A client with a history of Diabetes Mellitus recently has ketone bodies in urine, a blood glucose level of 720 mg/dl, and a CO2 level of 39. A nurse knows that this is a classical finding of?

Appeared in: AIIMS Delhi NO - 2018

Explanation

The combination of severe hyperglycemia (>250 mg/dL), ketonuria, and a history of diabetes are the classic triad for Diabetic Ketoacidosis (DKA).
DKA results from a profound insulin deficiency, which leads to the breakdown of fats for energy.
This fat metabolism produces acidic byproducts called ketones (acetoacetic acid and β-hydroxybutyric acid).
The accumulation of these acids in the blood overwhelms the body's buffering systems, leading to a decrease in blood pH, which is defined as metabolic acidosis.

Option B: Metabolic alkalosis is characterized by an excess of bicarbonate (base) or a loss of acid, leading to a high blood pH. This is the opposite of the acidic state seen in DKA.
Option C: Respiratory acidosis is caused by the lungs' inability to remove enough carbon dioxide (CO₂), a condition known as hypoventilation. The primary problem is respiratory, not metabolic.
Option D: Respiratory alkalosis is caused by excessive breathing (hyperventilation), leading to too much CO₂ being blown off. While patients with DKA do hyperventilate (Kussmaul's respirations), this is a compensatory mechanism for metabolic acidosis, not the primary problem.

Clinical Relevance

Nursing practice connection: Use the key finding related to Acid-Base Imbalance in Diabetic Ketoacidosis (DKA) to guide bedside assessment, documentation, and the next nursing action.
Recognizing the signs of DKA (hyperglycemia, ketosis, acidosis) is a critical nursing skill, as it is a life-threatening emergency.
Immediate nursing interventions for DKA include administering IV fluids to correct dehydration, starting an insulin infusion to lower blood glucose and stop ketone production, and carefully monitoring and replacing electrolytes, especially potassium.
What if? If the patient's primary symptom was severe vomiting for two days with a normal blood glucose, the nurse should suspect metabolic alkalosis due to the loss of gastric acid, not DKA.

How to Approach the Question

First, identify the key clinical data: a history of Diabetes Mellitus, extremely high blood glucose (720 mg/dl), and ketones in the urine.
Recognize this classic triad as the hallmark of Diabetic Ketoacidosis (DKA).
Recall the pathophysiology of DKA: the 'K' stands for 'Keto,' and the 'A' stands for 'Acidosis.' The condition is caused by the buildup of acidic ketone bodies.
Connect the term 'acidosis' with the four acid-base options. Since the problem originates from a metabolic process (diabetes and ketone production) and not a primary breathing issue, it must be a metabolic imbalance.
Therefore, DKA is a form of metabolic acidosis. Select this option, even if one lab value (CO2) seems ambiguous, as the other signs are overwhelmingly definitive.

Concept Tested & Keywords

Concept Tested: Acid-Base Imbalance in Diabetic Ketoacidosis (DKA)
Stem keywords: Diabetes Mellitus, ketone bodies, blood glucose 720 mg/dl, CO2 level 39
Lead-in keywords: classical finding of
Clinical cues: History of Diabetes Mellitus: Increases suspicion for diabetic complications.
Clinical cues: Blood glucose 720 mg/dl: Severe hyperglycemia, a hallmark of DKA.

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