Question

nurse has just been assigned to care for three patients: A, B, and C. Selected lab work for each patient is listed below.

Chemical Patient A Patient B Patient C Nat 138 mEq/L 142 mEq/L 148 mEq/L 5.1 mEq/L 6.1 mEq/L 3.8 mEq/L Cat 8.9 mg/dL 7.5 mg/dL 9.5 mg/dL Mg+ 1.3 mg/dL 0.9 mg/dL 2.1 mg/dL pH 7.40 7.32 7.42 PCO2 42 mm Hg 48 mm Hg 40 mm Hg PO2 95% 98% 99% HCO3 22 28 26

1. Which patient needs to be assessed first based on the information above? Why?
2. What could be some possible causes of the hyperkalemia?
3. Patient B is also complaining of numbness and tingling, especially around the mouth. What are the other two electrolyte imbalances in this patient that could be causing these symptoms?
4. Discuss the possible etiology associated with each electrolyte imbalance identified in question number 3.
5. What manifestations are associated with the three electrolyte imbalances in Patient B?
6. How would you interpret Patient B’s arterial blood gases?
7. What body system will attempt to compensate?

Answer 1

1) patient B should be assessed first because of impaired electrolyte balance potassium of 6.1meq/Lehich can lead to arrythemia and sometimes cause death.pstirnt also has a pH of 7.32 which shows that the patient is in acidosis and if not treated can lead to compromised respiratory status .

2)hyperkalemia can be caused by various reasons like dehydration,increased intake of potassium Rick food like banana's,fruits, vegetables.certain medication like antibiotics,ACE inhibitors can cause high serum potassium diseases like Addison's disease which is caused by decreased secretion of urinary potassium causes hyperkalemia.acute kidney injury or chronic kidney disease can cause hyperkalemia.diseases like burns , uncontrolled diabetes, rahbdomylosis affect the intracellular movement of potassium leading to hyperkalemia.

3)Numbness and tingling sensation caused by involuntary muscular movement is the classical symptoms of hypocalcemia patient B has a low serum calcium level normal is 8.5-10 mg/dl . Hypomagnesemia can also cause tremors . patient B has serum magnesium of only 0.9 mg/dl which is very low .normal magnesium levels are 1.5-2.8mg/dl.

4)Etiology of Hypomagnesemia

Hypomagnesemia is caused by various reasons like insufficient magnesium intake consuming less amount of food containing magnesium can cause Hypomagnesemia.Certain Gastro intestinal diseases like diarrhoea, vomiting, malabsorption or chrons disease,ulcerative colitis can cause hypomagnesemia.certain medicines like antibiotics,diuretics,proton pump inhibitor can lead to hypomagnesemia.Patients having chronic kidney disease which affects the absorbtion of magnesium also causes hypomagnesemia

Etiology of hypocalcemia

Hypocalcemia is caused by various reasons like hypoparathyroidism which leads to decreased production of parathyroid hormone which regulates the serum calcium as a result of which causes hypocalcemia.certain diseases like vitamin D deficiency,burns, rahbdomylosis, chronic kidney disease can cause hypocalcemia.certain medication like excessive use of calcium channel blockers can cause hypocalcemia.

Etiology of Hyperkalemia

Hyperkalemia is caused by various reasons like kidney disease which affects the urinary absorption of potassium causes hyperkalemia.diseases like uncontrolled diabetes,rahbdomylosis,burns can cause hyperkalemia,intake of potassium Rich foods like fruits and vegetables can lead to hyperkalemia.certain medications like antibiotics,ACE inhibitors can cause hyperkalemia.