A 42-year-old patient is brought to the ED with severe nausea, vomiting, and diarrhea for the past 3 days. Labs show: Na+ 129 mEq/L, K+ 2.8 mEq/L, Cl- 88 mEq/L, HCO3- 32 mEq/L, BUN 28 mg/dL, Creatinine 1.1 mg/dL. Which of the following best describes the patient's acid-base and electrolyte status?
Hypochloremic metabolic acidosis with hyponatremia
Uremic acidosis with hyperkalemia and hyponatremia
Metabolic alkalosis with hypokalemia and hyponatremia
Metabolic acidosis with hypernatremia and hypokalemia
The correct answer is metabolic alkalosis with hypokalemia and hyponatremia. The patient's history of vomiting and diarrhea has led to significant fluid and electrolyte losses. The low chloride (88 mEq/L) and elevated bicarbonate (32 mEq/L) indicate metabolic alkalosis, likely due to gastric acid loss from vomiting. The potassium is low at 2.8 mEq/L, indicating hypokalemia, which often accompanies metabolic alkalosis. The sodium is also low at 129 mEq/L, indicating hyponatremia. While the patient likely has some degree of dehydration, the lab values don't support hypernatremia or hypochloremic metabolic acidosis. The normal creatinine suggests that acute kidney injury is not present, ruling out uremic acidosis.
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