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Tony Montana, an international businessman, 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, PaC02 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and C- 95 mmol/L. What is your assessment?

A.

Respiratory Acidosis, Uncompensated.

B.

Respiratory Acidosis, with Partial Compensation.

C.

Metabolic Alkalosis, with Partial Compensation.

D.

Metabolic Acidosis, with Partial Compensation.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Uncompensated respiratory acidosis would display a low pH (normal 7.35-7.45) and an elevated PaCO2 (normal 35-45 mmHg), with the bicarbonate (normal 22-26 mEq/L) remaining within the normal range. This patient's PaCO2 is low, and the primary issue is metabolic, not respiratory.

Choice B rationale

Partially compensated respiratory acidosis would show a low pH (normal 7.35-7.45), an elevated PaCO2 (normal 35-45 mmHg), and an elevated bicarbonate (normal 22-26 mEq/L). This patient's PaCO2 is low, and the bicarbonate is significantly low, indicating a metabolic origin.

Choice C rationale

Metabolic alkalosis is characterized by an elevated pH (normal 7.35-7.45) and an elevated bicarbonate level (normal 22-26 mEq/L). This patient has a significantly low pH and bicarbonate, directly contradicting the parameters of metabolic alkalosis.

Choice D rationale

The patient's pH of 7.0 is highly acidic (normal 7.35-7.45). The bicarbonate level of 12 mmol/L is significantly low (normal 22-26 mEq/L), indicating a primary metabolic acidosis. The PaCO2 of 23 mm Hg is low (normal 35-45 mmHg), demonstrating respiratory compensation through Kussmaul breathing. The pH is still acidic, showing partial compensation.


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Related Questions

Correct Answer is C

Explanation

Choice A rationale

Intubation into the cranial vault is anatomically impossible during standard endotracheal intubation. The tube is designed to pass through the oral or nasal pharynx, larynx, and vocal cords into the trachea. The cranial vault is a completely separate anatomical structure, superior to the airway, protected by the skull, and has no direct communication with the respiratory tract for tube misplacement.

Choice B rationale

While left mainstem bronchus intubation can occur, it is less common than right mainstem intubation. The left mainstem bronchus branches at a more acute angle from the trachea compared to the right, making it less likely for an endotracheal tube, which typically follows a straighter path, to inadvertently enter. This anatomical difference reduces the incidence of left-sided misplacement.

Choice C rationale

The right mainstem bronchus branches off the trachea at a less acute angle and is a more direct continuation of the tracheal lumen compared to the left mainstem bronchus. This anatomical alignment makes it the most common site for inadvertent endotracheal tube misplacement, leading to ventilation of only the right lung and potential collapse of the left lung.

Choice D rationale

Duodenal intubation is an anatomical impossibility for an endotracheal tube. The duodenum is part of the gastrointestinal tract, located inferior to the stomach, and has no direct anatomical connection with the respiratory system. Endotracheal intubation is specifically designed for airway management, not gastrointestinal access.

Correct Answer is B

Explanation

Choice A rationale

Uncompensated respiratory acidosis would exhibit a low pH (normal range 7.35-7.45) and an elevated PaCO2 (normal range 35-45 mmHg), with a bicarbonate level (normal range 22-26 mEq/L) that remains within the normal range. In this scenario, the bicarbonate is elevated, indicating a renal compensatory response has begun.

Choice B rationale

The patient's pH of 7.3 indicates acidosis (normal 7.35-7.45). The PaCO2 of 68 mmHg is elevated (normal 35-45 mmHg), indicating a respiratory origin. The HCO3 of 28 mmol/L is elevated (normal 22-26 mEq/L), signifying that the kidneys are attempting to compensate by retaining bicarbonate. Since the pH is still acidic, but the bicarbonate is responding, it is partially compensated respiratory acidosis.

Choice C rationale

Metabolic acidosis is characterized by a low pH (normal 7.35-7.45) and a low bicarbonate level (normal 22-26 mEq/L). The PaCO2 (normal 35-45 mmHg) would either be normal if uncompensated or low if the respiratory system was compensating. Here, the primary disturbance is respiratory.

Choice D rationale

Metabolic alkalosis presents with an elevated pH (normal 7.35-7.45) and an elevated bicarbonate level (normal 22-26 mEq/L). The PaCO2 (normal 35-45 mmHg) would be normal if uncompensated or elevated if the respiratory system was compensating. This patient's pH is acidic, ruling out alkalosis.

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