Douglas S. Paauw, MD


October 27, 2014

Why So Tired?

A 66-year-old woman presents with fatigue. She has a history of bipolar disorder and reflux disease. She reports that she had been feeling well over the past several months until just the past few weeks.

The patient's physical examination is normal. As part of her work-up, you order a basic metabolic panel, which is notable for a sodium level of 120 mEq/L, potassium level of 3.6 mEq/L, blood urea nitrogen level of 3 mg/dL, and a serum creatinine concentration of 0.7 mg/dL.

Current medications include:

  • Rabeprazole;

  • Lithium;

  • Paroxetine; and

  • Calcium.


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