An 87-year female, with a 3-day history of intermittent abdominal pain, abdomina

Question

An 87-year female, with a 3-day history of intermittent abdominal pain, abdominal bloating, and nausea and vomiting, came to the emergency department. She moved from Puerto Rico to join her grandson and his family only 2 months ago and speaks very little English. All information was obtained through her grandson.

PMH includes an abdominal hysterectomy 12 years ago and an inguinal hernia repair 2years ago. She has nod history of coronary artery disease, diabetes or pulmonary disease. She takes only ibuprofen occasionally for mild arthritis. She has no known drug allergies (NKDA).

Vital signs are: Blood Pressure 134/84, Pulse 84 beats/minute and regular, Respirations 20/minute and Temperature 97.2º F (36.2 ºC). An IV of D5 ½ NS with 20 mEq KCl at 100 mL/hour is started Nasal O2 at 2 L is also ordered.
After 3-days of NGT suctioning the client’s symptoms are unrelieved. She reports continued nausea, cramping, and sometimes very strong abdominal pain. She seems increasingly lethargic.

You look up her latest laboratory test values and compare them to the admission data. Na from 136 to 132 mEq/L, K has changed from 3,7 to 2.8 mEq/L, Cl from 108 to 97 mEq/L, G from 126 to 79, CO2 from 25 to 31 mEq/L, BUN form 19 to 31 mg/dL and Cr from 1 to 1.6 mg/dL. . What are the reasons for these abnormal lab values? What IV solution should this client be receiving?

Explanation / Answer

Many elderly patients have underlying conditions such as diabetes or malignancy, further suppressing immunity. There is a drop in electrolytes and blood glucose level but that is very mild disturbance. Increased biochemistry values like Cr, BUN CO2 that is may be related to Kidney, liver or gastro intestinal bleeding.

Some of the common causes of electrolyte imbalance are due to fluid loss, which can stem from situations including: Being sick with symptoms including vomiting, diarrhea, sweating or high fevers that can all produce fluid loss or dehydration.

Drop in blood glucose level may be due to some disturbance in pancreas, may be the abdominal pain due to acute pancreatitis/tumor, So she need to get checked her Serum Lipase and serum amylase to consider.

A poor diet that's low in essential nutrients from whole foods caused drop in electrolytes. This may happen due to kidney disease or liver disease or due to severe nausea vomiting.

Elevated creatinine level signifies impaired kidney function or kidney disease. As the kidneys become impaired for any reason, the creatinine level in the blood will rise due to poor clearance of creatinine by the kidneys. Abnormally high levels of creatinine thus warn of possible malfunction or failure of the kidneys. Urea nitrogen levels tend to increase with age. BUN, Cr, Co2 increases because of the following reasons

-Urinary tract obstruction

-Congestive heart failure or recent heart attack

-Gastrointestinal bleeding

-Dehydration resulting from not drinking enough fluids or for other reasons

This lab values alone may not conclude the diagnosis, this female has to undergo CT abdomen with and without contrast to rule out the exact cause of her cramping pain and proceed with the treatment.

She is currently on IV of D5 ½ NS with 20 mEq KCl at 100 mL/hour

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