Abstract A 67-year-old female with a history of primary pulmonary carcinoid tumor with metastasis to the liver presented with shortness of breath and generalized weakness. On presentation, her vital signs were BP 170/100 mm Hg, pulse 99/min, RR 18/min, O2 saturation 85% on room air. Physical exam was significant for diffuse rhonchi in bilateral lungs. Initial labs showed marked hypokalemia with K+ 2.5 and HCO3- 42. CT scans showed increased numbers of nodules and sizes in the lungs and numerous large liver masses.…