Alkalotic Alice — Metabolic Alkalosis
Vomiting and diuretics, tingling fingers, pH ↑ · HCO₃⁻ ↑
Alice spends three days vomiting after a stomach bug and keeps her water pill going the whole time. Every heave sends hydrochloric acid down the drain until her blood turns sweet and her fingers start to buzz.
Alice loses acid instead of gaining base — protracted vomiting, nasogastric suction or loop diuretics. Expect tingling, tremors, tetany and shallow slow breathing as her lungs try to hold CO₂. Labs: pH > 7.45, HCO₃⁻ > 26, K⁺ and Cl⁻ low.
Read Alkalotic Alice's full story →The story arc
The setup
Three days of vomiting, no fluids kept down, and a furosemide dose she never skipped.
The turn
Her fingers and lips start tingling, her hands cramp when the blood pressure cuff inflates.
The crisis
Her breathing slows and shallows out; the monitor shows a run of PVCs while her K⁺ reads 2.9.
The save
Normal saline with potassium chloride replaces the chloride she vomited away, and the diuretic is held.
NCLEX study section — Metabolic Alkalosis
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Endocrine & Metabolic
Take this chapter into practice questions on the same topic.