Question

A 55 year old male shortly after finishing a marathon became confused, dizzy, extremely weak and began to cramp. He immediately began to drink water but did not improve, instead he suddenly collapsed without becoming unconscious. The nurse on the scene assessed the patient’s condition and concluded that he was severely dehydrated. She proceeded to give him 1000 mL of D5W intravenously. The patient did not improve, instead he began to have a seizure so he was immediately taken to the hospital. At the hospital a blood panel was ran and it revealed that he was severely hyponatremic. Medical history also revealed that the patient suffers from chronic hyperglycemia (diabetes), adrenal insufficiency, lactose intolerance and high blood cholesterol. He was treated with hypertonic saline (3% NaCl) and a diuretic. He recovered within 24 hours.

1. What mistake did the nurse make that lead him to have a seizure? Explain.
2. What information about the patient's medical history could have helped the nurse? Why?
3. Why was he given hypertonic saline?
4. Why was he given a diuretic?
5. How should have the nurse initially treated him to prevent him from having a seizure? Based on the information she had.

Answer 1

#An individual who is doing physical exercise or a marathon may loose fluid and risk them for dehydration but it is essential to be be knowledgeable what electrolytes alteration can lead to dehydration .Here the nurse didn't think about the hyponatremia rather thought hypoglycemia and administered Dextrose .As patient is already diabetic this has increased the blood glucose levels very highly causing seizure .

#The information about the patient 's medical condition (Known case of diabetes ) could have helped the nurse in choosing the right type of IV fluids

#The hypertonic saline can improve the concentration of very low levels of sodium in the cells by volume expansion. Also it can help to manage diabetic ketoacidosis in a diabetic patient whose blood glucose is considered to be in a potentially dangerous high levels .

#The diuretic was given to flush out fluids and importantly to prevent cerebral edema .

#She should have administered simple 0.9% NaCl to the patient.This will not increase blood glucose levels but just increase the fluid volume and replace the basic electrolytes if lost and this preventing elevation of blood glucose by administering D5 and causing seizure .