A 60-Year-Old Man with Alcoholism Is Admitted After Being Found

question 71

Multiple Choice

A 60-year-old man with alcoholism is admitted after being found unresponsive in the street.  No other history is available.
His temperature is 37.1 C (98.8 F) , blood pressure is 130/86 mm Hg, pulse is 110/min and regular, and respirations are 20/min.  On examination, the patient is disheveled and appears chronically ill.  He has decreased muscle mass and no subcutaneous fat.  He responds to painful stimuli and has slurred speech.  Carpal spasm was noted in the hand of the arm in which his blood pressure was taken.  Mucous membranes are dry and there is no moisture in the axillae.  He has nystagmus on end lateral gaze of both eyes.  No other focal neurologic findings are present.
Laboratory results are as follows:

Intravenous thiamine and fluids consisting of 3 L normal saline/5% dextrose containing 40 mEq of potassium are administered over 4 hours.  Electrolytes are re-measured with the following results:

Which of the following is the most likely cause of this patient's hypokalemia?

• A)Beta-adrenergic stimulation
• B)Hypomagnesemia
• C)Primary hyperaldosteronism
• D)Refeeding syndrome
• E)Renal tubular acidosis

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