Question

In: Nursing

A 62-year-old postal employee is brought to the ER because of mental confusion. His family thinks...

A 62-year-old postal employee is brought to the ER because of mental confusion. His family thinks he has been ill for a few months. He has lost 25 pounds because of chronic anorexia and has a chronic, nonproductive cough. About 10 days ago he was found to be unusually irritable and became irrational. For the last 2 days, he has been confused and disoriented.

Na 116

K 4.7

Cl 85

CO2 22

glucose 90

BUN 5

creatinine 0.7

TP 6.1

serum osmo 245

urine Na/day 70

urine osmo 300

liver profile normal

cardiac profile normal

•1. What is the most obvious lab abnormality?

•2. List causes of hyponatremia.

•Further biochemical analysis revealed ­ ADH.

•3. Calculate the anion gap. Is it normal, increased, decreased?

–(Reference range = 7-16 or 10-20)

•4. Name 2 major compounds (hormones, enzymes) involved in electrolyte and water regulation.

Solutions

Expert Solution

1.hyponatremia

Normal blood sodium level is between 135 and 145mEq/L .Here,its 116 and its hyponatremia (decrease in serum Na level)

2.causes of hyponatremia

There can be true hyponatremia and pseudo hyponatremia

Pseudo hyponatremia is the hyponatremia with normal or high osmolarity.

These are caused by effective solutes in the body ,like

glucose mannitol glycine and maltose

True hyponatremia ,Based on the volume status of the patient can be

Hypervolemic hyponatremia- Chronic kidney disease,Cirrhosis of liver, Congestive cardiac failure, nephrotic syndrome ,drugs like loop diuretics(frusemide,thiazide diuretics )

Hypovolemic-vomiting diarrhoea,3rd space losses (burns pancreatitis , rhabdomyolysis),Renalntubular acidosis,overuse of diuretics

Euvolemic : cortisol insufficiency, hypothyroidism,SIADH (Syndrome of inappropriate ADH secretion)

Note :Why euvolemic in SIADH?

SIADH causes water retention and this will cause secretion of ANP ,which will excrete water and sodium and thus finally making it euvolemic hyponatremia

3.Anion gap is calculated by the equation

Measured cation-measured anion

Ie Na-(Cl+HCO3) - here the reference range will be 7 to 16

Or Na+K-(Cl+HCO3)-Reference range =10 to 20

Here ,the HCO3 value isn't given and thus ,anion gap can't be calculated

4.ADH(Antidiuretic hormone )and Aldosterone

Nightingale answered 2 years ago
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