A patient, diagnosed with sepsis and multiple organ dysfunction syndrome, has developed acute renal failure. Which arterial blood gas (ABG) result would the nurse expect to find?
1. pH = 7.35, PaCO2 = 45, HCO3 = 24, PaO2 = 70
2. pH = 7.46, PaCO2 = 42, HCO3 = 28, PaO2 = 80
3. pH = 7.30, PaCO2 = 38, HCO3 = 16, PaO2 = 60
4. pH = 7.50, PaCO2 = 30, HCO3 = 26, PaO2 = 90
3
Rationale: The choice pH = 7.30, PaCO2 = 38, HCO3 = 16, and PaO2 = 60 metabolic acidosis is correct because of anaerobic metabolism due to hypoxia and an increase in lactic acid and the kidney's inability to excrete hydrogen ions. In acute renal failure metabolic acidosis can be caused by loss of bicarbonate. The choice pH = 7.35, PaCO2 = 45, HCO3 = 24, PaO2 = 70 is incorrect; it is a normal ABG. The choice pH = 7.46, PaCO2 = 42, HCO3 = 28, PaO2 = 80 is incorrect because it is metabolic alkalosis. The choice pH = 7.50, PaCO2 = 30, HCO3 = 26, PaO2 = 90 is incorrect because respiratory alkalosis can be found initially when patient is hyperventilating or adjustments to the ventilator need to be made but not in an acute renal failure.
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