CO 19 - 27 HIGH

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The abnormality chosen is:

an elevated serum bicarbonate level. This is indicative of two possible underlying acid-base abnormalities. Both metabolic alkalosis and compensated respiratory acidosis may result in an elevated serum bicarbonate. An arterial blood gas should be performed to determine which acid-base abnormality is truly present. Once the blood gas results are available, the cause of the elevated serum bicarbonate will be found in the differential diagnosis for either metabolic alkalosis or respiratory acidosis, whichever is present.

If metabolic alkalosis is the underlying abnormality, then the next step in the workup is to determine a random urine chloride level. If the urine chloride is low (<15 mEq/L ), then the alkalosis is considered chloride responsive and the differential includes diuretic use, loss of gastric acid (vomiting, nasogastric suctioning, etc.), or volume contraction. If the urine chloride is greater than 15 mEq/L (chloride resistant), then the next step is to determine the blood pressure. If the blood pressure is elevated, then the differential includes renal artery stenosis, hyperaldosteronism, hypercortisolism, or licorice ingestion. In patients in whom the blood pressure is not elevated, hypomagnesemia or hypokalemia or both are potential causes.