NURS 3380 CASE STUDY FLUID AND ELECTROLYTE

NURS 3380 CASE STUDY FLUID AND ELECTROLYTE Fluid and Electrolyte Case Study Breanna Lively, RN Nursing 3380 Pathophysiology for RN’s Austin Peay State University School of Nursing June 11, 2019 Fluid and Electrolyte Case Study L.S. is brought to the emergency department for management of acute acetaminophen poisoning. Her respirations are slow and shallow, and she is nonresponsive. She is admitted to the critical care unit to be closely monitored for the development of respiratory failure and renal failure, which often accompany acetaminophen poisoning. Her urine output is decreased to about 20 mL/hr. Her laboratory values are serum K+ = 5.7 mEq/L; arterial blood gases (ABGs): pH = 7.13, PaCO2 = 56 mm Hg, PaO2 = 89 mm Hg, and HCO3- = 18 mEq/L. Answer the following questions about LS’s situation. 1. What is the most likely cause of LS’s potassium imbalance? Explain the role of the kidney in potassium excretion? The most likely cause of LS’s hyperkalemia is probably acute kidney injury (AKI). Usually the kidneys in normal function will excrete 90% of your daily potassium intake (Clegg and Palmer, 2016). “Metabolic acidosis occurs with the retention of acidic waste products of metabolism. It is also produced in association with hyperkalemia, when potassium ions in the blood are exchanged for intracellular hydrogen ions, lowering the pH of the blood” (Copstead and Banasik, 2018, p. 603). Clegg, D. J., & Palmer B. F. (2016). Physiology and pathophysiology of potassium homeostasis. Advances in Physiology Education, 40(4), 480-490. doi:10.1152/advan.00121.2016 Copstead, L. E., & Banasik, J. L. (2018). Pathophysiology. St. Louis, MO: Elsevier. 2. What is the relationship between acid-base balance and serum potassium level? LS is in an acidotic state, as seen by her pH and PaCO2 levels. According to Copstead and Bansik (2018), “Metabolic acidosis develops as a result of the kidney’s decreased ability to excrete hydrogen ions (acid load). The hydrogen ions shift into the cells in exchange for intracellular potassium. Thus hyperkalemia and metabolic acidosis often occur together” (p. 600). Furthermore Clegg and Palmer (2016) state, “Metabolic acidosis promotes K exit from cells dependent upon the type of acid present” (p.486). Clegg, D. J., & Palmer B. F. (2016). Physiology and pathophysiology of potassium homeostasis. Advances in Physiology Education, 40(4), 480-490. doi:10.1152/advan.00121.2016 Copstead, L. E., & Banasik, J. L. (2018). Pathophysiology. St. Louis, MO: Elsevier. 3. What is the reason for LS’s low urine output? How should her fluids be managed? She is experiencing AKI with acute tubular necrosis (ATN) from the poisoning. According to Copstead and Banasik (2018), she is in the oliguric phase of ATN with oliguria and hyperkalemia. She needs fluids monitored closely to avoid overload, as her kidneys are not functioning and overloading them will worsen her state. (Farkas, 2019).