Hypernatremia Case Summary

Case 1: Q1: What is the most likely cause of this patient’s hypocalcemia? Explain your answer?

Deficient fluid volume happens when there is a significant loss of fluid and electrolytes as with excessive sweating. Dehydration can occur from an insufficient fluid intake, excessive fluid loss, and fluid shifts. The first sign of dehydration is thirst. If the patient would have drunk water when he first became thirsty, him collapsing may not have occurred, and no further treatment may not have been needed. If fluids continue to be lost, the heart pumps faster but is rapid and weak and causes orthostatic hypotension, explaining his pulse being 136 and blood pressure being 88/52. Orthostatic hypotension may have caused him to collapse due to the

Depending on the magnitude and rate of development, hyponatremia may or may not cause symptoms. Generally, slowly progressive hyponatremia is associated with fewer symptoms than is a rapid drop of serum sodium to the same value. Symptoms of hyponatremia include but are not limited to the following: confusion, disorientation, delirium, generalized muscle weakness, myoclonus, tremor, asterixis, hyporeflexia, ataxia, dysarthria, Cheyne-Stokes respiration, pathologic reflexes, generalized seizures, and

Hypotension that occurs during hemodialysis primarily results from rapid removal of vascular volume (hypovolemia), decreased cardiac output, and decreased systemic vascular resistance (Lewis, 2014, pp. 1122-1123). The patient may experience a drop in blood pressure during dialysis process. As a result of cardiac ischemia the patient may also exhibit symptoms of light- headedness, nausea, vomiting, seizures, vision changes, and chest pain. To combat these complications of hypotension the volume of fluid being removed is decreased and administering 0.9% saline solution through IV therapy (Lewis, 2014, pp. 1122-1123).

Severe weakness, fatigue, weight loss, symptoms suggestive of a possible hypoglycemia, nausea and vomiting, circulatory collapse, suggest to secondary hypoadrenalism.

Hyponatremia is a result of an overabundance amount of water compared to an insufficient quantity of sodium in the body which can activate headaches, nausea, vomiting and seizures. Sodium is a crucial aspect in regulating blood pressure along with controlling the proper muscle and nerve movement. Sodium maintains the transportation of fluids throughout the body in order to make sure the cells do not shrink or swell up. Hyponatremia can be caused by certain medications, liver and kidney failure, drinking too much water or dehydration. It is important not to have your body enter into a hyponatremic state since this can be fatal without immediate medical attention. Severe hyponatremia causes neurological symptoms such as brain damage, coma, or

Prerenal failure is one of the most developed causes of kidney failure in patients who are hospitalized. Most conditions, such as burns, long-term vomiting, bleeding, dehydration results in a decrease amount of blood flow to the kidney. Due to blockage or tightening of blood vessel carrying blood to the glomerular filtration rate, this may complicate fluid and electrolytes and result in excess fluid volume. According to Best Practice & Research (2007), “it may lead to ischemic tubular necrosis when the reduction in blood flow is sufficient to result in the death of tubular cells.” However, without sufficient fixation to prerenal failure, it may result in the next stage of intrarenal acute kidney failure.

The symptoms associated with the syndrome are hypoglycemia, encephalopathy, fatty liver, elevated ammonia levels in the blood and elevated liver function enzymes. This lack of mitochondrial metabolism can explain the hypoglycemia due to the body being unable to create ATP. With the lack of ATP production, the body would naturally deplete its glucose stores to gain more energy. The metabolic failure in the liver causes the elevated liver function enzymes, elevated ammonia levels, and over time the fatty liver. The encephalopathy is caused by the increased

Hypovolemic shock is the result of whole blood loss, and plasma or interstitial fluid loss in large amounts. Moreover, hypovolemic shock begins when the intravascular volume decreases by approximately fifteen percent. The pathophysiology of hypovolemic shock includes both the heart rate and SVR increasing. As a result cardiac output and tissue perfusion pressures are boosted and interstitial fluid moves into the vascular compartment. Also, both the liver and spleen boost the body’s blood volume by disgorging the stored red blood cells and plasma. In the kidneys, renin prompts the release of aldosterone and also the retention of sodium. Whereas, ADH that is from the posterior pituitary gland surges water retention. In addition, if the initial

Hypovolaemia pertains to an abnormal loss of blood volume and body fluid. It is a life-threatening condition brought on by low blood venous return to the heart that results to decreased Cardiac Output (CO), leading to a lack of adequate circulatory filling, reduced organ blood flow and organ damage (Brown & Edwards, 2013; Craft, Gordon, Huether, Tiziani, McCance, & Brashers, 2013; Plenderleith, 2007).

□ Dehydration, hypotension, or shock out of proportion to severity of current illness are distinguishing features

It is secondary to under-perfusion of otherwise normally functioning kidneys and if detected early can be reversible. In Mr Jones’s case, his kidney’s experienced hypo-perfusion during surgery. Hypo-perfusion consequently causes azotemia due to the excess nitrogenous wastes in the blood. Medications, such as high doses of dopamine, can cause prerenal kidney injury due to the production of intrarenal vasoconstriction, which can lead to hypo perfusion of the glomeruli (Nissenson, 1998). The kidneys have an enormous blood supply and account for 20-25% of cardiac output. This blood supply is needed for the removal of waste products and the management of fluid and electrolyte balances. If the blood flow to the kidneys is reduced, this has a decreasing effect on the GFR leading to a decreased urine output, filtration and reabsorption of filtered material through the glomerulus. This can lead to further issues and effect other organs in the body. Fredrick experienced a decreased urine output as a symptom of his reduced GFR. Fredrick’s increased respiration rate noted during assessment was an indicator of his deterioration and alerted the medical team that there was an underlying issue. During the nurse’s assessment, they observed that Frederic had very poor urine output, which is also linked with the drop in the GFR in the kidneys. Thus, encouraging the nursing staff to take immediate action with thereputic

Next, the nursing assessment findings that I would expect to see in a patient with hypokalemia is weakness of the muscles, fatigue, and possible cardiac dysrhythmias. The findings that I would discover upon assessment

leads to acidemia, blood pH is low (less than 7.35) due to increased production of hydrogen ions

The potential cause of hypernatremia and other electrolyte imbalance in patients results from changes in fluid level, either