ELECTROLYTE QUIZ

A 58-year-old male in the intensive care unit is intubated for respiratory failure due to severe pneumonia and is paralyzed with vecuronium and sedated with lorazepam. A renal consult is called because of the laboratory finding of metabolic acidosis.

Laboratory Studies

Serum sodium 136 mEq/L

Serum potassium 4.0 mEq/L

Serum chloride 101 mEq/L

Serum bicarbonate 14 mEq/L

Blood urea nitrogen 13 mg/dL

Serum creatinine 0.8 mg/dL

Serum glucose 108 mg/dL

Serum lactate 10 mmol/L

Serum osmolality 299 mOsm/kg

Arterial blood studies on 60% O2:

pH 7.37

PCO2 20 mm Hg

The most appropriate next step in the management of this patient is:

A. Dopamine

B. Dobutamine

C. Abdominal computed tomography

D. Discontinue lorazepam

E. None of the above