Advanced pathophysiology

Fluid and Electrolyte Case Study

Case Study:

A 65 year old female is admitted to your unit complaining of nausea vomiting and diarrhea for 3 days. Her history is unremarkable except hypertension for which she takes hydrochlorothiazide. She relates feeling exhausted and having leg cramps which interfere with her sleeping. Notable assessment findings include:

Temp: 38.6C. AP 102 and irregular, BP 90/50; absent bowel tones, dry skin and poor turgor, and poor muscle tone. As the causes

Labs: K 2.0mEq/L; NA 137 mEq/L; CL 97 mEq/L; and WBC 20,000/ul.

MD orders:

I V D50 .9%Nacl with 20mEq KCL/L to infuse @ 90cc/hr.

40mEq of KCL IV over the next 2 ho0urs

K level 30 minutes after the 40mEq IV KCL has infused.

Bedrest: May use Bathroom



1. What fluid and electrolyte disturbances does this client have?

2. What electrolyte disturbance is o0f most concern with this client and why?

3. What signs and symptoms that the patient exhibits can result from this electrolyte disturbance?

4. What do you suspect as the cause(s) of this electrolyte disturbance?

5. What type of solution is D50NS + 20 mEq KCL?

6. Would you question any of these orders? Why or why not?

7. Would you expect to see any changes on an EKG if one is taken?