Question

	Patient A	Patient B	Patient C
Na+	138 mEq/L	142 mEq/L	148 mEq/L
K+	5.1 mEq/L	6.1 mEq/L	3.8 mEq/L
Ca+	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?

Answer 1

Patient B needs to be assessed first based on the information provided because of the following.

Electrolyte imbalance:

1. Severe hyperkalemia: Patient has potassium level of 6.1 mEq/L. Normal potassium level is 3.5 - 5.0 mEq/L.
2. Hypocalcemia: Patient has calcium level of 7.5 mg/dL. Normal calcium level is 8.5-10.2 mg/dL.
3. Hypomagnesemia: Patient has magnesium level of 0.9 mg/dL. Normal magnesium level is 1.5-2.5 mEq/L.

Acid-base imbalance:

pH: 7.32 (normal: 7.35-7.45)

PCO2: 48 mmHg (normal: 35 – 45 mm Hg)

HCO3: 28 (normal: 22-26 mEq/L)

Patient is in uncompensated respiratory acidosis.