A 19-year-old female sophomore college student presents to the university health clinic seeking help for worsening sadness, low energy, and difficulty focusing on her coursework over the past four months. During the interview, she tearfully admits to intense dissatisfaction with her body weight. She describes periods where she consumes unusually large amounts of food in secret, immediately followed by the use of laxatives and self-induced vomiting. This cycle occurs almost daily. Her current body mass index is 22.1 . Vital signs reveal a blood pressure of 105/65 mm Hg and a heart rate of 88/min. Physical examination notes bilateral parotid gland enlargement and abrasions on the dorsal aspect of her hands.
| Parameter | Value | Reference Range |
|---|---|---|
| Sodium | 139 mEq/L | 136-145 mEq/L |
| Potassium | 3.0 mEq/L | 3.5-5.0 mEq/L |
| Chloride | 90 mEq/L | 95-105 mEq/L |
| Bicarbonate | 33 mEq/L | 22-28 mEq/L |
| Parameter | Value | Reference Range |
|---|---|---|
| pH | 7.49 | 7.35-7.45 |
| 46 mm Hg | 35-45 mm Hg | |
| 92 mm Hg | 75-105 mm Hg |
The patient asks about starting a medication to help with her mood and eating patterns. Which of the following is the most accurate statement regarding this patient's clinical picture and pharmacological management?
- Bupropion is absolutely contraindicated due to a significantly increased risk of precipitating generalized seizures.Answer
- BThe arterial blood gas results indicate an uncompensated primary metabolic alkalosis with a concurrent primary respiratory acidosis.
- CFluoxetine therapy is strongly discouraged as it has been shown to paradoxically increase the frequency of binge-eating episodes.
- DThe laboratory findings are consistent with a state of secondary hypoaldosteronism driven by chronic intravascular volume depletion.
- ESelective serotonin reuptake inhibitor monotherapy should be avoided to prevent a treatment-emergent manic episode.