Maria, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated-his eyes are sunken and mucous membranes are dry-and he has a two-week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, Pa02 90 mm Hg. PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L. K+ 5 mmol/L, and Cl-95 mmol/L.

What is your assessment?

Respiratory Acidosis, Partially Compensated

Metabolic Acidosis, Partially, Compensated

Metabolic Alkalosis. Uncompensated

Respiratory Acidosis, Uncompensated

Answer and Explanation

The Correct Answer is B

A.   This option can be ruled out because the pH and PaCO2 levels indicate acidosis, but the compensation is not partial as the HCO3 is also low.
B.   Maria's symptoms and the arterial blood gas values support this diagnosis. Metabolic acidosis is indicated by a low pH and a decreased bicarbonate (HCO3) level. The body attempts to compensate for this acidosis by hyperventilating, which is evidenced by her Kussmaul breathing, to decrease PaCO2. This compensation is partial because, despite the body's efforts, the pH is still significantly lower than normal.
C.   This option can be ruled out because the pH is low (acidosis) rather than high (alkalosis), and the HCO3 is low rather than high.
D.   Respiratory Acidosis, Uncompensated is ruled out because the pH is low (acidosis), but the PaCO2 is normal, indicating metabolic rather than respiratory involvement.

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Correct Answer is C

Explanation

A. Metabolic Acidosis, Uncompensated, is ruled out because the elevated PaCO2 and low pH indicate a respiratory problem rather than a metabolic one.
B. Respiratory Alkalosis. Partially Compensated is ruled out because the pH and PaCO2 levels are both abnormal and indicate acidosis rather than alkalosis.
C. The low pH (acidosis) along with the high PaCO2 indicate respiratory acidosis, and there is no evidence of compensation by the kidneys (normal HCO3).
D. Metabolic Alkalosis. Partially Compensated, is ruled out because the pH is low (acidosis) rather than high (alkalosis), and the PaCO2 is elevated, suggesting a respiratory problem rather than a metabolic one.

A. Respiratory Acidosis, Partially Compensated B. Respiratory Alkalosis, Uncompensated C. Metabolic Alkalosis. Uncompensated D. Metabolic Alkalosis. Partially Compensated

Correct Answer is B

Explanation

A. This is incorrect because the pH is indicative of alkalosis, not acidosis, and the body has not compensated.
B. The arterial blood gas (ABG) values provided indicate a pH of 7.6, which is above the normal range (7.35-7.45), suggesting alkalosis. The PaCO2 is low at 31 mm Hg, indicating hyperventilation, which is a respiratory process. Since the HCO3 is normal at 25 mmol/L, it suggests that the metabolic system is not the cause of the alkalosis. The body has not had time to compensate for the high pH with renal adjustments to the bicarbonate level, which would be seen in a partially compensated state.
C. This is incorrect because the bicarbonate level is normal, suggesting the metabolic system is not the cause.
D. This is incorrect because the bicarbonate level is normal, suggesting the metabolic system is not the cause.

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

Correct Answer is B

Explanation

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