Electrolyte Imbalance and Clinical Question(?)

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I have a question regarding a scenario that I just cannot seem to figure out completely. Could somebody help me? The patient is M, 50 y/o. NPO post abdominal surgery. IV D5RL @ 100cc/hr. IV stopped. Poor skin turgor and hypotensive. Large furrows on tongue.

Chem K-2.8 Na-132 CL-95 Urine gravity >1.025 Hemat-

My take is that he is hypckalemic w/dehydration. Also hypovolemic. This would be due to the IV stoppage -- the patient isn't getting the electrolyte-enhancing fluid. The IV is hurting because there is a blockage. The higher CL level indicates a possible acid-base imbalance but that is unknown due to the fact that no ABG's were ordered. The CL is probably related to the low Na.

Does this sound correct? If not, what am I missing? Thank you for your help!!:nurse:

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Specializes in Pulmonary/MedicalICU.

If CL is Chloride, its not high, its low. 95-105 (some use 108).

He definitely needs some K...probably hypovolemic as you noted (BP, Urine spec grav, oliguria, etc.). Dehydration is related to hypovolemia, as well. Also, with a hypokal, you can become acidotic because hydrogen ions take the place of K and Calcium in the cells. That is your likely cause of acid-base imbalance.

If this is a test question or something similar, sounds like he needs to be pounded with NS c 40K and/or given some NS and some PO and IV K+.

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Specializes in psych, addictions, hospice, education.

It's pertinent to know how long the IV has been stopped.

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You're right....CL is low. Don't know why I said high. Anyhow, what (if any) is the significance of the IV stoppage and the IV hurting? Would that be due to a blockage, infiltrate??? I'm a bit stumped on that one. I'm also leaning toward renal failure? But the urine specific gravity seems to contraindicate that to some degree. **sigh**

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It's pertinent to know how long the IV has been stopped.

Don't know the answer to that one. :(

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Specializes in OR, peds, PALS, ICU, camp, school.
You're right....CL is low. Don't know why I said high. Anyhow, what (if any) is the significance of the IV stoppage and the IV hurting? Would that be due to a blockage, infiltrate??? I'm a bit stumped on that one. I'm also leaning toward renal failure? But the urine specific gravity seems to contraindicate that to some degree. **sigh**

Well, what would you do if your pt c/o IV hurting? just IVF (not a caustic med or lyte) I would assess, but even if I can't see obvious signs of an infiltrate I would stop the solution and replace the PIV. Maybe that's why the IV was stopped? Someone turned it off due to pt c/o. Or maybe it was a downstream occlusion alarm. Often that's a kink or clamp in the tubing but in the presence of pain could well be an infiltrate. PIV must be D/C and replaced. This pt needs the IV. If the IV has been stopped a while: restart, and notify the MD that the pt is behind in therapy and may need some catch-up- a fluid bolus and lyte replacement? If the IV recently stopped and the labs are so off: restart and notify the MD that the pt is sub-therapeutic and needs more aggressive therapy and monitoring. ie: was the IV stoppage the cause of imbalance or just a co-incidence?

What else will the MD want to know when you call? What assessments do you do when your electrolytes are imbalanced as they are? Are you anticipating any additional tests might be ordered?

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Specializes in Pulmonary/MedicalICU.
You're right....CL is low. Don't know why I said high. Anyhow, what (if any) is the significance of the IV stoppage and the IV hurting? Would that be due to a blockage, infiltrate??? I'm a bit stumped on that one. I'm also leaning toward renal failure? But the urine specific gravity seems to contraindicate that to some degree. **sigh**

Don't know on the IV, I guess your best option (if you're answering a question) would be to address the patency of the IV and the need for a new one.

As for the renal failure, you are probably right that there is some prerenal ARF (aka AKI) going on due to hypovolemia and dehydration. All of your labs as well as vital signs seem to indicate this. The solution is giving fluids or lasix...in this case you'd want to give a bunch of fluids and monitor the UOP for an increase (which would be expected).

Hope this helps...

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Specializes in ER/ICU/STICU.

This patient is very hypovolemic. The IV being infiltrated for how long is important because the patient is NPO so they haven't been getting any replacement for as long as the IV has been infiltrated. Also depending on the type of surgery, if it was an open belly you can estimate this patient lost around 1L every hour he was open so by the time he comes to the floor he is already behind. As others said he is probably pre-renal due to the hypovolemic shock. This patient needs IVF boluses and K riders.

The urine specific gravity is elevated because of the decreased urine output. Remember the body is trying to conserve as much fluid as possible.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
i have a question regarding a scenario that i just cannot seem to figure out completely. could somebody help me? the patient is m, 50 y/o.

npo post abdominal surgery.what day post op

iv d5rl @ 100cc/hr. iv stopped. why was the iv stopped and for how long? is the k in the iv?

poor skin turgor and hypotensive. tachycardia = dehydration

large furrows on tongue. dehydration

chem k-2.8 na-132 cl-95 urine gravity >1.025 hemat-

urine is dark amber and has passed only 100cc within the last 8 hours. dehydration..... 30 cc of urine per hour is indicative of end organ perfusion.

my take is that he is hypckalemic w/dehydration. also hypovolemic. your patient is severly dehydrated therefore he is hypovolemic causing electrolyte imbalances low urine output, furrowed tongue, poor skin turgor and acidosis and renal insufficiency this would be due to the iv stoppage --or the surgery itself and third space loss from the abd or......how long prior to or was patient ill or npo....what was the estimated blood loss......... the patient isn't getting the electrolyte-enhancing fluid. you said the ivf was d5rl......what is the electrolyte? how much potassium? the iv is hurting because there is a blockage. are you sure?is there potassium in the iv as that can cause burning....check the iv for patency. the higher cl level indicates a possible acid-base imbalance but that is unknown is it unknown? dehydration, renal insuff, fluid and electrolyte imbalance due to the fact that no abg's were ordered.

the cl is probably related to the low na.

does this sound correct? if not, what am i missing? thank you for your help!!:nurse:

http://quizlet.com/2777994/disorders-of-fluid-and-electrolyte-balance-flash-cards/

http://tinyurl.com/4lrs2p9

look up signs and symptoms of dehydration. this patient is showing signs of severe dehydration. furrowed tongue, poor turgor, tachycardia low urine output. most of these labs would self correct with hydration and some potassium in the ivf which is why the iv and how long it has been out is so important. how many days post op. does the patient have or have they ever had a naso-gastric tube. is there potassium in the iv now? potassium can really hurt when infusing. is the iv patent? is there a blood return.?

there are alot of reasons for this patient to be dehydrated. look up post op abdominal surgeries, dehydration and fluid an electrolyte balances.....

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Specializes in OB, ER.

Couldn't they be septic- fever, low bp, tach, recent OR. Kidney's shutting down, poor circulation

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Couldn't they be septic- fever, low bp, tach, recent OR. Kidney's shutting down, poor circulation

Yes..... but the furrowed tongue and turgor is hydration. but that is also why post op day can be improtant and the actual surgery done as well

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I'd like to thank all of you for your assistance. :)

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