## Patient Encounter 8 Putting It All Together

TO, a 77-year-old male nursing home resident is admitted to the hospital with a 3-day history of altered mental status. The patient was unable to give a history or review of systems. On physical examination, the vital signs revealed a BP of 100/60 mm Hg, pulse 110 beats per minute, respirations 14 per minute, and a temperature of 38.3°C (101°F). Rales and dullness to percussion were noted at the posterior right base. The cardiac exam was significant for tachycardia. No edema was present. Laboratory studies included sodium 160 mEq/L (160 mmol/L), potassium 4.6 mEq/L (4.6 mmol/L), chloride 120 mEq/L (120 mmol/L), bicarbonate 30 mEq/L (30 mmol/L), glucose 104 mg/dL (5.77 mmol/L), BUN 34 mg/dL (12.14 mmol/L), and creatinine 2.2 mg/dL (194.5 ^mol/L). The CBC was within normal limits. Chest x-ray indicated a right lower lobe pneumonia.

The patient is 5 ft 10 in. (152.4 cm) tall and currently weighs 72.6 kg (160 lb). His normal weight is 77.1 kg (170 lb).

What are the likely causes for the increased sodium concentration in this patient? Calculate the TBW, ICF, and ECF for this patient. Calculate TO's fluid deficit if one is present.

In the next 24 hours, the medical team wants to replace 50% of the fluid deficit plus an extra 240 mL to account for increased insensible losses in addition to the patient's maintenance needs. Using the equation (1,500 mL + 20 mL for each kilogram greater than 20 kg), calculate the rate of fluid administration for the total fluids needed in this 24-hour period and over the next 48 hours.

Calculate TO's daily maintenance fluids.

Calculate TO's fluid administration rate for the first 24 hours (Hospital day 1).

Calculate TO's fluids for the subsequent 48 hours (hospital days 2 and 3) if the goal is to replete the remaining fluid deficit during that time.

What type of fluid should be used to treat TO's fluid disorder?

Abbreviations Introduced in This Chapter

 ADH Antidiuretic hormone ASHP American Society of Health-System Pharmacists ATP Adenosine triphosphate BUN Blood urea nitrogen CaCI Calcium chloride CHF Congestive heart failure CI Chloride D.W Dextrose 5% water ECF Extracellular fluid FFP Fresh-frozen plasma I&Os Ins and outs 1JJW Ideal body weight ICF Intracellular fluid IVIG Intravenous immune globulin JCAHO Joint Commission on Accreditation of Healthcare Organizations KPO, Potassium phosphate KVO Keep the vein open LR Lactated Ringers (solution) NaCl Sodium chloride NaPO, Sodium phosphate NG Nasogastric NS Normal saline SAFE Saline versus Albumin Fluid Evaluation SIADH Syndrome of inappropriate antidiuretic hormone secretion TRW Tntfll hnHv wfltfr

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^ Self-assessment questions and answers are available at ht-tp://www. mhpharmacotherapy. com/pp.html.

## Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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