FNP pharm case study
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I was wondering if there are any NP students out there that can look at and critique my case study answers. I was never provided the correct answers for this case study despite reaching out to my instructors via e-mail - the case studies were meant to be discussed amongst study groups and then I would have to make an office appointment and drive approximately 1 hour to see my instructor in person. It's ridiculous.
Other classmates that I have talked to have not completed this case study so I don't really have anything that I can compare to.
A 50-year-old male weighs 95 kg, 188 cm male with acute heart failure that decided to increase his dose of furosemide to 80 mg TID because he had so much peripheral edema that he could not walk without extraordinary pain. Now he presents heart rate of 240 bpm and 12â€lead ECG that reveals ventricular tachycardia. Laboratory values include potassium = 3.0mEq/L (normal 3.5 – 5 mEq/L); magnesium = 1.6 mEq/L (normal 1.8â€2.9 mEq/L); Serum Creatinine = 1.2 mg/dL).
Current Medications: Furosemide 40 mg BID; Quinapril 4 mg once daily;
What is his estimated creatinine clearance?
188cm = 74in
IBW = 50 + ((2.3)(74-60))
IBW = 82.2kg
>30% of IBW would be 106.8kg. The patient's actual weight is 95kg so there is no need to figure out an AdjBW.
(140-50)(95) / (72)(1.2) = 8550/86.4 = CrCl 98.9mL/min
How would you treat his ventricular tachycardia?
I would treat with an amiodarone bolus of 150mg IV over 10min and repeat if necessary. I would also correct the fluid and electrolyte imbalances which are more than likely the etiology of the ventricular tachycardia. Procainamide can also be given but I would be worried about the worsening of arrhythmia in the face of hypomagnesemia and hypokalemia. (is this correct? Am I correct on my thinking here? )
To assist in alleviating his ventricular tachycardia, what volume and type of intravenous fluid and electrolyte replacement would you initiate?
1500 + (20 * 75) = 3000mL
Patient requires a maintenance of 3000mL.
D5NS is a hypertonic solution that would help pull fluid from the interstitial compartment to the intravascular compartment and alleviate the third spacing. The fluid would be given at 125cc/hr.
Additionally, this patient requires potassium and magnesium supplementation. Although mildly low, the magnesium needs to be supplemented to help bring up the potassium level. 2gm of IV magnesium over 1 hr should be given.
Potassium requirements were calculated through the following equation:
(Goal K – Serum K) / SrCr x 100 = total mEq required
Based on a goal of 4.0 mEq: (4-3)/1.2 x 100 = 83mEq and I would change the dose to 80mEq since KCl supplements come in increments of 10mEq. If the patient can tolerate PO, a dose of 60mEq of KCl can be given and the remaining 20mEq can be given IV over 2 hours. Alternatively, KCl can also be added to the maintenance fluids as D5NS with 20mEq KCl.
Based on etiology of his ventricular tachycardia will he need medical management for prevention of recurrent VT?
Electrolytes should be replenished and levels maintained to help reduce the risk of arrhythmias. The patient will need to be monitored for additional arrhythmias while in the hospital and serial electrolytes should be checked during the patient's stay. This patient is on furosemide and not on a potassium supplement; he should be placed on a potassium chloride supplement of at least 20mEq divided BID.
I really appreciate it. Thank you! Never have I ever had to use Google so much and pull from so many different resources just to understand something because of an instructor's failure to explain