RICHARD
Richard is a 68-year-old man with chronic renal failure who was in the hospital in serious condition recovering from a heart attack. He had just undergone "balloon angioplasty" to redilate his left coronary artery, and was thus on an "npo" diet (i.e. he was not allowed to have food or drink by mouth). He received fluid through an intravenous (IV) line. Late one night, a weary nurse who was on the 11th hour of a 12-hour shift came into the patient's room to replace the man's empty IV bag with a new one. Misreading the physician's orders, he hooked up a fresh bag of IV fluid that was "twice-normal" saline rather than "half-normal" saline (in other words, the patient starting receiving a fluid that was four times saltier than it should have been). This mistake was not noticed until the following morning. At that time, the man had marked pitting edema around the sacral region and had inspiratory rales ("wet-sounding crackles") at the bases of the lungs on each side. He complained that it was difficult to breathe as well. Blood was drawn, revealing the following:
Na+ 157 mEq / liter (Normal = 136-145 mEq / liter)
K+ 4.7 mEq / liter (Normal = 3.5-5.0 mEq / liter)
C1- 101 mEq / liter (Normal = 96-106 mEq / liter)
A chest x-ray revealed interstitial edema in the lungs.
I NEED HELP DIAGNOSING HIM AND WHAT TO DO TO MAKE HIM BETTER.
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