A 42-year-old woman with poorly controlled type 2 diabetes mellitus presents to the emergency department with a 2-day history of polyuria, polydipsia, and progressive dyspnea. She reports fruity-smelling breath and denies fever or recent infections. On examination, she is alert but drowsy, breathing deeply and rapidly. Vital signs: BP 98/62 mmHg, HR 118 bpm, RR 28 breaths/min, temperature 37.2°C, SpO2 94% on room air. Arterial blood gas reveals pH 7.24, PCO2 22 mmHg, HCO3− 9 mEq/L. Serum glucose 487 mg/dL, serum β-hydroxybutyrate elevated, serum osmolality 318 mOsm/kg. Urinalysis shows 3+ glucose and 3+ ketones. Which of the following best describes the primary acid-base disturbance and respiratory response?
- A)Metabolic acidosis with inadequate respiratory compensation (PCO2 too high)
- B)Respiratory acidosis with metabolic compensation
- C)Mixed metabolic and respiratory acidosis
- D)Metabolic alkalosis with compensatory hyperventilation
- E)Metabolic acidosis with appropriate respiratory compensationGABARITO
Explicação
This patient has diabetic ketoacidosis (DKA) causing metabolic acidosis (pH 7.24, HCO3− 9). The respiratory system is appropriately compensating with hyperventilation (RR 28, PCO2 22). Using Winter's formula, expected PCO2 = 1.5 × HCO3− + (23 ± 2) = 1.5(9) + 2... Ver explicação completa e trilha adaptativa →