Case Studies 3

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Ms. Renolds, age 72, has a history of CHF. She came to the ED with crackles, edema and weight gain.  She has been on a sodium restricted diet and only takes her diuretic when her feet swell.

Lab values:  Na  133,  K  3.0,  Cl  93, CO2  21, BUN  25, Creat  1.0

  1. Which values are abnormal?

  2.   Why?

  3.  What treatment do you expect?  

  4. What preventative interventions will you institute?

Mr. Lawson, age 53, has been on diuretics and a sodium restricted diet for CHF.  In the last 2 weeks he has noticed fatigue, nausea, vomiting, and light-headedness. Assessment reveals: weight has decreased by 5 kg, no edema, lungs are clear. 

BP 120/60 lying, 90/50 standing.  HR 92 and irregular.

Lab values:  Na 132, K  3.0, Cl  103, CO2  18, BUN  50, Creat  1.8

  1.  Identify what lab values are abnormal, hypothesize about why and what you expect to be done. 

  1. Analyze the following ABGs for acid-base and oxygenation:

pH        7.15
PaCO2    70
PaO2      70
HCO3      26
SaO2        91

 

Ms. Raymond is admitted for reoccurrence of regional enteritis. She is on a low sodium diet and hydrochlorothiazide for hypertension. During surgery she had a hypotensive episode and is admitted to ICU receiving mechanical ventilation. 

pH        7.55               K  2.8
PaCO2   35      
PaO2     110            
HCO3      30            

  1.  Identify abnormal lab values.  Discuss why labs are abnormal and what you expect to be done. 

 Mr. Evans comes in with no edema, normal BP, and 7 pound weight gain. Na   126, K   3.5,  Cl  93. 

  1. What is your best statement of the fluid and electrolytes status and why.

A 35 year old teacher was involved in a motor vehicle crash. 48 hours after the crash the urine output was 350 ml/day, BP 165/94. A fluid challenge was given without incrase in urine.

BUN    36 Urine Na     39 mEq/L
Creat  4.2 Spec. grav  1.028
Serum osmo  650

  1. Based upon the history and lab work, you expect a diagnosis of

a.  dehydration
b.  fluid overload
c.  prerenal failure
d.  intrarenal failure 
e.  postrenal failure 

 

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