A CLD patient was having pedal oedema and was prescribed thiazides. He complains of muscle cramps and excessive sleepiness. Work up shows the following repo. pH= 7.55, pCO2= 38 mmHg, Na= 140, K= 3.0mEq, Chloride= 91mEq and HCO3= 33. Comment on the diagnosis.

CLD, pedal edema - GFR|- RAAS stimulate | Aldosterone | Hypokalemic Metabolic alkalosis Here, AG = Na - (Cl- + HCO3-) = 140 - (91+33) = 16 (|) The "normal" value for the AG repoed by clinical laboratories has declined with improved methodology for measuring plasma electrolytes, and ranges from 6 to 12 mmol/L, with an average of ~10 mmol/L.