CASE LEARNING OBJECTIVES
Recognize the signs and symptoms of hypovolemic hyponatremia
Identify the goals of therapy for hypovolemic hyponatremia
Develop an appropriate treatment and monitoring plan for fluid replacement based on individual patient characteristics
Select an appropriate resuscitation fluid
Recognize what type of patient may be predisposed to fluid overload
Diarrhea and altered mental status as per neighbor
History of Present Illness
Frank Secretion is a 78-year-old Caucasian man who was found by a neighbor wandering outside his residence with his pants saturated with urine and watery stool. The patient appeared intoxicated but he was oriented to person. He was found to have been falling down repeatedly while walking. The patient lives alone and is a widower. His daughter last spoke to him 4 days ago. The patient was unwillingly taken to a university hospital, where he was seen in the emergency department (ED) and admitted to the ICU for further management. In the ED, the following laboratory results were noted: sodium 121 mEq/L (121 mmol/L), potassium 3.0 mEq/L (3.0 mmol/L), chloride 88 mEq/L (88 mmol/L), BUN 47 mg/dL (16.8 mmol/L), creatinine 2.5 mg/dL (221 μmol/L), and ethanol level 150 mg/dL (32.5 mmol/L).
Father died of MI in his 50s. Mother died at age 92 from Alzheimer's disease. He has one daughter (46 years), who is healthy.
Retired carpenter. Completed high school. Married for 50 years. Widower for 1 year. Lives alone.
Long history of alcoholism; (−) tobacco or illicit drug use
Allergies/Intolerances/Adverse Drug Events
Medications (Prior to Admit)
Simvastatin 40 mg PO daily
IV potassium chloride 40 mEq (40 mmol) IV × 1
Piperacillin/tazobactam 2.25 g IV q 6 h
Lorazepam 1 mg IV/PO q 1 h PRN (agitation or tremor) per CIWA alcohol-withdrawal protocol
Multivitamin 1 tablet PO daily
Enoxaparin 40 mg SC q 24 h
Unobtainable. Patient is extremely drowsy and disoriented.
Physical Examination (in ED)
Unshaven unkempt elderly man with clothing saturated with urine and stool. He is oriented to person ...