Fluid_Lyte_LectureFinal_2012

Her pmh includes htn non insulin dependent diabetes

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Her PMH includes HTN, non-insulin dependent diabetes, & glaucoma. She takes furosemide 20 mg QD, diltiazem 90 mg QID, and metformin 500 mg BID. Her physical exam is unremarkable with the exception that her extremities & mucous membranes are dry. 154 / 98 / 15 87 Ca +2 8.7 Mg + 1.5 PO 4 2.9 3.1 / 22 / 1.6
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Case # 6 A 67 y/o volunteer gardener arrives to her routine physician visit tired and weak. When asked she indicates that the weeds are out of control & she is just tired from to much work. Her PMH includes HTN, non-insulin dependent diabetes, & glaucoma . She takes furosemide 20 mg QD, diltiazem 90 mg QID, and metformin 500 mg BID . Her physical exam is unremarkable with the exception that her extremeties & mucous membranes are dry . 154 / 98 / 15 87 Ca +2 8.7 Mg + 1.5 PO 4 2.9 3.1 / 22 / 1.6
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Case #7 A 40 y/o male presented to the ED with a chief complaint of profound weakness. He had noticed some mild weakness, generalized malaise, & mild nausea for 2 days but this marked weakness developed suddenly on the morning of admission. He was unable to weight bear & had to slide himself along the floor to call a neighbor. He was brought in by ambulance. Until 3 weeks ago, the pt had been healthy w/ no known medical problems, when he suffered a small MI. On that admission HTN and hypercholesterolemia were diagnosed & he was started on enalapril 20 mg BID, metoprolol 50 mg BID, pravastatin 20 mg QD, ASA 81 mg QD & clopidogrel 75 mg QD.
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Case 7 On arrival in the ED, the pt complained of severe, bilateral weakness in the lower extremities greater than upper, lower extremity numbness, tingling, & nausea. VS: 154/83-67-20 36.3 PE: unremarkable except mild abdominal tenerness Labs: 127 / 94 / 31 95 7.2 / 15 / 1.5 An EKG was ordered:
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Question: A 60 year old Caucasian male with a history of myocardial infarction presents to your clinic with a 2 week history of progressive shortness of breath and swelling of bilateral lower extremities. What fluid and/or electrolyte disorder(s) would you expect to find? A) Edema B) Hypernatremia C) Hypo calcemia D) All of the above
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What is the degree of edema? 1+ 2+ 3+ 4+
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Question: An anxious appearing 52 year old African-American female presents to the ED complaining of mild chest pain for the past few hours. When asked she also acknowledges feeling unusually tired. What fluid or electrolyte disorder might you expect to find? A) Potassium B) Magnesium C) Calcium D) Free water
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Reference Material Electrolyte Normal Range Sodium 135-145 mEq/L Potassium 3.5-5 mEq/L Chloride 90-110 mEq/L Bicarbonate 24-30 mEq/L Calcium (total) 8.5-10.5 mg/dl Magnesium 1.8-2.2 mEq/L** Phosphate 2.5-4.5 mEq/L Na / Cl / BUN glucose K / HCO 3 / SCr **Range different than DiPiro
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Objectives: At the end of this dis- cussion the learner should be able to: State compartmental distribution of body fluids Explain factors that cause body fluids to shift Explain the mechanisms of regulation for: H 2 O, Na + , K + , Ca ++ , Mg + , PO 4 - balance List common disorders that result in Na and water imbalances List the causes of electrolyte disturbances Describe the manifestations of electrolyte disturbances Indicate common findings of fluid & electrolyte disorders (physical, laboratory)
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