Fluid_Electrolyte_cases_Bb_2012 (1)

Heart failure hf secondary to an acute myocardial

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heart failure (HF) secondary to an acute myocardial infarction (AMI) 3 years ago. She presents for a routine medicine clinic visit. She indicates that she has been short of breath; more recently has had swelling in her lower leg and headaches. PE: 132/88-118-12 afebrile Lungs: crackles in the lower base, Ext: see next slide 132 / 97 / 24 128 3.8 / 27 / 1.2
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Case # 3 Q: Calculate the serum osmolality Q: How do you assess her fluid balance? Q:Why is the sodium low? Q: Are there any signs/symptoms of hyponatremia present?
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Case # 4 The family of a 65 y/o female called EMS after witnessing her having a seizure. On arrival to the ED she is confused and combative. She has a recent diagnosis of small cell lung cancer. On physical exam she appears to be well nourished, mucous membranes are moist, normal skin Turgor, no signs of edema. Lab: 122 / 92 / 18 78 urine Osm 430 mOsm/L 4.2 / 24 / 1.4 urine Na 32 mEq/L Q: What is the serum osmolality? Q: Is there an electrolyte abnormality? Q: What should be considered in the differential diagnosis?
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Case # 5 Joe is an 85 y/o with advanced dementia who was sent to the ED from his skilled nursing facility. This AM the nurse found him to be unresponsive. The remainder of his PMH is unknown. Aside from his mental status, his physical exam is remarkable for a BP 100/50, HR 110. Labs:
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heart failure HF secondary to an acute myocardial...

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