Fluid, electrolyte and acid-base balance case study.pdf
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Hostos Community College, CUNY *
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Course
216
Subject
Medicine
Date
Apr 3, 2024
Type
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3
Uploaded by yukaterada30
Ann is 28-year-old woman with a history of type 1 diabetes mellitus diagnosed when she was 5-
year-old. She has been brought into the emergency department this morning by her partner, Greg as she is lethargic and unable to make any sense. Greg reports she has been sick with a flu-like illness for the past week, with nausea and vomiting over the past 2 days. Ann had decided not to take her usual insulin dose last night as she hadn’t been eating and her blood sugar was only 145. On examination, you find Ann has a Glasgow Coma Scale score of 10 (eye opening:3, verbal response: 3, motor response: 4). She has deep, rapid respirations, acetone smell on her breath, and her skin is flushed and dry. Greg reports she had gone to the toilet several times during the night and, when she woke up this morning, she had wet the bed. Her blood glucose level is 375 Urinalysis shows large amounts of glucose and ketones with low specific gravity. Her vital signs are: BP 102/54 mmHg HR 112 beats/minute RR 36 breaths/minute, rapid and shallow T 36.2 SpO2 96% on RA Medical staff suspects Ann has diabetic ketoacidosis (DKA) and order two large bore IVs inserted for fluid resuscitation and IV insulin administration. 1.
Which of the following explains the patient’s hypotension and diuresis? a.
Increased extracellular fluid b.
Increased osmotic pressure c.
Hyperkalemia d.
Increased vascular tonicity. 2.
Which of the following intravenous fluid is appropriate to treat this patient’s dehydration? a.
Isotonic b.
Hypertonic c.
Hypotonic d.
All of the above
Ann has been in the ER for half an hour. An indwelling catheter is placed to closely monitor Ann’s fluid balance while the diuresis continues. Ann is initially started on a rapid infusion of normal saline to replace fluid lost through the osmotic diuresis and improve her BP. Medical staff ordered to start IV insulin infusion to slowly decrease Ann’s blood sugar. Blood tests are taken to determine urea and electrolytes status as well as arterial blood gas analysis to assess the presence and extent of acidosis. Although Ann’s initial oxygen saturation levels were good, you apply a simple face mask with 6 L O2 supplemental oxygen as she is tachypnoea and you want to optimize her FiO2. After receiving 2 L of normal saline, Ann’s BP begins to improve. Her current vital signs are: BP 110/62 mmHg HR 102 beats/minute RR 34 beats/minute, still rapid and shallow T 37.2 SpO2 97% with 6 L O2 via simple face mask 1.
Which of the following has activated the renin-angiotensin-aldosterone mechanism? a.
Low pH/acidosis b.
Hyperkalemia c.
Hypotension d.
Osmotic diuresis The results of the blood tests, received 30 minutes later, show Ann’s potassium levels are 6.2 mmol/L. Her other electrolytes were within normal ranges. You immediately place her on a continuous electrocardiogram monitor and take a 12- lead ECG, which shows high peaked T waves. Her ABG results are: PH - 7.18 PaCO2- 40 mmHg HCO3 - 13 mmol/L PaO2- 125 mmHg SaO2 - 95% Twenty minutes after you take your initial ECG, Ann loses consciousness and her continuous ECG monitor shows a 6-second episode of ventricular tachycardia (VT), after which Ann regains consciousness, back to the original GCS 10 assessed on arrival. You notify medical staff
and take another 12-lead ECG, which still shows peaked T waves, but no other abnormality. You monitor Ann closely for any further VT episodes. Her vital signs are: BP - 106/62 HR- 121 RR- 30 , still rapid and shallow T 37.0 SpO2- 97% with 6L O2 via simple face mask. Anna is admitted and following and transferred to a medical ward to continue her treatment. 1.
Which of the following is shown in the ABG results? a.
Metabolic acidosis b.
Metabolic alkalosis c.
Respiratory alkalosis 2.
Which of the following can explain the dysrhythmia experienced by the patient? a.
Hyperkalemia b.
Hypotension c.
Intravenous fluid administration d.
Acidosis
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