Fluid-Electrolytes Lab Questions

Question 1

A person fainted while working in the summer heat for a long time. Complaints: thirst, dry mouth, weakness, oliguria. Physical examination: decreased skin turgor,
blood pressure: 110/70 mmHg.
Laboratory parameters:
se [Na+]: 152 mmol/l
se [K+]: 5 mmol/l
hematocrit: 0.45
HGB: 160 g/l
MCV: 70 fl
How do you explain the laboratory parameters? What is to be done with the patient?

Answer 1

Hypernatremic Hypovolemia due to Heat Exhaustion

Normal-Slightly Low BP, Hct and Hb are Normal

Sodium↑, Potasium~↑- Loss of fluid in sweating (more than salt)

MCV↓ - Microcytosis due to H2O leaving RBCs (osmosis)

Treatment: Cooling, Trendelenburg (Feet up) Position, Oral Hypotonic Rehydration or IV 5% Glucose (if Unconscious)

Question 2

An elderly person gets sick while enjoying himself on Octoberfest: he complains of a headache and muscle cramps. He is disoriented. He has drunk 4 liters of beer during the past 2 hours (normal - 1.5l per hour). Physical examination: alcoholic breath, increased plantar extensor reflex. Blood pressure: 180/100 mmHg.
Laboratory parameters:
se [Na+]: 126 mmol/l
se [K+]: 4 mmol/l
MCV: 102 fl
hematocrit: 0.36
se [creatinine]: 150 μmol/l
se [urea]: 18 mmol/l
urine - density: 1.015 kg/l; [Na+]: 20 mmol/l
How do you explain the symptoms and the laboratory results?

Answer 2

Hyponatrimic Hypervolemia (Water poisening)

• Excessive Drinking, Hypertension, Sodium↓↓
• Plantar Extensor↑= Babinski Reflex→ Brain edema
• Azotemia =Seum Creatnine and Urea↑
• Hypoosmolar Blood = Macrocytic RBC with Hct↓
• Elderly Person = Renal and Liver Function↓
• Normal Density Urine→ No Reabsorption response →​ Renal Insufficiency
• Treatment: IV 3% Saline/Manitol and Possible Dialysis

Question 3

An elderly woman has been on NSAID treatment for a long time, because of her Rheumatoid Arthritis. She got very weak after having an acute diarrhea, she feels
too dizzy and needs to sit down. Physical examination: decreased skin turgor. Blood pressure in the supine position: 120/80 mmHg, standing: 90/55 mmHg.
Laboratory parameters:
se [Na+]: 116 mmol/l
se [K+]: 6.2 mmol/l
Ht: 0.48
se [creatinine]: 180 μmol/l
se [urea]: 18 mmol/l
urine: [Na+]: 50 mmol/l.
How do you explain the symptoms and the laboratory results?

Answer 3

Hyponatremic Hypovolemia

• Orthostatic Hypotension+Acute Diarrhea: Volume↓
• Hct↑ and Skin turgor↓ also: Volume↓
• ARF: Azotemia, Urinary Sodium↑, Hyponatermia and Hyperkalemia
• Long term use of NSAID*→ Acute Tubular Necrosis

*Analgestic Nephropathy (Phenacetin): NSAIDs inhibit renal blood flow by inhibiting Prostaglandins while RAAS is active as a baseline in the elderly, arthritis pateint.

Question 4

A) How will the following laboratory 3 values be changed in a protracted, untreated diabetic ketoacidotic coma before treatment?

1) total potassium of the body
2) total sodium of the body
3) total water (fluid) of the body

Answer 4

A) Protracted, Untreated Diabetic Ketoacidotic Coma

• [K]↓ : Acidosis comes with Hyperkalemia+Diuresis
• [Na]↓ : Osmotic Diuresis of Ketones and Glucose
• TBW↓: Osmotic Diuresis of Ketones and Glucose

Question 5

B) Does the serum potassium concentration change in parallel with the total potassium amount of the body?

in a protracted, untreated diabetic ketoacidotic coma

Answer 5

B)​​ Pottasium loss is Unparallel: Total Body/Serum -

• Glucose osmotic draw→water to EC→K to EC
• H/K exchanger compensate Acidemia→ Hyperkalemia
• Insulin↓ → Na/K Pumps↓ → [K]_IC↓ and [K]_EC↑

Question 6

C) How do you think the appropriate treatment will
change the serum potassium concentration?

Protracted, Untreated Diabetic Ketoacidotic Coma

Answer 6

C)Treatment Steps: Protracted, Untreated DKA Coma

1. Dialysis: Since it is a severe emergency case
2. Ringer-Lactate Solution: Replenish Fluids
3. Bicarbonate: to Balance Acidosis
4. Potasium Infusion (very slowly)
5. Insulin: to Lower glucose and enable Na/K Pumps
6. if K is more than 8mM : Ca-Gluconate: Anti-V. Fibrilation

Question 7

An elderly man gets chemotherapy for his chronic lymphoid leukemia. He complains of intermittent palpitation, and being disoriented. Blood pressure: 90/60 mmHg.
Laboratory parameters:
se [Na+]: 135 mmol/l
se [K+]: 8.2 mmol/l
hematocrit: 0.28
How can you explain these laboratory results? What kind of ECG-abnormalities you expect to see? What would you do with him?

Answer 7

Tumerolysis Syndrome+Bone marrow insufficiency

• Hypotension - Possibly from Cardiotoxicity-Chemo
• Hyperkalemia - Many Cells ruptured
• Hct↓ - Anemia of Chronic Disease
• ECG: Wide QRS, Long QT, Tall T → Arrythemia

​Treatment:

1. Dialysis
2. For Hyperkalemia: Ca⁺²-Gluconate, Insulin (with Glucose) and Furosemide.
3. IV saline and Blood transfusion (Possibly Bicarbonate)

Question 8

A woman gets hospitalized after having broken several of her bones in a car accident. Blood pressure: 80/50 mmHg, HR: 130/min. The patient develops
oliguria after being stabilized.
Laboratory parameters (later):
se [Na+]: 150 mmol/l
se [K+]: 7.2 mmol/l
se [creatinine]: 250 μmol/l
se [urea]: 18.8 mmol/l
hematocrit: 0.33
Urine amount (by catheterization): 200 ml
What emergency treatment is necessary? How can you explain the parameters seen
later?

Answer 8

Crush Syndrome: Hypotension, Tachycardia, , Hypernatremia, Hyperkaelmia+Azotemia (ARF, Retention Parameters elevation), Anemia and Oliguria.

• This is a Circulatory Shock with Multi-organ failure due to major trauma.
• Skeletal Muscle Myoglobin causes renal failure.
• Emergency treatment: ABC protocol, IV DEXTRAN.
• Tx after staibilized - Calcium Gluconate and Insulin for Hyperkalemia, Manitol for Oligouria following by dialysis/Donor Kidney. The Patient Renal Stem cell regeneration will determine prognosis in long term.