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

  • Identify 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.


Chief Complaint

“I feel very weak and tired.”


Brandon O’Byrne is a 60-year-old man who presents to the ED with complaints of generalized weakness, fatigue, myalgias, and polyuria over the past 2 days. He states that recently he has felt bloated and has been taking extra doses of his “water pill.” He also mentioned that he may have eaten something bad because he has thrown up three times since dinner last night.


Hypertension (diagnosed 15 years ago)

HFrEF (diagnosed 3 years ago)

Diabetes, type 2—diet controlled

Dyslipidemia (diagnosed 3 years ago)


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


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


Lisinopril 20 mg PO once daily

Carvedilol 25 mg PO BID

Furosemide 40 mg PO once daily

Atorvastatin 40 mg PO once daily

Last dose of all medications was this morning 3 hours before arriving at the ED


Codeine—patient reports “I get short of breath”


Denies unusual weight gain or loss. He 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. He denies diarrhea, constipation, or change in bowel habits. He reports a recent increase in thirst and urination, but no change in urine color. He reports myalgias and perioral numbness that began recently with the fatigue and weakness.

Physical Examination


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

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