With which of the following clients should the nurse be prepared to administer bicarbonate intravenously?

Question

A. 25-year-old client with an acute asthma attack who has the following arterial blood gases: pH 7.28, HCO3– 22 mEq/L, PCO2 52 mm Hg, PO2 82 mm Hg
B. 25-year-old client with excessive diarrhea who has the following arterial blood gases: pH 7.28, HCO3– 16 mEq/L, PCO2 45 mm Hg, PO2 98 mm Hg
C. 65-year-old client with chronic emphysema and bronchitis who has the following arterial blood gases: pH 7.30, HCO3– 30 mEq/L, PCO2 60 mm Hg, PO2 72 mm Hg
D. 65-year-old client with a urinary tract infection and type 2 diabetes who has the following arterial blood gases: pH 7.31, HCO3– 20 mEq/L, PCO2 34 mm Hg, PO2 96 mm Hg

Answer 1

B
The only client who has lower than normal bicarbonate levels is the client with diarrhea. This deficit is most likely an actual bicarbonate loss and should be replaced to help return this client's acid-base balance back to normal. Giving bicarbonate to any of the other clients listed would be adding too much base and would risk pushing them into alkalosis.