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Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services (userservices@mheducation.com) for more information.
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After completing this case study, the reader should be able to:
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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.
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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.
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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.
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PMH (Per Patient Report and Medical Records)
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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
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Both parents are deceased
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Lives with husband. No alcohol use. Former smoker—quit 8 years ago. No illicit drugs.
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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