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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Recognize the signs and symptoms of metabolic alkalosis.

  • Interpret laboratory findings that are consistent with metabolic alkalosis.

  • Describe patient-specific factors that contribute to the development of metabolic disorders.

  • Recommend appropriate first-line treatment regimens and alternatives for metabolic alkalosis.

  • Formulate a patient-specific pharmacotherapeutic plan for the treatment and monitoring of metabolic alkalosis.

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PATIENT PRESENTATION

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Chief Complaint

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“I feel very weak and tired.”

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HPI

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Lois Strickland is a 60-year-old woman who presents to the ED with complaints of generalized weakness, fatigue, myalgias, and polyuria over the past 2 days. She states that recently she has felt bloated and has been taking an extra dose of her “water pill” every day for the past week and a half. She also mentioned that she may have eaten something bad because she has thrown up three times since dinner last night.

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PMH

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  • Hypertension (diagnosed 15 years ago)

  • HF (diagnosed 2 years ago)

  • Diabetes, type 2—diet controlled

  • Dyslipidemia (diagnosed 2 years ago)

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FH

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Mother is alive with a history of HTN and dyslipidemia. Father is alive with HTN. Younger sister is alive with dyslipidemia.

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SH

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Patient reports she does not consume alcohol except a glass of wine “at special occasions.” She denies tobacco or illicit drug use. Lives at home with her husband of 35 years and their two dogs.

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Meds

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  • Lisinopril 10 mg PO once daily

  • Carvedilol 25 mg PO BID

  • Furosemide 40 mg PO once daily

  • Atorvastatin 40 mg PO at bedtime

  • Last dose of all medications was this morning 3 hours before arriving at the ED (except atorvastatin, which was taken yesterday evening)

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All

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Codeine—patient reports “I get short of breath”

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ROS

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Denies unusual weight gain or loss. She denies fever, chills, or night sweats, but reports dizziness that has occurred off and on over the past week in addition to generalized fatigue and weakness. No reported chest pain, palpitations, shortness of breath, or cough. She denies diarrhea, constipation, or change in bowel habits. She reports a recent increase in thirst and urination, but no change in urine color. She reports myalgias and perioral numbness that began recently with the fatigue and weakness.

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Physical Examination

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Gen
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The patient is ill-appearing and feels warm to the touch

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VS
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BP 93/62 mm Hg, HR 101, RR 20, T 37.9°C; Wt 80 kg, Ht 5′7″; O2 sat 96% on RA

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Skin
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Soft, intact, warm, dry

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