You have just arrived to work and been assigned to care for three patients: A, B
ID: 123062 • Letter: Y
Question
You have just arrived to work and been assigned to care for three patients: A, B, and C. Selected lab work for each patient is listed below.
Which patient needs to be assessed first based on the information above? Why?
What could be some possible causes of the hyperkalemia?
Patient B is also complaining of numbness and tingling, especially around the mouth. What are the other two electrolyte imbalances in this patient that could be causing these symptoms?
Discuss the possible etiology associated with each electrolyte imbalance identified in question number 3.
What manifestations are associated with the three electrolyte imbalances in Patient B?
How would you interpret Patient B’s arterial blood gases?
What body system will attempt to compensate?
Chemical Patient A Patient B Patient C Na+ 138 mEq/L 142 mEq/L 148 mEq/L K+ 5.1 mEq/L 6.1 mEq/L 3.8 mEq/L Ca+ 8.9 mg/dL 7.5 mg/dL 9.5 mg/dL Mg+ 1.3 mg/dL 0.9 mg/dL 2.1 mg/dL pH 7.40 7.32 7.42 PCO2 42 mm Hg 48 mm Hg 40 mm Hg PO2 95% 98% 99% HCO3 22 28 26Explanation / Answer
Patient B needs to be assessed first becaise his lab investigation revealed high potassium, low calcium and magnesium value which can cause cardiac arrhythmias and can be fatal in some cases.
The possible cause of hyperkalemia could be over dosing of the drug, tumor lysis, acute kidney failure, some drugs like ace inhibitor, potassium sparing diuretics.
Patient B symptoms can be associated with low calcium becuse it can cause muscke twitching as well which is observed by patient B arround the mouth. Patient also hav low magnesium can be associated.
Possible etiology:
The hyperkalemia occours due to increased potassium intake or taking medicine like ace inhibitor or can also be due to cell lysis like in tumor lysis syndrome.
The low calcium can be due to inappropriate functioning of gland or can also be due to medicines like bisphosphonates and can also present with vitamin D deficiency. It can also be seen in tumor lysis.
Clinical menifestation involves:
Cardiac arrhythmia, numbness, tingling sensation, muscle twitching, muscle cramps, bradycardia or tachycardia, seizure, confusion and muscle weakness.
The arterial gases intrpretation reveals metabolic acidosis because ph is low, bicarb is high
The body system will attempt to compensate the acidosis im the body.
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