A venous blood gas shows K+ 5.4 mmol/L, pH 7.30, pCO2 60 mmHg, HCO3- 28 mmol/L. The presumptive diagnosis is:

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Multiple Choice

A venous blood gas shows K+ 5.4 mmol/L, pH 7.30, pCO2 60 mmHg, HCO3- 28 mmol/L. The presumptive diagnosis is:

The main idea is identifying the acid–base disorder by the pattern of pH, pCO2, and HCO3−. The pH is acidic (7.30), and the pCO2 is elevated (60 mmHg), which means the primary problem is a respiratory cause that is acidifying the blood. The bicarbonate is also elevated (28 mmol/L), indicating the kidneys have increased HCO3− to compensate for this respiratory acidosis. Since the pH remains acidic despite this compensatory rise in bicarbonate, the overall picture is respiratory acidosis with metabolic (renal) compensation. The accompanying mild hyperkalemia supports acidosis. The other possibilities don’t fit because a metabolic disturbance would present with a low bicarbonate, a metabolic alkalosis would raise pH, and a respiratory alkalosis would lower pCO2.

The main idea is identifying the acid–base disorder by the pattern of pH, pCO2, and HCO3−. The pH is acidic (7.30), and the pCO2 is elevated (60 mmHg), which means the primary problem is a respiratory cause that is acidifying the blood. The bicarbonate is also elevated (28 mmol/L), indicating the kidneys have increased HCO3− to compensate for this respiratory acidosis. Since the pH remains acidic despite this compensatory rise in bicarbonate, the overall picture is respiratory acidosis with metabolic (renal) compensation. The accompanying mild hyperkalemia supports acidosis. The other possibilities don’t fit because a metabolic disturbance would present with a low bicarbonate, a metabolic alkalosis would raise pH, and a respiratory alkalosis would lower pCO2.

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