Question

• A patient presents in DKA (diabetic ketoacidosis), in addition to that they are lethargic and complaining of severe fatigue, nausea and vomiting. What is fluid imbalance is also going on with this patient? What are interventions for this patient?

• A patient with chronic renal failure presents with a wet cough, bilateral lower extremity and abdominal swelling. What fluid imbalance is also going on with this patient? What are interventions for this patient?

Answer 1

▪︎ Increased blood sugar raises extracellular fluid osmolality. So the water enters into the extracellular space and intracellular dehydration occurs. Increased Urine output and electrolyte loss can result in total body dehydration and sodium depletion. Acidosis can cause nausea and vomiting and leads to more fluid loss.

•Management:

*Administer IV fluids to compensate the fluid loss

*Administer insulin to reduce blood sugar levels

*Administer potassium supplements to correct electrolyte imbalance

*Correction of acid base imbalance

▪︎In chronic renal failure excessive fluid loss from the body and inability of kidney to concentrate the urine results in electrolyte imbalance. Fluid retention is in body can cause swelling in the extremities.

* Administer diuretics to reduce fluid retention

*Restrict sodium and potassium intake

*Instruct the patient to strictly avoid high intake of protein

*Correct acid base imbalance