Question

Adam is a 68-year-old male admitted to the hospital with a 1-month history of nausea, vomiting, and diarrhea resulting in weight loss and fatigue. He presents tachycardic with abdominal pain, fever, and chills. Adam is a retired engineer and lives at home with his wife.

Anthropometric Data:
Height: 165 cm (65”)
Weight: 75 kg (165 lbs)
BMI: 27.5 kg/m2

Weight History
Usual body weight: 82 kg (180 lbs) 1 year ago

Biochemical Data:
Sodium 129 (135-145 mEq/L) Potassium 3.2 (3.6-5.0 mEq/L) Low-density lipoprotein 41 (Desirable <100 mg/dL)
Chloride 90 (98-110 mEq/L) High-density lipoprotein 52 (Desirable ≥40 mg/dL)
Carbon dioxide 43 (20-30 mEq/L) Triglycerides 40 (Desirable <150 mg/dL)
Blood urea nitrogen 30 (6-24 mg/dL) Hemoglobin 11.1 (13.5-17.5 mg/dL)
Creatinine 0.5 (0.4-1.3 mg/dL) Hematocrit 36.4 (42%-52%)
Glucose 166 (70-139 mg/dL) White blood cells 6 × 109 (5-10 × 109/L)
Magnesium 1.3 (1.3-2.1 mg/dL) Mean corpuscular volume 89 (80-99 fL)
Calcium 8.0 (8.5-10.5 mEq/L) Mean corpuscular hemoglobin concentration 32 (32-36 g/dL)
Phosphorus 2.7 (2.7-4.5 mg/dL) Red cell distribution width 50 (39-36 fL)
Serum osmolality 250 (275-295 mOsm/kg)
Albumin 2.6 (3.5-5.0 g/dL)

Clinical Data:
Past Medical History: Hypertension, hypercholesterolemia, hypertriglyceridemia, gastroeophageal reflux disease
Medications: Lipitor, Captopril, aspirin, Immodium, omeprazole
Vital Signs: Blood pressure 110/50 mm Hg, temperature 99.6° F, heart rate 115 beats/min,
tachycardic
Nutrition-focused Physical Exam: Patient noted to be pale with dry skin and poor skin turgor.
Temporal muscles mildly wasted. Upper arm and lower extremity fat loss evident. Abdomen appears
slightly distended. Oral exam notable for a dry tongue and good dentition. No wounds observed and
no edema noted. No shortness of breath evident.

Dietary Data:
Dietary History: Normal appetite. Adam reveals he has avoided high-fat foods for the past year, and
limits his sodium intake. He reports that he has had minimal intake for 3 to 4 days prior to admission.
Usual Diet Recall:
Breakfast: 8 oz orange juice, hard-boiled egg, 1/2 bagel with 2 oz cream cheese
Lunch: Sandwich with 3-4 oz turkey or ham and mustard on white bread, canned soup, 1 oz potato
chips, 1% milk, apple
Dinner: 4 oz baked chicken, 2/3 cup rice, ½ cup cooked green beans
Diet Prescription: NPO (nil per os or nothing by mouth)

Adam requires treatment for his hyponatremia (Na+ 129 mEq/L; normal: 135 - 145 mEq/liter). The medical team asks for possible means of correcting his sodium through nutritional modifications of his diet.

Questions
1. What are the possible causes of Adam’s hyponatremia?

2. What labs might help you determine its cause?

3. How would you recommend his hyponatremia be treated?



4. Explain your rationale.

Answer 1

Q. No 1. Answer :

Possible causes of hyponatremia including vomitings, and diarrhea, because through these the sodium may flushing out.

* and also he was on low sodium intake diet.

Q. No 2. Answer :

By doing urine examination we can find out sodium loss, because through kidneys filtration may taken place.

Q. No 3. Answer : I will advise to talk sodium content diet, by including additional salt in diet. If client can take orally.

* if not takes orally, administration of normal sodium chloride solutions, and sodium bicarbonate injection in normal saline.

Q. No 4 .answer :

By administration of fluids we can correct the dehydration level, and can maintain normal sodium levels By these valumes entering into the blood.