A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values would the nurse expect this client to have?

This scenario requires understanding acid-base balance and renal pathophysiology. Acute kidney injury impairs the kidneys ability to excrete hydrogen ions and regenerate bicarbonate. Identifying metabolic acidosis with partial respiratory compensation is necessary based on the interpretation of arterial blood gas values. Choice A rationale Metabolic acidosis occurs in kidney injury due to decreased acid excretion. The pH is low at 7.26 (7.35 to 7.45) and bicarbonate is low at 14 (22 to 28), while the PaCO2 of 30 shows compensatory hyperventilation. Choice B rationale A pH of 7.26 indicates acidosis, but the normal bicarbonate level of 24 and elevated PaCO2 of 46 indicate respiratory acidosis. This occurs with hypoventilation and carbon dioxide retention rather than the metabolic issues seen in kidney failure. Choice C rationale The pH of 7.49 indicates alkalosis. A high bicarbonate of 30 with a normal PaCO2 of 40 represents uncompensated metabolic alkalosis. This is typical of excessive acid loss or base gain, which is opposite of kidney failure. Choice D rationale The pH of 7.49 and low PaCO2 of 30 suggest respiratory alkalosis. Bicarbonate is normal at 24. This state results from hyperventilation and excessive carbon dioxide loss, which does not characterize the pathophysiology of acute kidney injury.