The nurse is caring for a client with sepsis due to acute Clostridium difficile infection. Due to the higher than normal production of lactic acid, the nurse knows that which of the following is most likely to occur?

Metabolic acidosis

Explanation

• Metabolic acidosis from the formation of lactic acid causes an alteration in serum HCO3− and is common during sepsis. The client's pH will be expected to be low (acidosis) with a low HC03. 

• The PC02 will be normal only until respiratory compensation begins, at which time the lungs will begin to attempt to balance the pH by increasing respirations to blow off excess C02, which will lowers the PC02.

• Initial laboratory evaluation of acid-base disorders include ABG, serum electrolytes, and calculation of the anion gap.

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

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

Respiratory Alkalosis:
• Caused by excessive ventilation
• Decrease in PCO2, increase in pH
• Compensation - Kidneys excrete HCO3

Metabolic Alkalosis
• Acid (H+) loss from emesis, diuretics. Or retention of HCO3 from medications, hyperaldosteronism
• Increase in HCO3, Increase in pH
• Compensation - Respiratory centers are not stimulated, this leads to hypoventilation and CO2 retention.

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