A diabetic patient in the emergency department has a blood glucose of 400 mg/dL, muscle twitching, and an increased respiratory rate. What is the priority concern?

A diabetic patient in the emergency department has a blood glucose of 400 mg/dL, muscle twitching, and an increased respiratory rate. What is the priority concern?

• A. Respiratory acidosis
• B. Respiratory alkalosis
• C. Metabolic acidosis
• D. Metabolic alkalosis

Answer: (C)

The main idea here is that diabetic ketoacidosis causes a metabolic acidosis from accumulated ketone bodies. When insulin is deficient, fats break down into ketones, which lower the blood pH and bicarbonate level. The body responds by breathing faster and deeper to blow off carbon dioxide, a compensatory mechanism known as Kussmaul respiration. That’s why you see an increased respiratory rate—the body is trying to correct the acid-base imbalance. Because the metabolic acidosis is the driving problem, it’s the priority to address. The high blood glucose supports the picture of diabetic ketoacidosis, and the muscle twitching can relate to electrolyte disturbances that accompany DKA (like potassium shifts), but the immediate life-threatening issue is the underlying metabolic acidosis. The other choices describe primary disturbances that don’t fit the scenario: respiratory acidosis would involve CO2 retention from hypoventilation; respiratory alkalosis would imply excessive CO2 loss without an underlying acidosis driving it; metabolic alkalosis would arise from loss of hydrogen ions or gain of bicarbonate, which isn’t expected here.

The main idea here is that diabetic ketoacidosis causes a metabolic acidosis from accumulated ketone bodies. When insulin is deficient, fats break down into ketones, which lower the blood pH and bicarbonate level. The body responds by breathing faster and deeper to blow off carbon dioxide, a compensatory mechanism known as Kussmaul respiration. That’s why you see an increased respiratory rate—the body is trying to correct the acid-base imbalance. Because the metabolic acidosis is the driving problem, it’s the priority to address.

The high blood glucose supports the picture of diabetic ketoacidosis, and the muscle twitching can relate to electrolyte disturbances that accompany DKA (like potassium shifts), but the immediate life-threatening issue is the underlying metabolic acidosis. The other choices describe primary disturbances that don’t fit the scenario: respiratory acidosis would involve CO2 retention from hypoventilation; respiratory alkalosis would imply excessive CO2 loss without an underlying acidosis driving it; metabolic alkalosis would arise from loss of hydrogen ions or gain of bicarbonate, which isn’t expected here.