Question

A 78 year old patient with cancer of the esophagus has not been able to eat, has lost 80 pounds and appears cachectic. His breath smells fruity, like acetone. His pH is 7.14 and HCO₃ 18. Looking at his pH and HCO₃, plus the corroborating patient picture, what acid/base imbalance is he in?

1) respiratory alkalosis
2) metabolic alkalosis
3) metabolic acidosis
4) respiratory acidosis

Answer 1

The patient's symptoms and lab results indicate that he has metabolic acidosis, characterized by a low pH and low bicarbonate level, with the fruity breath suggesting ketoacidosis.

Step-by-step explanation:

The 78-year-old patient with cancer of the esophagus is likely suffering from metabolic acidosis. The patient's low pH of 7.14 is indicative of acidosis, and the low bicarbonate (HCO₃) level of 18 mEq/L points toward a metabolic cause. Metabolic acidosis can occur due to an increase in acid production, as in the case of ketone bodies produced during starvation or uncontrolled diabetes, or from the loss of bicarbonate, which may occur in conditions like diarrhea. The fruity breath, which smells like acetone, provides additional evidence of excessive ketone bodies in the blood, a condition known as ketoacidosis. Therefore, the correct answer from the given options is 3) metabolic acidosis.