A 52-year-old woman is brought to the emergency department by her husband due to altered mental status and confusion. She has a history of type 2 diabetes mellitus and severe chronic osteoarthritis of the knees, for which she takes multiple over-the-counter analgesics. For the past three days, the patient has experienced severe nausea, tinnitus, and intractable nonbilious vomiting.
Vital signs show a temperature of 38.2°C (100.8°F), pulse of 118/min, blood pressure of 105/65 mm Hg, and respiratory rate of 26/min. Physical examination reveals dry mucous membranes, diffuse mild abdominal tenderness, and tachypnea with clear lungs bilaterally.
Laboratory results are as follows:
| Test | Result | Reference Range |
|---|---|---|
| Sodium | 142 mEq/L | 136-145 mEq/L |
| Potassium | 3.1 mEq/L | 3.5-5.0 mEq/L |
| Chloride | 92 mEq/L | 98-106 mEq/L |
| Bicarbonate | 14 mEq/L | 22-28 mEq/L |
| Blood urea nitrogen | 45 mg/dL | 7-18 mg/dL |
| Creatinine | 1.8 mg/dL | 0.6-1.2 mg/dL |
| Glucose | 110 mg/dL | 70-110 mg/dL |
| Albumin | 4.0 g/dL | 3.5-5.0 g/dL |
Arterial blood gas (room air):
| Test | Result | Reference Range |
|---|---|---|
| pH | 7.49 | 7.35-7.45 |
| PaCO2 | 19 mm Hg | 35-45 mm Hg |
| PaO2 | 95 mm Hg | 75-105 mm Hg |
Based on the provided laboratory data, which of the following best characterizes this patient's acid-base status?
- High anion gap metabolic acidosis, metabolic alkalosis, and respiratory alkalosisCevap
- BHigh anion gap metabolic acidosis and primary respiratory alkalosis
- CHigh anion gap metabolic acidosis and primary metabolic alkalosis
- DHigh anion gap metabolic acidosis with appropriate respiratory compensation
- EPrimary respiratory alkalosis with appropriate metabolic compensation