Question

I NEED ANSWERS TO ALL 3 QUESTIONS BELOW

Brian is a 68-year-old man with chronic renal failure who was in the hospital in serious condition recovering from a heart attack. He had just undergone "balloon angioplasty" to redilate his left coronary artery, and was thus on an "npo" diet (i.e. he was not allowed to have food or drink by mouth). He received fluid through an intravenous (IV) line. Late one night, a weary nurse who was on the 11th hour of a 12-hour shift came into the patient's room to replace the man's empty IV bag with a new one. Misreading the physician's orders, he hooked up a fresh bag of IV fluid that was "twice-normal" saline rather than "half-normal" saline (in other words, the patient starting receiving a fluid that was four times saltier than it should have been). This mistake was not noticed until the following morning. At that time, the man had marked pitting edema around the sacral region and had inspiratory rales ("wet-sounding crackles") at the bases of the lungs on each side. He complained that it was difficult to breathe as well. Blood was drawn, revealing the following:Na+157 mEq / liter (Normal = 136-145 mEq / liter)K+4.7 mEq / liter (Normal = 3.5-5.0 mEq / liter)C1-101 mEq / liter (Normal = 96-106 mEq / liter)A chest x-ray revealed interstitial edema in the lungs

1. What is this man suffering from?
2. What manifestations are mentioned in the case and what has caused them?
3. How might this problem be treated?

Answer 1

The patient is suffering from pulmonary edema (interstitial edema) due to fluid overload

The patient has the following manifestation

Difficulty in breathing due to the accumulation of fluid in the alveolar sacs making the air exchange difficult and thus leading to dyspnea because of low oxygen level.

Pitting edema in the sacrum due to the combination of both heart and kidney disease. In addition to this the increased sodium level in the blood affects the circulatory (poor circulation) and the eliminatory (CRF) system of the body leading to retention of the fluid in the dependent areas of the body.

This problem can be treated by doing a dialysis to remove excess sodium from the blood and maintain homeostasis

Provide a low or zero sodium diet to patient

The other treatment is to control an elevated blood pressure due to hypernatremia

Diuretics to improve the urine output to prevent fluid overload and excretion of sodium

Oxygen administration to relieve breathing difficulty