NUR 502 Module 4 Discussion Urinary Function CASE STUDY 2 Fluid, Electrolyte, and Acid-Base Homeostasis

Electrolyte imbalances are common as a result of electrolyte loss, shifts in specific electrolytes, or relative concentration changes caused by water loss (Constable, 2017). Common electrolyte abnormalities are hyponatremia, hypokalemia, hyperkalemia, hypocalcemia, hypochloremia, and hypophosphatemia. Acid-base imbalances, known as acidemia or alkalemia, occur when acid is added and alkali reserves are depleted, or when acid is lost while alkali reserves increase (Constable, 2017). Ms. Brown is a 70-year-old woman with type 2 diabetes who has been too ill to get out of bed for the past two days. On admission, her laboratory values showed elevated glucose, sodium, potassium, and chloride. Ms. Brown’s arterial blood gas levels showed a normal pH and low PaCO2, PaO2, and HCO3. Based on these laboratory results, it’s evident that the water and electrolyte imbalance that Ms. Brown is experiencing is hypernatremia, hyperkalemia, and hyperchloremia.

Signs and Symptoms of Water Imbalance and Treatment

Fluid and electrolyte balance is a key concept to understand for maintaining homeostasis, and for a successful treatment of many metabolic disorders (Balci, 2013). The signs and symptoms associated with hypernatremia include excessive thirst, lethargy, muscle twitching, and spasms. The symptoms associated with hyponatremia include nausea, vomiting, headache, and seizures. The clinical manifestations that Ms. Brown may experience with her potassium level are symptoms that correlate with hyperkalemia. These symptoms include fatigue, muscle cramps, unusual heartbeat, and chest pains. These symptoms are created due to the increased level of potassium in the bloodstream. In this case, the indicated treatment would be to treat Ms. Brown with insulin to help bring down her glucose. According to Li and Vijayan (2014), insulin therapy can also be used to bring down potassium levels, because it forces potassium into the cells that are later excreted via the renal system. Also Ms. Brown should receive intravenous fluid therapy to help improve her electrolyte imbalance.

Acid-Base Imbalance and Anion Gaps

An arterial blood glass is a test that measures the levels of oxygen, carbon dioxide, and bicarbonate in the blood. Based on the arterial blood gas results, shows that Ms. Brown may be in metabolic acidosis. Metabolic acidosis occurs when the chemical balance of acids in the blood becomes unbalanced. This causes a decrease in bicarbonate levels in the body making it more acidic. Anion gaps are a common blood test that measures the difference between positively charged ions and negatively charged ions (Pandey & Sharma, 2019). A high anion gap means the blood is more acidic than normal indicating acidosis is occurring in the body.

References

Balci, A. K. (2013). General characteristics of patients with electrolyte imbalance admitted to emergency department. World Journal of Emergency Medicine, 4(2), 113. https://doi.org/10.5847/wjem.j.issn.1920-8642.2013.02.005