Case Study, Chapter 13, Fluid and Electrolytes: Balance and Disturbance

1. Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L.

What are possible causes of a low potassium level?

What action should the nurse take in relation to the serum potassium level?

What clinical manifestations might the nurse assess in Mrs. Dean?

2. Conrad Jackson is a 28-year-old man who presents to the emergency department with severe fatigue and dehydration secondary to a 4-day history of vomiting. During the interview, he describes attending a family reunion and states that perhaps he “ate something bad.” Upon admission his vital signs are a temperature of 102.7°F, heart rate of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas.

The following results are returned from the laboratory:

Sodium (Na+) 150

Potassium (K+) 5.5

Chloride (Cl¯) 110

BUN 42

Creatinine 0.8

Glucose 86

pH 7.32

PaCO2 35

HCO3¯ 20

PaO2 90

O2 Sat 98%

What is your interpretation of this arterial blood gas sample?

Explain the high potassium in this patient.

Calculate the patient’s anion gap:

What is the interpretation of this anion gap?


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