Fluid and Electrolyte Case Study

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A 65 year old female is admitted to your unit complaining of nausea vomiting and diarrhea for 3 days. Her history is unremarkable except hypertension for which she takes hydrochlorothiazide. She relates feeling exhausted and having leg cramps which interfere with her sleeping. Notable assessment findings include:
Temp: 38.6C. AP 102 and irregular, BP 90/50; absent bowel tones, dry skin and poor turgor, and poor muscle tone. As the causes
Labs: K 2.0mEq/L; NA 137 mEq/L; CL 97 mEq/L; and WBC 20,000/ul.
MD orders:
I V D50 .9%Nacl with 20mEq KCL/L to infuse @ 90cc/hr.
40mEq of KCL IV over the next 2 ho0urs
K level 30 minutes after the 40mEq IV KCL has infused.
Bedrest: May use Bathroom
NPO
Questions
1. What fluid and electrolyte disturbances does this client have?
2. What electrolyte disturbance is o0f most concern with this client and why?
3. What signs and symptoms that the patient exhibits can result from this electrolyte disturbance?
4. What do you suspect as the cause(s) of this electrolyte disturbance?
5. What type of solution is D50NS + 20 mEq KCL?
6. Would you question any of these orders? Why or why not?
7. Would you expect to see any changes on an EKG if one is taken?

Sample Solution

. What fluid and electrolyte disturbances does this client have?

The patient has hypokalemia (low potassium level), hyponatremia (low sodium level), and dehydration.

2. What electrolyte disturbance is of most concern with this client and why?

The most concerning electrolyte disturbance is hypokalemia. This is because potassium is an important electrolyte that helps regulate the heart rhythm. Low potassium levels can lead to arrhythmias, which can be life-threatening.

3. What signs and symptoms that the patient exhibits can result from this electrolyte disturbance?

The patient’s symptoms of nausea, vomiting, diarrhea, and leg cramps are all consistent with hypokalemia. Other symptoms of hypokalemia can include fatigue, weakness, muscle cramps, and confusion.

4. What do you suspect as the cause(s) of this electrolyte disturbance?

The patient’s hypokalemia is likely due to the vomiting and diarrhea she has been experiencing. These conditions can cause the body to lose large amounts of potassium. The hydrochlorothiazide that the patient is taking for hypertension can also contribute to hypokalemia.

5. What type of solution is D50NS + 20 mEq KCL?

D50NS + 20 mEq KCL is a type of IV solution that contains dextrose (sugar), sodium chloride, and potassium chloride. The dextrose and sodium chloride help to replenish the body’s fluids and electrolytes, while the potassium chloride helps to correct the hypokalemia.

6. Would you question any of these orders? Why or why not?

I would not question any of the orders. The IV fluids are appropriate to correct the patient’s fluid and electrolyte imbalances. The potassium chloride is also appropriate, and the dose is correct. The bedrest and NPO orders are also appropriate, as they will help to prevent further fluid and electrolyte losses.

7. Would you expect to see any changes on an EKG if one is taken?

Yes, I would expect to see changes on an EKG if one is taken. Hypokalemia can cause changes in the heart’s electrical activity, which can be seen on an EKG. These changes can include flattening of the T waves, ST segment depression, and QT prolongation.

Here are some additional things to keep in mind about this patient:

  • The patient is at risk for developing acute kidney injury (AKI) due to the dehydration and hypokalemia.
  • The patient should be monitored closely for signs of AKI, such as decreased urine output, rising creatinine levels, and electrolyte imbalances.
  • The patient should also be monitored for arrhythmias, as these can be life-threatening.

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