A 58-year-old man with heart failure has been taking high doses of furosemide for several weeks. He comes to the clinic because of fatigue and muscle cramps. Laboratory studies show pH 7.50, HCO3− 36 mEq/L, potassium 3.0 mEq/L, and urine chloride 8 mEq/L. Which of the following is the most appropriate initial therapy for this acid-base disorder?
- A)Normal saline infusionGABARITO
- B)Mechanical ventilation
- C)Hydrochloric acid infusion
- D)Acetazolamide only
- E)Sodium bicarbonate infusion
Explicação
This patient has chloride-responsive metabolic alkalosis due to volume contraction and diuretic use. Low urine chloride suggests the kidneys are avidly reabsorbing chloride, and isotonic saline corrects the alkalosis by restoring volume and providing chloride ... Ver explicação completa e trilha adaptativa →