Lena Mason, who has diabetes, is admitted in a stuporous condition. Her blood gases show a pH of 7.33, PaCO2 of 40 mm Hg, and HCO3- of 20 mEq/L. What type of acid-base imbalance does this patient have?

Choice A reason: This is correct because prolonged bed rest can cause hypocalcemia, or low serum calcium level. Calcium is stored in the bones and is released into the blood when the bones are stressed by weight-bearing activities. When a person is on bed rest, the bones are not stimulated and the calcium remains in the bones, leading to a decrease in serum calcium level.

Choice B reason: This is incorrect because too much butter consumption does not affect the serum calcium level directly. Butter is a source of fat and calories, which can affect the cholesterol and triglyceride levels, but not the calcium level. However, too much butter consumption can cause obesity, which can increase the risk of osteoporosis and fractures.

Choice C reason: This is incorrect because hyperparathyroidism can cause hypercalcemia, or high serum calcium level. Hyperparathyroidism is a condition where the parathyroid glands produce too much parathyroid hormone (PTH), which regulates the calcium and phosphorus balance in the body. PTH stimulates the release of calcium from the bones into the blood, leading to an increase in serum calcium level.

Choice D reason: This is incorrect because excessive ingestion of vitamin D can also cause hypercalcemia, or high serum calcium level. Vitamin D is a fat-soluble vitamin that helps the body absorb calcium from the food and supplements. When a person takes too much vitamin D, the calcium absorption is increased and the serum calcium level rises.

Choice A reason: Kidney function is not indicated by the PaCO2 level, but rather by the creatinine and blood urea nitrogen (BUN) levels. The kidneys are responsible for regulating the HCO3- level, which is the other component of the carbonic acid-bicarbonate buffer system.

Choice B reason: Bicarbonate buffers are not indicated by the PaCO2 level, but rather by the HCO3- level. Bicarbonate buffers are substances that can accept or donate hydrogen ions to maintain the pH of the blood. They are part of the carbonic acid-bicarbonate buffer system, which is the main buffer system in the body.

Choice C reason: Phosphate buffers are not indicated by the PaCO2 level, but rather by the PO4^3^- level. Phosphate buffers are substances that can accept or donate hydrogen ions to maintain the pH of the intracellular fluid and the urine. They are part of the phosphoric acid-phosphate buffer system, which is the second most important buffer system in the body.

Choice D reason: Lung ventilation is indicated by the PaCO2 level, which is the partial pressure of carbon dioxide in the blood. Lung ventilation is the process of moving air in and out of the lungs, which affects the amount of carbon dioxide exhaled. The lungs are responsible for regulating the PaCO2 level, which is the other component of the carbonic acid-bicarbonate buffer system.