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LEARNING OBJECTIVES

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

  • Develop a plan for implementing fluid or medication therapies for treating a patient in the initial stages of shock.

  • Outline the major parameters used to monitor hypovolemic shock and its treatment.

  • List the major disadvantages of using only isolated hemodynamic recordings, such as blood pressure measurements, for monitoring the progression of shock.

  • Compare and contrast fluids and medications used for treating hypovolemic shock.

PATIENT PRESENTATION

Chief Complaint

“I’m beat. I have vomited four times in the last 24 hours and had diarrhea last evening. Now is not a great time to get sick since I’m in college and have finals next week.”

HPI

Four days PTA, Mr Hobbs, a 20-year-old college student, had abdominal pain that he attributed to a flare-up in his Crohn disease due to the stress of final examinations. He has an infliximab infusion scheduled for next week; he has them every 8 weeks and does not miss these infusions. However, he admits that he forgets to take his oral medications now that he lives away from his family. When he has Crohn disease pain, he does not feel like eating since this worsens his stomach pain. Furthermore, he has vomiting and diarrhea, which is aggravated by food intake. Per the recommendation of his community pharmacist, Mr Hobbs purchased a commercially available rehydration solution and attempted to drink the small but frequent volumes recommended by his pharmacist, but he could not keep up with fluid losses. His primary care physician referred him to the local hospital for rehydration and further evaluation.

PMH

Crohn disease, diagnosed 4 years ago

Ankylosing spondylitis, diagnosed 3 years ago

Pulmonary coccidioidomycosis (small ill-defined mass in the lungs with positive cocci titers), diagnosed 1 year ago

FH

Noncontributory

SH

Does not smoke or use illicit drugs; admits to occasional ETOH use at parties

Meds

Infliximab 300 mg by IV infusion over 3 hours every 8 weeks

Azathioprine 100 mg PO daily

Fluconazole 400 mg PO daily

Fish oil (unknown strength) one capsule PO BID

Multivitamin one tablet PO daily

Whey shakes for protein supplementation, one shake PO daily

All

NKDA

ROS

The patient has had a recent increase in weight over the past month (6 kg), although this has decreased by 2 kg in the past few ...

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