69: Diuretic Induced Metabolic Alkalosis with Guest Annie RN

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 treatmentThe results of the patient's VBGWhat can cause metabolic alkalosis and its symptomsIntravascular vs extravascular fluid volume statusContraction alkalosis and how to treat itHow Annie’s patient was treatedThe right time to stop and start diuresis on a patientWhy the patient’s clinician declined to give antibioticsThe debate on sepsis mimicsListen to Annie Fulton’s Up My Nursing Game Podcast: http://www.upmynursinggame.com/Connect with Annie Fulton on Instagram: https://www.instagram.com/upmynursinggame/Mentioned in this episode:Coming Soon! Rapid Response Academy: The Heart and Science of Caring for the SickClick here to learn more about the community that Sarah is building: https://www.rapidresponseandrescue.com/community