We often are looking for an acidosis when patients present with lethargy but what about when it’s an alkalosis!? In last week’s episode with Annie Fulton RN of the “Up My Nursing Game” podcast, she and host Sarah Lorenzini presented a patient story but left the diagnosis a mystery.  You heard why Annie’s patient was admitted and her initial assessment, what caused her to think something more was going on, and why she ruled out sepsis as a diagnosis. Now, find out what her diagnosis was and how she was treated! Hint: today, we’re talking all about diuretic induced metabolic alkalosis.

To start off this episode, Annie recaps her patient’s story, walks us through the patient’s VBG results, and how they arrived at a diagnosis of metabolic alkalosis. Sarah then breaks down the pathophysiology of diuretic induced metabolic alkalosis, including what causes it at the cellular level and how to treat the condition. They specifically talk about contraction alkalosis, and how it’s possible for a patient to be both intravascularly dry but extravascularly still fluid volume overloaded.

Sarah and Annie also discuss the patient’s mild leukocytosis, the clinician’s decision to NOT prescribe antibiotics after a positive urinalysis, and their thoughts on antibiotic stewardship and critical thinking in diagnostics.

Listen to part two of this mystery series to find out how to treat metabolic alkalosis from diuretics, and find out if there’s anything you can do to look out for its symptoms! 

Topics discussed in this episode:

• How Annie’s patient presented and her initial treatment
• The results of the patient's VBG
• What can cause metabolic alkalosis and its symptoms
• Intravascular vs extravascular fluid volume status
• Contraction alkalosis and how to treat it
• How Annie’s patient was treated
• The right time to stop and start diuresis on a patient
• Why the patient’s clinician declined to give antibiotics
• The debate on sepsis mimics

Listen to Annie Fulton’s Up My Nursing Game Podcast: http://www.upmynursinggame.com/

Connect with Annie Fulton on Instagram: https://www.instagram.com/upmynursinggame/

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