Dehydration Case Study

/in /by

 

Ruth Olson, a 74 year old Caucasian, non-Hispanic female has a past medical history significant for hypothyroidism and urinary incontinence.   She takes levothyroxine once daily and Detrol twice daily.  She admits that she does not drink as much water as she should because of the urinary incontinence.  Upon physical examination, you notice her mucus membranes are dry, delayed skin turgor and delayed capillary refill. 

As the nurse practitioner, you diagnose Ruth with dehydration.  You order a BMP. Her labs results are below:

Lab ResultsBasic Metabolic Panel:

BUN

30

(7 – 20 mg/dL)

CO2

27

(20 – 29 mmol/L)

Creatinine

1.4

(0.8 – 1.2 mg/dL)

Glucose

90

(64 – 100 mg/dL)    

Chloride

101

(101 – 111 mmol/L)

Potassium

4.0

(3.7 – 5.2 mEq/L)

Sodium

136

(136 – 144 mEq/L)  

Questions:

  1. Discuss laboratory abnormalities in the BMP.
  2. Does Ruth have any potential drug related causes of laboratory abnormalities? If yes, which ones?  If yes, why? If no, why not?
  3. What are non-pharmacologic treatment strategies for the management of dehydration?
  4. What pharmacologic treatment would you prescribe today (be sure to include, at a minimum, drug name, dose, route, frequency)? What other treatment options exist (include at least 3 crystalloids and 2 colloids in your discussion here)? Why did you choose your treatment option over other available options (if applicable)?
  5. What is the mechanism of action of your selected pharmacologic agent? How does the mechanism of action correlate with the physiology/pathophysiology of dehydration?
  6. What are the most common adverse effects?
  7. What is the cost of your selected treatment option?
  8. Discuss pharmacokinetics and pharmacodynamics of your selected pharmacologic agent (be sure to include, at a minimum, onset, peak, duration, half-life, etc).