Mixed Respiratory Alkalosis Metabolic Acidosis — ESENeph MCQ

Correct answer: A — Primary respiratory alkalosis with a concurrent metabolic acidosis

The best answer is “Primary respiratory alkalosis with a concurrent metabolic acidosis”. The alkalemia and hypocapnia establish respiratory alkalosis, while bicarbonate is lower than expected from compensation alone, revealing a second primary metabolic acidosis. “Primary metabolic alkalosis with appropriate respiratory compensation” is less appropriate because bicarbonate is low rather than elevated “Primary respiratory alkalosis with expected acute metabolic compensation” is less appropriate because the bicarbonate reduction is too substantial for the degree of acute hypocapnia “Primary respiratory acidosis with expected acute metabolic compensation” is less appropriate because PaCO2 is low, not high “Primary metabolic acidosis with inadequate respiratory compensation” is less appropriate because the alkalemic pH and marked hypocapnia indicate an additional primary respiratory process

Reference: KDIGO 2024 CKD guideline: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf