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Chief Complaint

Generalized muscle weakness, poor oral intake, and fatigue

History of Present Illness

Flo Ovalod is a 64-year-old female who presented to the emergency department secondary to general muscle weakness, fatigue, poor oral intake, dizziness, and headache for the last week. Her son reports that the patient has been compliant with her home medications including her diuretic and recently changed to a low salt diet due increased weight and lower extremity edema. She later disclosed she has been taking an extra tablet of her torsemide daily in addition to her current regimen.

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Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. What acid- base disorder(s) do you recognize?

    Hint: See Basic Pathophysiology in PPP

  2. What factors may have contributed to this disorder

    Hint: See Etiology and Treatment in PPP

  3. What is the management for this acid-base disorder

    Hint: See Etiology and Treatment in PPP

  4. What electrolytes disorder(s) do you recognize?

    Hint: See Etiology and Treatment in PPP

  5. Describe your treatment plan to correct the patient’s electrolyte derangement.

    Hint: See Electrolytes in PPP


  1. How fast should the sodium be corrected?

    Hint: See Electrolytes in PPP

  2. What are the physiological consequences if her metabolic alkalosis were to worsen?

    Hint: See Basic Pathophysiology, Etiology and Treatment in PPP


Global Perspective

Metabolic alkalosis is a common acid-base disorder in hospitalized patients world-wide and can be life-threatening. In this disorder, the loss of chloride and/or net accumulation of bicarbonate results in an elevated pH with a compensatory increase in PaCO2. Common clinical conditions leading to metabolic alkalosis include excessive diuresis, nasogastric suctioning, vomiting, and primary hyperaldosteronism. Because the symptoms of metabolic alkalosis are not specific, a thorough clinical history - including medication administration - is helpful in identifying the precipitating cause(s). The treatment of this acid-base disorder depends upon the underlying etiology, the severity of pH derangement, and the patient's volume status.

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