Acid-base disturbances Quiz: Ace Your Exams

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A 43-year-old woman is brought to the emergency department after being found down on the side of the street. The patient is able to provide her name and date of birth but no additional information. Review of the medical record reveals a history of alcohol use disorder, hypertension, and type II diabetes mellitus. Her medications include acetazolamide, furosemide, and insulin. Her temperature is 37.6°C (99.7°F), pulse is 85/min, and blood pressure is 141/76 mmHg. The patient is oriented to self but not time or place. The abdomen is nondistended and nontender. Vomitus and the smell of alcohol is noticed on the patient’s clothing. Laboratory testing is ordered and reveals the following findings:

 Laboratory value  Result 
 Serum chemistry 
 Sodium   139 mEq/L 
 Potassium   3.4 mEq/L 
 Chloride   93 mEq/L 
 Bicarbonate  31 mEq/L 
 Calcium  9.9 mg/dL 
 Arterial blood gas  
 pH  7.49 
 PaCO2  42 mmHg 
 PaO2  104 mmHg 

Which of the following pathophysiologic mechanisms is the most likely cause of this patient’s laboratory findings?  

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