The nurse is triaging a client with type 1 diabetes mellitus who presented to the emergency department with increased lethargy and Kussmaul respirations. A blood glucose test reveals a level of 525 mg/dL (28 mmol/L). Which laboratory results are consistent with diabetic ketoacidosis (DKA)?

Reference Ranges

Blood Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)]

pH [7.35 to 7.45]

HCO3- [21 to 28 mEq/L (21 to 28 mmol/L)]

Arterial blood pH 7.5 and bicarbonate level 32 mEq/L (32 mmol/L).

Arterial blood pH 7.42 and bicarbonate level 18 mEq/L (18 mmol/L).

Arterial blood pH 7.25 and bicarbonate level 10 mEq/L (10 mmol/L).

Arterial blood pH 7.38 and bicarbonate level 29 mEq/L (29 mmol/L).

Answer and Explanation

The Correct Answer is C

DKA is a serious complication of diabetes mellitus characterized by hyperglycemia, ketosis, and metabolic acidosis. The laboratory results consistent with DKA include:

Elevated blood glucose level: A blood glucose level of 525 mg/dL (28 mmol/L) is significantly elevated and consistent with DKA.

Low arterial blood pH: A decreased arterial blood pH indicates acidosis, which is characteristic of DKA. Normal arterial blood pH ranges from 7.35 to 7.45.

Low bicarbonate (HCO3-) level: A low bicarbonate level indicates metabolic acidosis, which is also characteristic of DKA. Normal bicarbonate levels range from 21 to 28 mEq/L (21 to 28 mmol/L).

Among the options provided:

A) Arterial blood pH 7.5 and bicarbonate level 32 mEq/L (32 mmol/L):

This pH and bicarbonate level are indicative of alkalosis, which is not consistent with DKA.

B) Arterial blood pH 7.42 and bicarbonate level 18 mEq/L (18 mmol/L):

This pH is within the normal range, and the bicarbonate level is slightly decreased but not indicative of metabolic acidosis consistent with DKA.

C) Arterial blood pH 7.25 and bicarbonate level 10 mEq/L (10 mmol/L):

Correct. This pH is decreased, indicating acidosis, and the bicarbonate level is significantly below the normal range, consistent with metabolic acidosis characteristic of DKA.

D) Arterial blood pH 7.38 and bicarbonate level 29 mEq/L (29 mmol/L):

While the pH is within the normal range, the bicarbonate level is elevated, which is not consistent with metabolic acidosis seen in DKA.

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Correct Answer is C

Explanation

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.

A. Chronic kidney disease. B. Diabetic retinopathy. C. Peripheral neuropathy. D. Hypertension.

Correct Answer is C

Explanation

A. Chronic kidney disease:

Chronic kidney disease (CKD) is a complication of diabetes mellitus (DM), but it typically develops over time due to long-standing hyperglycemia and its effects on the kidneys. While CKD can lead to various complications such as electrolyte imbalances and cardiovascular disease, it is not directly associated with the development of gangrenous toes.

B. Diabetic retinopathy:

Diabetic retinopathy is a complication of diabetes that affects the eyes, specifically the retina. It results from damage to the blood vessels in the retina due to prolonged hyperglycemia. While diabetic retinopathy can lead to vision impairment and blindness if left untreated, it is not directly associated with the development of gangrenous toes.

C. Peripheral neuropathy:

Peripheral neuropathy is a common complication of diabetes that results from damage to the peripheral nerves due to prolonged hyperglycemia. It can lead to sensory, motor, and autonomic nerve dysfunction. Peripheral neuropathy contributes to the development of complications such as diabetic foot ulcers and Charcot arthropathy, which can ultimately lead to gangrene if not properly managed.

D. Hypertension:

Hypertension, or high blood pressure, is a common comorbidity in individuals with diabetes mellitus. While hypertension can exacerbate complications such as diabetic nephropathy and cardiovascular disease, it is not directly associated with the development of gangrenous toes.

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