A 66-year-old male with insulin-dependent diabetes mellitus, tobacco use, and COPD (FEV1 1.65 L, 50% predicted) presents to the emergency department with a 3-day history of diarrhea, fatigue, and lightheadedness. He recently returned from a cruise and both he and his wife are ill. He reports minimal oral intake over the past 2 to 3 days. His serum glucose is 160 mg/dL, and his urinalysis shows no ketones present. He has a baseline creatinine level of 1.0 mg/dL. He is hypotensive on presentation with a blood pressure of 80/50 mm Hg, heart rate 110 bpm.
| Laboratory Data: |
||||
| ABG |
Basic Metabolic Panel |
|||
| pH |
7.22 |
Na |
135 mEq/L |
|
| PaCO2 |
52 mm Hg |
K |
3.0 mEq/L |
|
| PaO2 |
80 mm Hg |
Cl |
102 mEq/L |
|
| HCO3 |
13 mEq/L |
CO2 |
12 mEq/L |
|
| BUN |
44 mg/dL |
|||
| Cr |
2.3 mg/dL |
|||
What is/are the primary acid-base disturbance(s) occurring in this case?
A - Metabolic acidosis only
B - Respiratory acidosis only
C - Metabolic acidosis and respiratory acidosis
D - Metabolic alkalosis and respiratory acidosis
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