Question

Electrolyte Imbalance	Patient History/Manifestations	Top Treatment	Unique defining characteristic
	Kevin Fostner is a 53-year-old male who had CABG 3 days ago and received one unit of PRBC which put him into fluid overload. He then received 20mg Lasix IV push and produced 2300 ml clear pale yellow urine. He is having multiple PVCs and ectopic beats on the cardiac monitor.
	Betty Cruz is a 52-year-old female admitted post-surgery after a tumor was removed from her pituitary gland. Her urine output has been 1000 ml clear pale per hour and treated hourly with Vasopressin and fluid volume replacement
	Mary Meadows is a 62-year-old female with a diagnosis of lung cancer. She has been on bedrest for the past two weeks. She complains of constipation, nausea, depression, bone pain. She has frequency and has been passing kidney stones. She is receiving Calcitonin 4 units per kg SQ every 6 hours. She is getting NS IV fluid at a rate of 100 ml/hour
	Diane Jones is a 48-year-old female admitted 3 days ago reporting severe nausea and abdominal cramping, with hyperactive bowel sounds. She has had an NG inserted to LIWS draining large amounts of pale yellow to clear secretions. She has had orthostatic hypotensive for the past 24 hours and her urine output as drastically decreased. She has become lethargic and is on seizure precautions
Electrolyte Imbalance	Patient History/Manifestations	Top Treatment	Unique defining characteristic
	Barney Daniels is a 57-year-old patient with a history of alcohol abuse was admitted status post full cardiac arrest. His heart rhythm was found to be Torsades de pointes. He was defibrillated and returned to sinus tachycardia with prolonged RR and QT intervals. He has been complaining of anorexia, nausea and vomiting for the past several days at the independent care center that he resides in. He has a distended abdomen and absent bowel sounds, confusion, hyperreflexia, positive Chvostek’s Sign and positive Trousseau’s Sign. His albumin level is low.
	Kendra Whitfield is a 28-year-old patient admitted with acute abdominal pain and a history of Crohn’s Disease. She has facial twitching/muscle tetany, hyperactive bowel sounds & reports of diarrhea and abdominal cramping, hypoalbuminemia, hyperphosphatemia, and a positive Chvostek’s Sign and positive Trousseau’s Sign, and prolonged QT interval. She is hypotensive
	Sally Anderson is a 67-year-old farmer’s wife who loves prune juice, cantaloupe, milk, apricots, avocados, raisins and the tomatoes just came into season. She has borderline renal dysfunction with a GFR of 70. She is on an ACE inhibitor and spironolactone. Her complaint upon admission is that she feels exhausted. Her HR is 45 and irregular, her B/P is 79/59, she is restless and weak. Upon looking at the heart monitor you notice peaked T-waves

Answer 1

#. Electrolyte imbalance :-

1) Kevin Fostner is a 53-year-old male who had CABG 3 days ago and received one unit of PRBC which put him into fluid overload. He then received 20mg Lasix IV push and produced 2300 ml clear pale yellow urine. He is having multiple PVCs and ectopic beats on the cardiac monitor.

- Hypokalemia

Thiazide diuretics increase sodium delivery to the distal segment of the distal tubule, this increases potassium loss potentially causing hypokalemia.

2) Betty Cruz is a 52-year-old female admitted post-surgery after a tumor was removed from her pituitary gland. Her urine output has been 1000 ml clear pale per hour and treated hourly with Vasopressin and fluid volume replacement

- Hyponatremia

Inappropriately elevated plasma levels of vasopressin in conditions such as SIADH and heart failure increase water reabsorption and retention, which will disproportionately expand the plasma volume, thus resulting in dilutional hyponatremia.

3) Mary Meadows is a 62-year-old female with a diagnosis of lung cancer. She has been on bedrest for the past two weeks. She complains of constipation, nausea, depression, bone pain. She has frequency and has been passing kidney stones. She is receiving Calcitonin 4 units per kg SQ every 6 hours. She is getting NS IV fluid at a rate of 100 ml/hour

- Hypocalcaemia

High concentrations of calcitonin may be able to increase urinary excretion of calcium and phosphate via the renal tubules leading to marked hypocalcemia.

4) Diane Jones is a 48-year-old female admitted 3 days ago reporting severe nausea and abdominal cramping, with hyperactive bowel sounds. She has had an NG inserted to LIWS draining large amounts of pale yellow to clear secretions. She has had orthostatic hypotensive for the past 24 hours and her urine output as drastically decreased. She has become lethargic and is on seizure precautions.

- Hypokalemia

Nasogastric suctioning produces volume depletion and metabolic alkalosis, which are accompanied by increased renal potassium excretion and causes hypokalemia .