Fred, 63 y/o male who had an MI 14 months earlier, is seen by his physician pres

Question

Fred, 63 y/o male who had an MI 14 months earlier, is seen by his physician presenting with shortness of breath, fatigability, and swelling of the lower extremities. Upon physical examination, Fred is found to have distended jugulars and pitting edema of the ankles. His breathing is rapid (20 breaths/min) and pulmonary rales (crackles) are heard bilaterally in the lower lobes of the lungs. He has a pulse rate of 110 beats/min and a BP of 150/88. Since his MI he has been taking digoxin and hydrochlorothiazide. Blood work shows: Na+lp 120 mEq/L [K+lp- 3.0 mEq/L HCO3-lp-24 mEq/L [creatinine!p = 0.8 mg/dl Urine osmolarity = 650 mOsm/L The Px has gained 11 lbs in the last 2 weeks. The physician administers 40mg of Lasix and 1 liter of 3% saline to Fred. What would this treatment have on Fred assuming that Lasix administration results in a Uosm of 300 mOsm/kg H20?

Explanation / Answer

Fred mainly has two problems

1.Right sided heart failure (due ti which fluid overload is present)

2.[Na+] is low which can have very serious complications.

Treatment has to be desined to treat these two conditions, Lasix will clear the fluid overload by causing diuresis and 3% saline(hypertonic in comparison to normal 0.9%) will take care of low sodium hence Fred will soon be fine.

Hope it help.

Thankyou

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