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CASE STUDY: Fluid, Electrolytes, and Acid-Base Imbalances

Patient Profile: Mr. T., a 73-year-old man who lives alone, is admitted to the hospital because of weakness and confusion. He has a history of chronic heart failure and chronic diuretic use.

Objective Data:

• Neurologic: Confusion,      slow to respond to questioning, generalized weakness
• Cardiovascular:      BP 90/62, HR 112 and irregular, peripheral pulses weak; ECG indicates sinus tachycardia
• Pulmonary: Respirations 12/min and shallow
• Additional      findings: Decreased skin turgor; dry mucous      membranes

Significant Lab Results:

Serum electrolytes

• Na+ 141 mEq/L
• K+ 2.5 mEq/L
• Cl- 85 mEq/L
• HCO3- 43 mEq/L

BUN 42 mg/dl

Hct 49%

Arterial blood gases

• pH 7.52
• PaCO2 55 mmHg
• PaO2 88 mmHg
• HCO3- 42 mEq/L

Critical Thinking Questions

1.  Evaluate Mr. T’s fluid volume and electrolyte status. Which physical assessment findings support your analysis? Which lab results support your analysis? What is the most likely etiology of these imbalances?

2.  Explain the reasons for Mr. T’s ECG changes

3   Analyze the arterial blood gas results. What is the etiology of the primary imbalance? Is the body compensating for this imbalance?

4  Why has Mr. T’s advanced age placed him at risk for his fluid imbalance?

5.  Discuss the role of aldosterone in the regulation of fluid and electrolyte balance. How will changes in aldosterone affect Mr. T’s fluid and electrolyte imbalances?