Fluids and Electrolytes Mohammad Ruhal Ain R Ph, PGDPRA, M Pharm (Clin. Pharm) Department of Clinical Pharmacy Pathophysiology 2.

Fluids and

Electrolytes

Mohammad Ruhal AinR Ph, PGDPRA, M Pharm (Clin.

Pharm)Department of Clinical Pharmacy

Pathophysiology 2

Case Study 1

A 65-year-old man with a 3-day history of temperature to 102°F, lethargy, and productive cough is hospitalized for community-acquired pneumonia. •His medical history includes hypertension and coronary artery disease. • His vital signs include HR 104 beats/minute, BP 112/68 mm Hg, and temperature 101.4°F. His weight is 80 kg, decreased skin turgor, urine output 10 mL/hour, BUN 16, Cr 1.5 mg/dL, and WBC 10.4. Other laboratory values are normal.

Subjective and objective for this patient are?

Subjective:

Objective:

Question:

What do you think this patient has ? I. Volume overload II. Volume depletion III. None of the aboveIV. Both

Question:

What do you think this patient has ? I. Volume overload II. Volume depletion III. None of the aboveIV. Both

• Signs (like HR and BP) in patient with Intravascular Volume Depletion improved after a 500- to 1000-mL fluid bolus

[T] [F] •Tachycardia is the earliest sign of

volume depletion [T] [F]

True and False Questions

Restore intravascular volume and prevent organ hypoperfusion. Fluid resuscitation is indicated for patients with signs or symptoms of intravascular volume depletion.

What’s the goal of therapy in this patient ?

• A 72-year-old woman , weight 60 kg , with a history of hypertension has after starting hydrochlorothiazide she experiences dizziness, fatigue, and nausea. 3 weeks earlier. Her serum Na+ is 116 mEq/L K+ is 4 mEq/L, BP is 86/50 mm Hg, and HR is 122 beats/minute.

Case Study 2

Question:This patient has I. Hypernatremia, hypervolemia II. Hyponatremia , hypovolemia III. Hyponatremia, hypervolemia

Sodium : 135–145 mEq/L Potassium : 3.5–5.0 mEq/L

Question:This patient has I. Hypernatremia, hypervolemia II. Hyponatremia , hypovolemia III. Hyponatremia, hypervolemia

This patient has (tachycardia, Hypotension )… hypovolemia Serum Na+ … low (hyponatremia)

• A 72-year-old woman , weight 60 kg , with a history of hypertension has after starting hydrochlorothiazide she experiences dizziness, fatigue, and nausea. 3 weeks earlier. Her serum Na+ is 116 mEq/L K+ is 4 mEq/L, BP is 86/50 mm Hg, and HR is 122 beats/minute. Question: This patient has symptoms of hyponatremia and it appears after what level ? I.< 130 mEq/L II.<140 mEq/L III.<120 mEq/L

Question: This patient has symptoms of hyponatremia and it appears after what level ? I.< 130 mEq/L II.<140 mEq/L III.<120 mEq/L Malaise: general feeling of discomfort

Obtundation: altered level of consciousness

Question: The cause of hyponatremia is HCT (hydrochlorothiazide) ? (T/F)

A 40-year-old man has been admitted to the hospital after several days of vomiting and diarrhea. In the emergency department, he had several runs of non-sustained ventricular tachycardia. His plasma K+ on admission was 2.8 mEq/L. After receiving 200 mEq of potassium chloride (KCl) infused over 24 hours, his repeat K+ is 3.2 mEq/L, and he continues to have runs of ventricular tachycardia.

Case Study 3

Other laboratory findingsinclude Na+ 143 mEq/L, magnesium 1.1 mEq/L, phosphorus 3 mg/dL, Ca++ 9 mg/dL, and ionized Ca++ 1.1 mmol/L.

What information (signs, symptoms, laboratory values) indicates the presence and severity of the electrolyte abnormalities? ( SOAP )

Subjective: vomiting and diarrhea

Objective: he had several runs of nonsustained ventricular tachycardia. plasma K+ on admission was 2.8 mEq/L. include Na+ 143 mEq/L, magnesium 1.1 mEq/L, phosphorus 3 mg/dL, Ca++ 9 mg/dL, and ionized Ca++ 1.1 mmol/L.

Assessment: Based on clinical presentation and lab values This patient has hypokalemia that’s resistant to the conventional treatment

Plan?

a. Reduced intake seldom causes hypokalemia because renal excretion is minimized

because of increased renal tubular absorption.

b. Increased shift of K+ into cells can occur with the following:

i. Increased pH ii. Insulin or a carbohydrate load iii. β2-Receptor stimulation caused by

stress-induced epinephrine release or administration of a β-agonist (e.g., albuterol, dobutamine)

iv. Hypothermia

The cause of hypokalemia in this case ?

c. Increased GI losses of K+ can occur with vomiting, diarrhea, intestinal fistula or enteral tube drainage, and chronic laxative abuse.

d. Increased urinary losses can occur with

mineralocorticoid excess and diuretic use (e.g., loop and thiazide type). ( common cause )

e. Hypomagnesemia is commonly associated

with hypokalemia caused by increased renal loss of K+; correction of plasma K+ requires simultaneous correction of serum magnesium.

Complete the following sentences

Regarding symptoms of mild hypokalemia ( 3.5-3 mEq/L) patient is ……………..……………( symptomatic / asymtomatic )

Regarding symptoms of moderate hypokalemia ( 3- 2.5 mEq/L) ) patient may complain of symptoms include …………………………………………. . Patient with severe hypokalemia ( <2.5 mEq/L) can have ……………………………. (signs ,symptoms )

Complete the following sentences

Regarding symptoms of mild hypokalemia ( 3.5-3 mEq/L) patient is ……………..……………( symptomatic / asymtomatic )

Regarding symptoms of moderate hypokalemia ( 3- 2.5 mEq/L) ) patient may complain of symptoms include …………………………………………. .

Patient with severe hypokalemia ( <2.5 mEq/L) can have ……………………………. (signs ,symptoms )

ANSWER: cramping, weakness, malaise, and myalgias

ANSWER Musculoskeletal: Cramping and impaired muscle contraction.

What type of hyperkalemia this patient has ?

I. Mild hypokalemia

II. Moderate hypokalemia

III. Severe hypokalemia

What type of hyperkalemia this patient has ?

I. Mild hypokalemia

II. Moderate hypokalemia

III. Severe hypokalemia