Question

A client with renal failure enters the emergency room after skipping three dialysis treatments to visit family out of town. Which set of ABGs would indicate to the nurse that the client is in a state of metabolic acidosis?

1.      PH of 7.43, PCO2 of 36, HCO3 of 26
2.      PH of 7.41, PCO2 of 49, HCO3 of 30
3.      PH of 7.33, PCO2 of 35, HCO3 of 17
4.      PH of 7.25, PCO2 of 56, HCO3 of 28

Answer 1

METABOLIC ACIDOSIS- when pH of blood is less then 7.40

IN COMPENSATION

pCO₂ = 1.5[ p HCO₃ ] + 8

--------> 1.5 * 17 +8

----->25.5 +8

------------> 33.5

AS ANSWER IS OPTION C

    PH of 7.33, PCO2 of 35, HCO3 of 17

in chronic kidney disease ,

impaired ammonia excretion, reduced tubulat bicarbonate absorbtion,insufficient renal bicarbonate present as compared to presence of acid synthesis by body

other cause of acidosis

• more loss of bicarbonate from GI
• medication
• increase loss of bicarbonate from kidney
• decrease renal acid excretions