Question

A. A patient presents to the emergency room with 3rd degree burns over 60% of their body. The patient's lab value is as follows: K 6.5, Na 150, glucose 250, Osmo 372, pH 7.29, HCO3 17, and paCO2 35. Which of the following intravenous fluids would you anticipate the doctor would order?

1. 0.45% Normal Saline with 100 mEq/liter of sodium bicarbonate
2. 0.45% Normal Saline with 40 mEq/liter of potassium
3. 0.9% Normal Saline
4. 2.5% Dextrose

B. After receiving your report, which patient should you assess first?

1. 76 year old female admitted 3 days ago with pneumonia, most recent blood gases are pH 7.35, paO2 90, HCO3 35, and paCO2 29
2. 48 year old male admitted yesterday with kidney stones complaining pain of a 5 on a 0-10 scale
3. 52 year old female admitted yesterday with acute renal failure, most recent lab results are pH 7.3, paO2 94, HCO3 15, paCO2 44, K 6.1, Na 148, and Osmo 369
4. 59 year old male admitted 2 days ago with Stage III bronchiogenic carcinoma complaining of nausea and pain of a 6 on a 0-10 scale

C. A patient presents to the emergency room with nausea, vomiting, and diarrhea for three days. The patient's lab value is as follows: K 3.8, Na 149, pH 7.32, HCO₃^– 20, and PaCO₂ 40. Which of the following intravenous fluids would you anticipate the doctor would order?

1. 0.45% Normal Saline with 100 mEq/liter of sodium bicarbonate
2. 0.9% Normal Saline with 40 mEq/liter of potassium
3. 0.9% Normal Saline
4. 2.5% Dextrose

Answer 1

0.45% Normal Saline with 100 mEq/liter of sodium bicarbonate

Since patient's lab value shows high value of potasium and sodium level (condition of Hyperkalemia) and metabolic acidosis (low pH and low HCO3) and to control this condition, sodium bicarbonate counteract acidosis which pushes potassium back into the cell and controls its level in the body.

52 year old female admitted yesterday with acute renal failure, most recent lab results are pH 7.3, paO2 94, HCO3 15, paCO2 44, K 6.1, Na 148, and Osmo 369

This patient has acute renal failure and is experiencing metabolic acidosis(low HCO3 and high paCO2) and hyperkalemia(high K and Na level) These conditions can be life threatening and she need to be assessed first.

0.45% Normal Saline with 100 mEq/liter of sodium bicarbonate
This patient's high level of Na(149), low pH(7.32), and high PaCO2(40) signifying that the patient is experiencing fluid volume deficit and metabolic acidosis. Sodium bicarbonate will control metabolic acidosis and normal saline will compensate the fluid volume in the body.