Fluid and Electrolytes: Balance and Disturbances?
Conrad Jackson is a 28-year-old male who presents to the Emergency Department with severe fatigue and dehydration secondary to a four-day history of vomiting. During the interview, he describes attending a family reunion and states that perhaps he “ate something bad.” Upon admission his vital signs are a temperature of 102.7, pulse of 116, respirations 18, and blood pressure of 86/54. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas. The following results are returned from the laboratory:
Sodium (Na+)150
Potassium (K+) 5.5
Chloride (Cl¯)110
BUN 42
Creatinine 0.8
Glucose 86
pH7.32
PaCO2 35
HCO3¯ 20
PaO2 90
O2 Sat 98%
What is your interpretation of this arterial blood gas sample?Why would the patient have these arterial blood gasses after vomiting? Explain the high potassium? Why .45 NS?