What clinical manifestation suggests a primary metabolic alkalosis in cases of laxative use?

In the context of laxative use leading to primary metabolic alkalosis, hypokalemia is a key clinical manifestation. Laxatives, specifically certain types such as stimulant laxatives, can lead to loss of potassium through the gastrointestinal tract. Frequent use of these laxatives can result in excessive loss of fluids and electrolytes, including potassium, contributing to hypokalemia.

Metabolic alkalosis occurs when there is an increase in bicarbonate in the body or a loss of acid, which can happen due to the contraction alkalosis from fluid loss and electrolyte imbalances, particularly in the case of laxative abuse. The loss of potassium is particularly notable because potassium plays an essential role in maintaining acid-base balance and its deficiency can exacerbate metabolic alkalosis.

Hyperkalemia would not align with this scenario, as it refers to elevated potassium levels, which is not expected with laxative-induced metabolic alkalosis. Additionally, hepatomegaly with acidosis does not typically relate to laxative use but could signify other underlying conditions. Lastly, hyponatremia indicates low sodium levels, which may occur in various fluid depletion scenarios but is not a primary manifestation of metabolic alkalosis from laxative use.

Thus, hypokalemia is clearly the manifestation that supports the