33 YO M with hx of CKD unknown stage, schizophrenia presents with severe metabolic alkalosis. In the past he has had
several admissions for severe hypokalemic, hypochloremic metabolic alkalosis. He had also been noted to self induce
vomiting several times during hospitalizations. Bicarbonate has been >50mg/dl. He has been hypokalemic as low as 2.1, despite supplementation, persistently <3.0mg/dl .He has also been Hypercalcemic (11.4mg/dl), and hyperphosphatemic >10mg/dl.
Serum Chloride has ranged 60-70mg/dl. Patient has been low
to normotensive . Aldosterone level was found to be low (12ng/dl), with renin elevated (15.98ng/dl). Urine potassium during
previous admission was noted to be elevated at 49, and urine chloride persistently found to be <20. Urine Na <20. PTH elevated at 486. VBG: 7.54/69/29/58.
Julian Seifter, MD
Director of Renal Medical Student Education at Harvard Medical School
Matthew Sparks, MD
Nephrologist at Duke University and Durham VA Medical Centers
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