RN Nursing · Diabetic Complications · Practice question
A patient with diabetic ketoacidosis presents with deep, rapid respirations and fruity breath odor. ABG shows pH 7.20. What compensatory mechanism is occurring?
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Bradypnea
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Hypoventilation
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✓
Hyperventilation (Kussmaul respirations)
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Apnea
Answer & explanation
Correct: Hyperventilation (Kussmaul respirations)
In diabetic ketoacidosis, the accumulation of ketoacids drives the blood pH below normal, as evidenced by the pH of 7.20. The body attempts to compensate for this metabolic acidosis through the respiratory system by increasing the rate and depth of breathing to eliminate excess carbon dioxide, which lowers carbonic acid levels and partially corrects the pH. This pattern — deep, labored, rapid respirations — is called Kussmaul breathing and is the hallmark respiratory compensation for severe metabolic acidosis. The fruity breath odor is caused by exhaled acetone, a byproduct of ketone metabolism. Bradypnea refers to abnormally slow breathing, which would worsen acidosis by retaining carbon dioxide and is the opposite of what occurs here. Hypoventilation similarly retains carbon dioxide, worsening respiratory acidosis on top of metabolic acidosis and would not be a compensatory response. Apnea, the absence of breathing, would be immediately life-threatening and is not a physiological compensatory mechanism. Understanding that respiratory compensation always moves in the opposite direction from the primary disorder is fundamental to interpreting acid-base imbalances.
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