Skip to Main Content

++

LEARNING OBJECTIVES

++

After completing this case study, the reader should be able to:

++

  • Analyze a patient case history and identify potential causes of electrolyte disorders.

  • Select the appropriate route of administration and dose of electrolyte replacement therapy specific for a patient.

  • Develop a monitoring plan for efficacy and toxicity in patients receiving electrolyte replacement therapy.

  • Outline a patient education plan for a patient receiving electrolyte replacement supplements.

++

PATIENT PRESENTATION

++

Chief Complaint

++

“I’m short of breath.”

++

HPI

++

Dorothy Snow is a 45-year-old woman with a history of nonischemic cardiomyopathy who presents to the ED with a 3-day history of shortness of breath with mild-to-moderate exertion. She reports three-pillow orthopnea × 2 days and cough during sleep. Denies chest pain; occasional palpitations. Reports a 10-lb weight gain in the last week and an increase in her lower extremity edema.

++

Two months ago, Mrs Snow was hospitalized briefly with atypical chest pain and had persistent hypokalemia for which her metolazone 5 mg daily was discontinued. Approximately one month ago, she subsequently developed significant fluid retention and her PCP restarted metolazone 5 mg PO MWF. About 2 weeks ago, she had an ED visit and her potassium was 7.2 mEq/L (hemolyzed sample). The potassium level was repeated with a result of 5.5 mEq/L. At that time, her potassium supplement dose was reduced from 80 mEq PO QID to 80 mEq PO BID.

++

PMH (Per Patient Report and Medical Records)

++

  • Nonischemic cardiomyopathy—echo LVEF 25% (11 months ago)

  • ICD placement (3 weeks ago)

  • Pulmonary hypertension—secondary to left heart disease

  • HTN

  • Asthma

  • Sleep apnea

  • Type 2 DM with peripheral neuropathy

  • Obesity

  • Chronic sinusitis

  • Anxiety disorder

  • Hypothyroidism

++

FH

++

Both parents are deceased

++

SH

++

Lives with husband. No alcohol use. Former smoker—quit 8 years ago. No illicit drugs.

++

Meds

++

  • Valsartan 160 mg PO BID

  • Omeprazole 20 mg PO daily

  • Carvedilol 25 mg PO BID

  • Digoxin 0.25 mg PO daily

  • Spironolactone 25 mg PO daily

  • Furosemide 80 mg PO BID

  • Citalopram 20 mg PO daily

  • Atorvastatin 20 mg PO daily

  • Insulin glargine 30 units SC Q 12 H

  • Insulin aspart 20 units SC TID with meals

  • Pregabalin 50 mg PO BID

  • Metolazone 5 mg PO MWF

  • Loratadine 10 mg PO daily

  • Tiotropium one puff daily

  • Fluticasone/salmeterol 500/50 one puff BID

  • Mometasone one spray each nostril daily

  • Meclizine 12.5 mg PO BID

  • Magnesium oxide 400 mg PO TID

  • Potassium chloride 80 mEq PO BID

  • Levothyroxine 75 mcg PO daily

  • Lorazepam 0.5 mg PO TID

  • Folic acid 1 mg PO daily

++

ALL

++

NKDA

++

ROS

++

Patient reports becoming short of breath for the past 3 days while walking up one ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.