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Chief Complaint

Fatigue and Dizziness

History of Present Illness

63-year-old female presented to the emergency department for evaluation of complaints of fatigue and fluctuating weight over the last several months. She had several ground levels falls without loss of consciousness or head trauma. She endorsed dizziness which was predominately with rising from a seated position. Nausea, vomiting, increased urination and nocturia were new symptoms which began a few weeks prior to this hospitalization. She manages her own medications and takes them routinely. She was instructed by nephrologist to stop taking hydrochlorothiazide sixty days ago, but she did not follow this advice.

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. What electrolyte disorders do you recognize?

    Hint: See Electrolytes in PPP

  2. What factors may have contributed to the hyponatremia?

    Hint: See Electrolytes in PPP

  3. What factors may have contributed to hypokalemia?

    Hint: See Electrolytes in PPP

  4. Describe your treatment plan to correct the patient’s hyponatremia?

    Hint: See Electrolytes in PPP

  5. Would you recommend phosphorous for this patient?

    Hint: See Electrolytes in PPP


What alternative medication can be used for BP control?

Hint: See Table 6-7 in PPP


Global Perspective

Hyponatremia is the most common electrolyte disorder in hospitalized patients and is defined as a serum sodium concentration below 135 mEq/L (mmol/L). Euvolemic hyponatremia is characterized by excessive free water. Nausea, vomiting, lethargy, confusion, muscle weakness, falls, and seizures are potential symptoms. Elderly patients are at increased risk of developing euvolemic hyponatremia secondary to diseases (thrombosis, hemorrhage, trauma, tumors) and medications (antidepressants, angiotensin converting enzyme inhibitors, thiazides, and opioids). Treatment involves holding the offending agent, fluid restriction, and potentially oral sodium replacement (salt tablets) and intravenous sodium replacement (normal saline or hypertonic saline).

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