A 63-year-old woman is brought to a remote rural emergency department by ambulance after being found in a stairwell on Monday morning. It is not known how long she was there, but she was last seen by her coworkers on Friday afternoon. She is not verbally responsive.
Workup shows an ischemic stroke in the posterior circulation and a hip fracture. The fracture may have been caused by her fall down the stairs from the stroke. Her arterial pH is 7.35 on initial arterial blood gas. The creatinine kinase level is elevated to 475 U/L. The sodium level is 130 mEq/L. Fluid resuscitation is immediately performed wide open upon her arrival because the patient’s initial blood pressure was 85/50 mm Hg.
At 120 minutes after her initial presentation, her blood pressure is 135/72 mm Hg, her heart rate is 68 beats/minute, and she is maintaining spontaneous respirations on 100% oxygen. Her oxygen saturation level is 99%. She is transferred to a larger facility, where a second arterial blood gas is obtained, which shows an arterial pH of 7.28 consistent with metabolic (not respiratory) acidosis. A repeat potassium level is 5.0 mEq/L.
What is a possible iatrogenic cause for this new metabolic acidosis?
This question appears in Med-Challenger Emergency Medicine Review with CME
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