A nurse is caring for four clients. Which of the following clients is at risk for developing metabolic alkalosis?

Acid–base balance is maintained through respiratory and metabolic processes that regulate hydrogen ion concentration in the body. Metabolic alkalosis occurs when there is a loss of hydrogen ions or an excess of bicarbonate, often related to gastrointestinal losses or prolonged acid depletion. Certain clinical conditions and treatments can predispose clients to this imbalance. Understanding these risk factors helps nurses anticipate and prevent complications. A. Opioid overdose primarily causes respiratory depression, leading to hypoventilation and carbon dioxide retention. This results in respiratory acidosis rather than metabolic alkalosis. Therefore, this condition is not associated with the development of metabolic alkalosis. B. Aspiration pneumonia can impair gas exchange and may lead to hypoventilation or hypoxemia. This condition is more likely to cause respiratory acidosis due to inadequate ventilation rather than a metabolic alkalosis. It is not a risk factor for increased bicarbonate levels. C. Uncontrolled diabetes mellitus, especially in diabetic ketoacidosis, leads to metabolic acidosis due to accumulation of ketone bodies. This is the opposite of metabolic alkalosis and reflects excess acid production in the body rather than loss of hydrogen ions. D. Continuous gastric suctioning removes gastric acid (hydrochloric acid) from the stomach, leading to a loss of hydrogen ions. This loss increases serum bicarbonate relative to acid levels, predisposing the client to metabolic alkalosis. This is a well-known cause of acid–base imbalance in clinical practice.