The ED nurse is caring for a client with type 1 diabetes who was brought in by ambulance after losing consciousness. Upon assessment, the client's breath was noted to be fruity. Which of the following ABG results would the nurse expect?

pH: 7.28, PCO2: 40, HCO3: 16


• This patient is in Diabetic ketoacidosis, as evidenced by the low pH (acidosis) and the low HCO3. Bicarb is used to compensate for the build-up of beta-hydroxybutyric and acetoacetic acids/ketoacids caused by the DKA.   

• The PCO2 will be high (if uncompensated) or low (if the lungs are compensating with classic Kussmaul respirations to blow off CO2).

• This finding is also supported by the history of type 1 diabetes, the fact the client was found unconscious, and the fruity breath.

Metabolic Acidosis:
• Caused by loss of bicarb or a buildup of acids (lactic acidosis, diarrhea, renal failure, ketones, or ammonium intoxication), not caused by respiration.
• HCO3 decreases, pH decreases
• Compensation- hyperventilation to eliminate CO2

Respiratory Acidosis:
• Respiratory system is the cause
• Increase in PCO2, decrease in pH
• Compensation- kidneys reabsorb Bicarb (HCO3)

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