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

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 Other laboratory values are normal.

3. Subjective and objective for this patient are?

4. Question:
What do you think this patient has ?
I. Volume overload
II. Volume depletion
III. None of the above
IV. Both

6. Question:
What do you think this patient has ?
I. Volume overload
II. Volume depletion
III. None of the above
IV. Both

7. True and False Questions
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

8. What’s the goal of therapy in this patient ?
Restore intravascular volume and prevent organ hypoperfusion. Fluid resuscitation is indicated for patients with signs or symptoms of intravascular volume depletion.

9. Case Study 2
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.

10. I. Hypernatremia, hypervolemia II. Hyponatremia , hypovolemia
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

11. I. Hypernatremia, hypervolemia II. Hyponatremia , hypovolemia
Question:
This patient has
I. Hypernatremia, hypervolemia
II. Hyponatremia , hypovolemia
III. Hyponatremia, hypervolemia
This patient has (tachycardia, Hypotension )… hypovolemia
Serum Na+ … low (hyponatremia)

13. 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

14. 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
Obtundation: altered level of consciousness
Malaise: general feeling of discomfort

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

16. Case Study 3
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.

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

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

19. 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 mmol/L.
Assessment: Based on clinical presentation and lab values
This patient has hypokalemia that’s resistant to the conventional treatment
Plan?

20. The cause of hypokalemia in this case ?
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

21. 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.

22. Complete the following sentences
Regarding symptoms of mild hypokalemia ( mEq/L) patient is ……………..……………( symptomatic / asymtomatic )
Regarding symptoms of moderate hypokalemia ( mEq/L) ) patient may complain of symptoms include …………………………………………. .
Patient with severe hypokalemia ( <2.5 mEq/L) can have ……………………………. (signs ,symptoms )

23. Complete the following sentences
Regarding symptoms of mild hypokalemia ( mEq/L) patient is ……………..……………( symptomatic / asymtomatic )
Regarding symptoms of moderate hypokalemia ( mEq/L) ) patient may complain of symptoms include …………………………………………. .
ANSWER: cramping, weakness, malaise, and myalgias
Patient with severe hypokalemia ( <2.5 mEq/L) can have ……………………………. (signs ,symptoms )
ANSWER
Musculoskeletal: Cramping and impaired muscle contraction.

24. What type of hyperkalemia this patient has ?
I. Mild hypokalemia
II. Moderate hypokalemia
III. Severe hypokalemia

25. What type of hyperkalemia this patient has ?
I. Mild hypokalemia
II. Moderate hypokalemia
III. Severe hypokalemia