Electrolyte Case 4 A 75-year-old man had had progressive generalized weakness an

Question

Electrolyte Case 4

A 75-year-old man had had progressive generalized weakness and an inability to rise from a sitting position for 10 days. He reported no sensory disturbances, use of drugs, loss of consciousness, shortness of breath, chest pain, diarrhea or vomiting. His previous medical history was negative for neurologic disease and hypertension.

A dietitian questioned the patient soon after admission. Because of his edentulous state, he had eaten mostly soup and soft vegetables for over a year. He also related a history of chewing 8 12 oz bags of chewing tobacco daily. Blood pressure was 160/110.

Laboratory data :

Patient Results

Reference Range

Na

149

136-145 mEq/L

K

1.8

3.5-4.5 mEq/L

Cl

101

98-107 mEq/L

CO2

37

23-29 mEq/L

Glucose

103

74-100 mg/dL

BUN

10

6-20 mg/dL

Creat

0.9

0.9-1.3 mg/dL

TP

6.3

6.4-8.3 g/dL

Osmo

288

275-299 mOsm/kg

U Osmo

639

50-1400 mOsm/kg

Further tests revealed:

Reference Range

Aldosterone

1.6 ng/dL

2-20 ng/dL

Renin

none detected

1-9 uU/mL

Cortisol

18.5 ug/dL

8-24 ug/dL

Patient Results

Reference Range

Na

149

136-145 mEq/L

K

1.8

3.5-4.5 mEq/L

Cl

101

98-107 mEq/L

CO2

37

23-29 mEq/L

Glucose

103

74-100 mg/dL

BUN

10

6-20 mg/dL

Creat

0.9

0.9-1.3 mg/dL

TP

6.3

6.4-8.3 g/dL

Osmo

288

275-299 mOsm/kg

U Osmo

639

50-1400 mOsm/kg

Explanation / Answer

Laboratory tests results showing

Hypokalemia - Decreased pottasium level

Increased carbon-dioxide level - High carbonic acid

Slightly increased sodium level and aldosterone level.

Respiratory Acidosis

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