabolic acidosis. The observed Kussmaul respirations serve as a respiratory compensatory mechanism, attempting to decrease overall blood acidity by forcefully exhaling excess carbon dioxide.

Step-by-Step Solution

1
Analyze the client's clinical presentation.
The client has severe hyperglycemia (450 mg/dL), deep and rapid breathing known as Kussmaul respirations, and a fruity breath odor.
Identifying these classic clinical signs is necessary to determine the underlying pathophysiological process occurring in the client.
2
Correlate the assessment findings with a specific disease process.
These findings are the hallmark signs of diabetic ketoacidosis (DKA), a serious acute complication primarily associated with type 1 diabetes mellitus.
Recognizing DKA allows the nurse to anticipate the physiological effects on the body, particularly concerning acid-base balance.
3
Determine the resulting primary acid-base imbalance.
DKA involves the accelerated breakdown of fats into ketone bodies, which are strongly acidic. Their accumulation in the bloodstream leads to a state of metabolic acidosis.
Understanding the metabolic source of the acid accumulation confirms that the primary imbalance is metabolic, not respiratory, in origin.

Key Concept

Diabetic Ketoacidosis and Acid-Base Imbalance
Estimated Time:45s
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Topics

Physiological Adaptation

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