A male client with type 1 diabetes mellitus (DM) develops a gangrenous toe and is admitted for possible amputation. Which pathophysiological consequence of DM has contributed to this client's complication?

The ABG results indicate respiratory acidosis (pH 7.0, PaCO2 66 mmHg) with compensatory metabolic alkalosis (HCO3- 24 mEq/L). The low PaO2 (60 mmHg) suggests hypoxemia.

pH 7.0: The pH is below the normal range (7.35 to 7.45), indicating acidosis.

PaCO2 66 mmHg: The PaCO2 is elevated above the normal range (35 to 45 mmHg), indicating respiratory acidosis.

HCO3- 24 mEq/L: The bicarbonate level is within the normal range (21 to 28 mEq/L), indicating compensatory metabolic alkalosis.

PaO2 60 mmHg: The PaO2 is decreased below the normal range (80 to 100 mmHg), indicating hypoxemia.

These findings suggest that the client is experiencing respiratory failure, which is characterized by inadequate gas exchange resulting in hypoxemia and hypercapnia. In this case, the massive pulmonary embolus is causing ventilation-perfusion (V/Q) mismatch, leading to impaired gas exchange and respiratory compromise. Tachycardia, hypotension, and audible bilateral pulmonary crackles further support the diagnosis of respiratory failure in the context of a massive pulmonary embolus.

The client's symptoms, along with the elevated serum amylase and lipase levels, suggest the development of acute pancreatitis as a postoperative complication. Here's a detailed explanation for why option A is the correct choice:

A) Acute pancreatitis:

Correct. Acute pancreatitis is characterized by inflammation of the pancreas, which can be triggered by various factors, including gallstones, alcohol consumption, and certain medications. In this case, the client's recent cholecystectomy for cholelithiasis (gallstones) may have led to the development of acute pancreatitis. The persistent upper abdominal pain radiating to the back, along with vomiting and fever, are classic symptoms of acute pancreatitis. Elevated serum amylase and lipase levels are common laboratory findings in acute pancreatitis due to pancreatic cell injury and leakage of these enzymes into the bloodstream.

B) Surgical site infection:

While surgical site infections are potential complications of cholecystectomy, the client's symptoms, including upper abdominal pain, vomiting, and fever, are more indicative of a systemic inflammatory process rather than localized infection at the surgical site.

C) Hepatorenal failure:

Hepatorenal failure, also known as hepatorenal syndrome, refers to kidney dysfunction that occurs as a complication of advanced liver disease. The client's symptoms and laboratory findings are not consistent with hepatorenal failure, as there are no signs of significant liver dysfunction or advanced liver disease.

D) Biliary duct obstruction:

While biliary duct obstruction can lead to symptoms similar to those of acute pancreatitis, such as upper abdominal pain and vomiting, the presence of elevated serum amylase and lipase levels strongly suggests pancreatic involvement rather than isolated biliary duct obstruction.