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After completing this case study, the reader should be able to:
Recognize the clinical and laboratory manifestations of metabolic acidosis.
Differentiate among different causes of metabolic acidosis.
Develop a patient-specific pharmacotherapeutic plan for treating chronic metabolic acidosis.
Provide medication education for patients with chronic metabolic acidosis.
“I just feel so weak all the time.”
Sue Rider is a 67-year-old woman with progressively declining renal function, due to hypertension, who is being seen in the nephrology clinic for management of fatigue, dyspnea, somnolence, and lethargy. She further reports that over the past few months she has experienced a decrease in appetite and occasionally feels nauseated without vomiting. She reports frequent nonadherence to her antihypertensive regimen “when I feel good.” She also reports no history of diarrhea.
She is a retired schoolteacher who lives with her husband of 38 years and has three grown children. She denies alcohol use. There is no history of tobacco habituation or recreational drug use.
History of CAD in her mother’s family
Amlodipine 5 mg PO daily
Metoprolol succinate 25 mg PO daily
Metolazone 2.5 mg PO daily, taken intermittently for lower extremity edema (reports that she has not taken any for the past few months)
Pleasant African-American woman in NAD
BP 145/85 mm Hg, P 78 bpm, RR 22, T 37.2°C; Wt 75 kg, Ht 5′4″
No hemorrhages or exudates on funduscopic examination
JVP was 5 cm; carotid pulses were 2+ bilaterally; no thyromegaly or lymphadenopathy
Unable to palpate PMI; regular rate and rhythm; normal S1 and S2; no murmurs
Obese, soft, nontender; normoactive bowel sounds; no organomegaly
Minimal sternal and quadriceps tenderness
No focal cranial nerve deficits; strength 5/5 in all extremities. DTRs are 1+ brachioradialis, 2+ biceps, 2+ quadriceps, 1+ ankle jerks, toes downgoing bilaterally.