Q1- A 66-year-old-man with bronchial asthma, congestive heart failure, and
stage G3a CKD is admitted for treatment of
pneumonia. Over the past 4 days, his oral intake
has been minimal. His home medications include
inhaled bronchodilators and diuretics.
The BP is 96/60 mmHg, the pulse rate is 120/min, and
the temperature is 38.1C. The oxygen saturation
is 98% on 2 L/min supplemental oxygen via
nasal cannula. The jugular venous pressure is low.
Laboratory studies show serum
sodium of 147 mEq/L, potassium of 3.0
mEq/L, chloride of 100 mEq/L, metabolic alkalosis, BUN of 45 mg/dl, and creatinine of 3.5
mg/dl (increased from a recent baseline level of
In addition to potassium supplementation and
continuous monitoring of the volume status,
which ONE of the following is the MOST
appropriate management strategy for this
man’s acid-base disorder?