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Fluid, Electrolyte and Acid-Base Homeostasis (Ms. Brown 70-year-old woman Case)

Analysis of Ms. Brown’s Laboratory values indicates

Ms. Brown electrolytes indicate that she has hyperglycemia (Serum glucose 412mg/dl).  Since Ms. Brown has not eating for two days and she has type 2 diabetes it is expected that her blood glucose will be high.  Also, the stress that her body in going through would elevate the glucose levels (McCance et.al., 2010).  Next, Ms. Brown is experiencing hypernatremia (Na+ 156mg/dl goes above the expected 147mg/dl range.  Since water follows sodium, edema is expected in the lower extremities and in the lungs.  The fact that Ms. Brown has not been able to eat or drink indicates a fluid overload in those body systems (McCance et.al., 2010).  The cough is the body’s attempt clear the lung field of excess fluid build-up.  The potassium level (5.6mEq/L) has far exceeded the 4.5mEq/L, so hyperkalemia is evident and alterations in contractility of the heart and skeletal muscles is expected (McCance et.al., 2010).  Lastly, Ms. Brown is experiencing hyperchloremia (115mEq/L) which surpasses the normal chloride range of 105mEq/L Ms. Brown will experience dehydration.

Signs and symptoms for Ms. Brown

Some signs and symptoms that are expected for Ms. Brown based on the above labs results are: In response to Hyperglycemia: elevated blood glucose, tiredness, increase risk of infection. Hypernatremia: pulmonary edema, lower extremities edema.  Hyperkalemia: cardiac arrythmias, skeletal muscle contraction, muscle weakness, and changes in the electrocardiogram.  Hyperchloremia: dehydration, headache, dry skin and mucus membranes. Other symptoms include poor tissue perfusion. elevated temperature, and decrease urine output (McCance et.al., 2010).

Appropriate treatment for Ms. Brown

Some treatment for Ms. Brown would be treat her with diuretics to remove excess water and sodium in the body.  Also, insulin injections to get glucose back into the cells.  Albuterol treatment to relieve the congestion of the airways. Keep the vein open fluid therapy to rehydrate the mucus membranes and skin in order to combat dehydration.  Place the client on a reduced sodium diet. Administration of calcium gluconate to decrease the potassium levels.  Lastly, the client may need some oxygen therapy to restore and lower respiratory demand placed on the heart ((McCance et.al., 2010).   

Ms. Brown ABGs indicate

Ms. Brown is experiencing hypertonic alterations due to the increase of sodium in the intracellular space resulting in hypervolemia.  The pH of 7.30 indicates slight or beginning acidemia. Lastly, the PaO2 70mmHg level indicates that Ms. Brown is in respiratory distress (McCance et.al., 2010). 

Anion Gaps and clinical significance

Traditionally the bicarbonate-anion gap system is the mainstay of treatment to detect metabolic imbalances.  The bicarbonate-anion gap system has failed to recognize accurately interpret metabolic disturbances in patients who are critically ill.  According to Paliwal et.al., 2022, the albumin corrected Anion Gap approach was able to identify missed metabolic disorders that were not obviously apparent in 11% of the participants he studies (Paliwal et.al, 2022).

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