GOO

Question 1

58 yrs. Female patient presented with persistent nonbilious vomiting Now is drowsy, hypokalemic, Hypochloremia and metabolic alkalosis .

Q. Why pt is hypoNa?

Answer 1

Na loss of vomiting

Question 2

Q1. what is your Diagnosis?

Answer 2

GOO

Question 3

Q2: Causes?

Answer 3

Begnin – > Pyloric stenosis
Malignant – Gastric / Pancreatic Ca.

Question 4

Q3: Why K is low?

Answer 4

Loss in vomiting / ↑ Aldosterone secretion in response to hypovolemia and hyponatremia ( in exchanging with Na)

Question 5

Q4: Why is Chloride low?

Answer 5

Loss in vomiting

Question 6

Q5. Why alkalosis ?

Answer 6

Loss of Cl- in vomiting and H+ + hypovolemia
Acid loss lead to more production of NAHCO3 as it stimulate acid secreation leading to Alkoloritic state
Once ability of kidney and gut to excrete it saturated

 Another answer;
kidney try to compensate by preserving NaHCO3 to keep the electrochemical neutrality
Reduction in pancreatic juice secretion in response to loss of acid load in duodenum which will lead to NAHCO3 retention

Question 7

Q6: Why hyponatremia ?

Answer 7

As this pt has Met Alkalosis so kidney will try to excrete mor NaHCO3 to compensate the condition and this will lead to hyponatremia.

Question 8

Q7: Is NaHCO3 excreted as a whole ion?

Answer 8

Yes

Question 9

Q8: Classification of Hyponatremia & give example to each ?

Answer 9

According to osmolarity could be
(Isotonic – Hypotonic (Hypo / Hyper/Euvolemic)- Hypertonic )
Depletion Loss of Na (Hypovolemic); Vomiting, Diarrhea, Diretics, Burns
Dilutional Excess of Water (Hypervolemic); HF , Over admin Glu 5%, SIADH, TURP
Loss of water and Na but Na is more – > Duritecs
Endocrine(Euvolemic) ; Addison dis / hypothyroidism
Pseudohypo; MM

Question 10

Q9: complications of hyponatremia ?

Answer 10

Confusion – cerebral edema - agitation –
seizures – AKI –
Arrythmia

Question 11

Q10: How to correct the condition of the patient ?

Answer 11

According to CCrisp protocol
ITU reg – NPO – Venous access – Labs – Fluid correction NACL
Endoscope Gastric dilatation

Question 12

Q11: Who will you involve?

Answer 12

My Consultant / ITU reg. / Anesthesia in case of intubation / Cardio?

Question 13

Q12:When will this patient be fit for surgery?

Answer 13

After improving of met acidosis / Correction of electrolyte and become hemodynamically stable.

Question 14

Q13: What is Chloride shift?

Answer 14

Bicarbonate shifts out into the plasma and chloride shift into RBCs to make cellular balance

Question 15

Q. Why are the Creatinine and urea are abnormal?

Answer 15

Due to decrease renal perfusion 2ry to dehydration.

Question 16

Q. Why urine is acidic?

Answer 16

Presestant dehydration – increase aldosterone – act on distal tubule and CDs – > reabsorption of Na in exchange of K or H+ leading to loss of H in urine

Question 17

Q. what’s optimal fluid to give the pt? explain?

Answer 17

0.9% NaCl (better than Hartman as it has more Cl)+ KCL
this will replace Na K Cl loss and will help in correcting alkalosis

Question 18

Q. what bedside procedure used should pt have to help his condition?

Answer 18

Nasogastric Tube and urinary catheter (UOP)

Question 19

Q. As a surgical Reg whom you’re going to involve in the care?

Answer 19

Surgeon (My consultant) / HDU lvl 2 facility nurse staff for placement of lines and ecg monitoring and fluid and electrolyte therapy

Question 20

Q. when to consider this pt is fit for surgical intervention?

Answer 20

When acid base and electrolytes have been corrected