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CASE ONE : A 49-yr-old Caucasian woman with a known diagnosis of HIV-AIDS was brought to the emergency room (ER) by her husband because of generalized weakness. The patient's mild dementia had been attributed to AIDS. Earlier in the evening she complained of not feeling well and suddenly became very weak. In the ER she was alert and oriented but could not recall the earlier events of the evening. Past Medical History : She had herpes zoster infection, hepatitis and denied seizures or syncope. She drank 68 beers daily, smoked tobacco for many years, and while she occasionally smoked crack cocaine she had not used it for >24 h. Her medications included didanosine (DDI), trimethoprim sulfamethoxizole (Septra®), amytriptoline(Elavil®), albuterol(Ventolin®) inhaler, and diphenhydramine. Physical Examination: well-nourished, well-developed female. Vital signs were: temperature 36.9°C (98.4°F); blood pressure 159/95 mm Hg; heart rate 100 beats/min; respirations 20 breaths/min. Examinations of the head and neck were unremarkable; cardiac evaluation revealed a regular tachycardia; there were rales at both bases; the abdomen was unremarkable; rectal examination was heme negative; the neurological examination was non-focal but there was generalized muscle weakness. Laboratory Studies: Electrolytes: Serum: Na 129 mEq/L, K 1.8 mEq/L, Cl 58 mEq/L, CO 2 55 mEq/L Urinary; K 21 mEq/L, Cl 42 mEq/L, Na 64 mEq/L BUN 35 mg/dL, Creatinine 2.8 mg/dL, Glucose 112 mg/dL Calcium 12.5 mg/dL, PO 4 4.0 mg/dL, Mg 1.5 mg/dL Hematocrit 47% Arterial Blood Gases (room air): pH 7.56, PO2 73 mm Hg, PCO2 65 mm Hg, HCO3 57 mEq/L. Head computed tomography (CT) scan was normal. No lumbar puncture was done. Which ONE of the following diagnoses BEST accounts for this patient's acid-base and electrolyte disturbances?
Primary hyperparathyroidism
Surreptitious vomiting
Primary hyperaldosteronism
Antacid abuse
Diuretic abuse