Respiratory failure (pediatrics) Quiz: Ace Your Exams

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A 3-year-old girl presents to the emergency department for evaluation of altered mental status. Earlier in the day, the infant was with her grandparents and was found playing with medication that included metformin and oxycodone. There has been no vomiting or seizure activity. Past medical and surgical histories are unremarkable. Temperature is 37 °C (98.6 °F), pulse is 78/min, respirations are 15/min, blood pressure is 80/40 mm Hg, and oxygen saturation is 84% on room air. On physical exam, the infant is unresponsive. Mucous membranes are moist. Shallow breathing is noted with equal air entry bilaterally. Heart sounds are normal. Bowel sounds are decreased, and the abdomen is soft and non-tender. There is no extremity edema. The infant is stabilized and admitted to the hospital. Laboratory results are shown below. Electrocardiogram (ECG) is normal. Chest X-ray is unremarkable. Given the most likely underlying diagnosis, which of the following additional findings would be expected?  
 
 Laboratory value     Results    
 pH     7.15    
 PaO2     60 mmHg    
 PaCO2     75 mmHg    
 Serum bicarbonate      22  mEq/L    
 Serum glucose     85 mg/dL    

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