Approach to metabolic alkalosis Quiz: Ace Your Exams
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A 48-year-old woman presents to the emergency department with a cough and shortness of breath for the past two days. The patient has not had any recent respiratory infections, has no past significant medical history, and does not take any medication. The cough is productive of yellow sputum and has worsened over the past two days. Temperature is 38.2 ºC (100.8 ºF), pulse is 96/min, respiratory rate is 18/min, blood pressure is 158/95 mm Hg, and SpO2 is 95% on room air. On physical examination, there are biapical wheezes on pulmonary auscultation, which the patient states are chronic. There is no digital clubbing and no new skin lesions. Chest radiograph shows mild left lingular pneumonia. Serum and urine laboratory studies are shown below. Which of the following is the most probable cause of this patient’s metabolic alkalosis?
| Laboratory Study | Result | Reference Range |
| Serum Sodium | 144 mEq/L | 136-146 mEq/L |
| Serum Potassium | 3.0 mEq/L | 3.5-5 mEq/L |
| Serum Bicarbonate | 30 mEq/L | 22-28 mEq/L |
| Blood urea nitrogen | 16 mg/dL | 7-18 mg/dL |
| Serum creatinine | 1.0 mg/dL | 0.6-1.2 mg/dL |
| Urine osmolality | 400 mOsm/kg | 50-1,400 mOsm/kg |
| Urine chloride | 45 mEq/L | < 20 mEq/L |
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