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Posted: October 31st, 2023
Fluid, Electrolyte and Acid-Base Homeostasis: Ms. Brown is a 70-year-old woman with type 2 diabetes mellitus who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. On admission, her laboratory values show the following:
• Serum glucose 412 mg/dL • Serum sodium (Na+) 156 mEq/L • Serum potassium (K+) 5.6 mEq/L • Serum chloride (Cl-) 115 mEq/L • Arterial blood gases (ABGs): pH 7.30; PaCO2 32 mmHg; Pa02 70 mmHg; HCO3- 20 mEq/L
Case Study Questions
1. Based on Ms. Brown admission's laboratory values, could you determine what type of water and electrolyte imbalance does she has? 2. Describe the signs and symptoms to the different types of water imbalance and described clinical manifestation she might exhibit with the potassium levevshe has. 3. In the specific case presented which would be the most appropriate treatment for Ms. Brown and why? 4. What the ABGs from Ms. Brown indicate regarding her acid-base imbalance? 5. Based on your readings and your research define and describe Anion Gaps and its clinical significance.
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Fluid, Electrolyte and Acid-Base Homeostasis: A Case Study
Introduction
Ms. Brown is a 70-year-old woman with type 2 diabetes mellitus who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time (Bagshaw et al., 2020). On admission to the hospital, her laboratory values showed hyperglycemia, hypernatremia, hyperchloremia, and hyperkalemia. Her arterial blood gases (ABGs) indicated a compensated metabolic acidosis. This case study aims to analyze Ms. Brown's fluid, electrolyte, and acid-base imbalances based on her clinical presentation and laboratory findings.
Fluid and Electrolyte Imbalances
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Based on the laboratory results, Ms. Brown appears to have multiple water and electrolyte disturbances. Her hyperglycemia (glucose 412 mg/dL), hypernatremia (sodium 156 mEq/L), hyperchloremia (chloride 115 mEq/L), and hyperkalemia (potassium 5.6 mEq/L) indicate dehydration (Gillis et al., 2020; Roberts et al., 2021). Her inability to eat or drink for two days coupled with her physical examination findings are consistent with dehydration. Hyperkalemia can cause muscle weakness, paralysis, and cardiac arrhythmias (Kovesdy & Kalantar-Zadeh, 2020).
Signs and Symptoms of Imbalances
The signs and symptoms of dehydration include increased thirst, dry mouth, decreased urine output, fatigue, dizziness, headache, loss of skin turgor, and sunken eyes. In severe cases, it can cause altered mental status. Hyperkalemia increases the risk of cardiac arrhythmias (Gillis et al., 2020; Kovesdy & Kalantar-Zadeh, 2020).
Acid-Base Imbalance
Ms. Brown's ABG values of pH 7.30, pCO2 32 mmHg, and HCO3- 20 mEq/L indicate a compensated metabolic acidosis likely due to her hyperglycemia and possibly also her dehydration (Kovesdy & Kalantar-Zadeh, 2020).
Anion Gap
The anion gap is a useful clinical tool to help identify acid-base disturbances. It is calculated by subtracting serum chloride and bicarbonate from sodium. An elevated anion gap suggests an acidosis caused by unmeasured anions like ketones, lactate, or uremic toxins (Bagshaw et al., 2020).
Treatment
Initial treatment for Ms. Brown should focus on intravenous rehydration with isotonic fluids to correct her dehydration along with close cardiac monitoring due to her hyperkalemia. Additional treatments may be needed depending on her response and acid-base status (Bagshaw et al., 2020).
Conclusion
In summary, Ms. Brown presented with dehydration and electrolyte disturbances of hyperglycemia, hypernatremia, hyperchloremia, and hyperkalemia. Her ABG results indicated a compensated metabolic acidosis. Prompt IV rehydration was the most appropriate initial treatment given her clinical status.
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