A 42-year-old patient is brought to the ED with severe nausea, vomiting, and diarrhea for the past 3 days. Laboratory studies reveal: Na+ 129 mEq/L, K+ 2.8 mEq/L, Cl− 88 mEq/L, HCO₃− 32 mEq/L, BUN 28 mg/dL, and creatinine 1.1 mg/dL. Which of the following best describes this patient's current acid-base and electrolyte status?
Metabolic acidosis with hypernatremia and hypokalemia
Uremic acidosis with hyperkalemia and hyponatremia
Hypochloremic metabolic acidosis with hyponatremia
Metabolic alkalosis with hypokalemia and hyponatremia
The elevated bicarbonate (32 mEq/L) together with low chloride (88 mEq/L) indicates a metabolic alkalosis, most consistent with hydrogen-ion loss from persistent vomiting. Potassium is low at 2.8 mEq/L, representing hypokalemia that typically accompanies metabolic alkalosis through renal potassium wasting. Sodium is also reduced at 129 mEq/L, reflecting dilutional hyponatremia secondary to volume depletion and ADH-mediated water retention. Taken together, the patient exhibits metabolic alkalosis with concurrent hypokalemia and hyponatremia. The other answer choices do not fit the lab profile: there is no metabolic acidosis, creatinine is normal (making uremia unlikely), and chloride is low rather than normal or elevated.
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