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| * Medicine question 9 |
| | #530859 |
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A 26 year old woman presents to the ER with generalized weakness associated with perioral numbness. She is moderately built and looks slightly depressed. On physical exam, she has mild pallor. She denies use of any medications. BP 120/88 mmHg and physical exam is normal. Lab data: Cr 1.2mg/dL, BUN 15mg/dLNa 136 , K 2.8 , Cl 88 , HCO3 38. Urine Na 45 meq/L, Urine K 35 meq/L, Urine Cl 8 meq/L, Urine specific gravity 1.010, Urine pH 7.
Most likely diagnosis is :
A)Laxative Abuse
B)Surreptious vomiting
C)Licorice abuse
D)Malabsorption Syndrome
E)Hyporeninemic Hypoaldosteronism
q21) Most appropriate next step in the management:
A)IV normal saline
B)Spronolactone
C)Amiloride
D)Psychiatry consult
E)Reassurance because this is self limiting
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| * Re:Medicine question 9 |
| #2187895 |
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Ans. B
Ans. A
Key concepts : Recognize the etiologies of metabolic alkalosis. Understand the concept of urinary chloride level in identifying the etiology of metabolic alkalosis. If urinary chloride is less than 10meq/L, it indicates Saline responsive alkalosis. A higher than 10 value indicates Saline resistant alkalosis.
Ans. B is the correct choice because the patient has hypokalemic, hypocholremic metabolic alkalosis. Urinary chloride less than 10 indicate that this is a saline responsive metabolic alkalosis and hence, should be treated with IV normal saline. NS can correct this metabolic alkalosis.
Ans. A incorrect because diarrhea due to laxative abuse should cause non anion gap metabolic acidosis.
Ans. C is incorrect. The active component in licorice is glycyrrhizic acid which inhibits 11B-HSD2, the enzyme that inactivates cortisol to cortisone in the collecting duct. Inhibition or deficiency of 11B-HSD2 causes cortisol to remain active and like aldosterone, cortisol binds to aldosterone receptors causing hypokalemia, metabolic alkalosis and low-renin and low-aldosterone hypertension. This is not licorice abuse because this patient does not have hypertension. Also, urinary chloride will be higher than 10 in licorice induced metabolic alkalosis
Ans. D is incorrect because it should cause chronic diarrhea and non-gap metabolic alkalosis.
Ans. E is incorrect because hyporeninemic hypoaldosteronism causes hyperkalemia and metabolic acidosis
( Type IV RTA) |
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