Case Scenario
A 65 year-old male went hiking with two friends up in themountains. The week before, Mr. C had the flu but he was determined to make thefive hour climb. Mr. C’s wife packed some chocolate covered- dried cranberriesfor his snack since she believed the “fruit” would be healthy. Shewas concerned because Mr. C. had been a little depressed over the last yearsince the NP could not get his blood pressure under control. Mr. C. was put ona thiazide diuretic for his Hypertension. He has been taking Celexa for a fewmonths. Although Mrs. C. was concerned about her husband’s condition, shethought the hike might be good for him.
When the group got to the top of the mountains, the temp was75 degrees. As they descended, the air was hot and humid. Mr. C drunk all ofhis water from the snack box prepared by his wife. He stated he was”feeling dehydrated and wanted to stay hydrated” since he had the flulast week.
Mr. C told his friends that he was seeing spots in his eyesand feeling dizzy. The friends asked if he wanted to take a break and herefused. About 20 minutes later, he yelled “Run there is a lion”. Thefriends became very concerned at this time since they thought Mr. C. wastalking “out of his head”. A few minutes later, Mr. C. complained offeeling dizzy and fell down. He said “I must still be weak and dehydratedfrom the flu that I had last week. I cant think straight”. “I wonderif this could be a side of effect of my meds?
The friends rushed him to the nearest clinic. As the NP, yousent his lab work to the on-site clinical laboratory which provided thefollowing electrolyte test results:
Na+ = 128 meq/L
K+ = 4.5 meq/L
Cl- = 95 meq/L
Ca++ = 1 mmol/L
CO2 Total = 26 meq/L
Anion gap =9.6 mEq/L
glucose = 120
HCT = 33%
BUN= 5
Cr+ .9 mg/dL
AST/SGOT = 32
Albumin = 3.3
Protein, total = 5.3g/dL
Based on the information presented:
Which lab values areabnormal? Identify if elevated or decreased and state the rationale for theabnormality.
Identify Mr. Cdiagnosis. (Include both electrolyte and fluid alterations).
What is the mostlikely cause of this problem?
What are the physicalsymptoms of this problem?
What would you as theNP tell Mr. C how to prevent the problem?
What informationshould Mr. C. report to the NP when he arrived at the clinic? Why is thisimportant?
Is it better tomeasure calcium level by the amount of ionized calcium or total calcium? Discussthe rationale for your answer.
Identify the signsand symptoms you would expect to see for the abnormal fluid volume.
Which factors play arole in the degree of fluid and or electrolyte imbalances? Explain in detail.
Discuss what wouldhappen to the cells if these clinical problems are not corrected. i.e wouldthey shrink, swell etc.
Did Mr. C’s snackimpact his condition? Explain your answer.
Why was the K+ levelnormal?
What other factorcould have contributed to Mr’s C’s condition?
What is theappropriate treatment by the NP for the fluid and electrolyte imbalances?
ABG practice for you to complete (Required):
1. PaO2= 80
PaCO2= 48
pH= 7.30
HCO3 (Serum CO2) =19
2. PaO2= 87
PaCO2= 32
pH= 7.55
HCO3 (serum CO2) = 25
3. PaO2= 58
PaCO2= 59
pH=7.32
Serum CO2=30
4. PaO2= 92
PaCO2= 26
pH= 7.55
Serum CO2=24.5
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