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Objectives:
A 65-year-old male with a new diagnosis of congestive heart failure (CHF) returns to your office after starting several new medications within the last month. A cardiologist at an academic health center 100 miles away prescribed these medications, and neither you nor your patient know what the drugs are. Over that same time period, he states that he has felt “worse than I did after my heart attack.” At first he was just fatigued, but in the last few days he has developed nausea, vomiting, and body aches.
On examination, his temperature is 37.1° C, pulse 70, respiratory rate 8, and blood pressure 100/58 mm Hg. He has trace pedal edema. His lungs are clear, and his abdomen is diffusely tender. When you stand him up to check his blood pressure, he loses consciousness. He quickly recovers. Your nurse draws blood, starts an IV, and obtains an arterial blood gas on room air. ABG: pH 7.52, PaCO2 49 mm Hg, PaO2 90 mm Hg, and HCO3 39 meq/L.
You have admitted the patient and are on your way to the hospital to see him when the lab tests return. His plasma studies: Na 140 meq/L, K 2.5 meq/L, Cl 94 meq/L, BUN 18 mg/dL, creatinine 0.9 mg/dL, Ca 8.4 mg/dL, Mg 1.9 mg/dL. Urine studies: specific gravity 1.025, chloride 45 meq/L (high).
You are able to obtain the cardiologist’s records and your patient’s medications. He started taking captopril, furosemide, and metoprolol in the last month. He also takes aspirin and isosorbide dinitrate.
Your patient is not responding to the KCl you are administering.