Subject: Disorders of Fluid, Electrolyte and Disorder of Acid Base Balance

Assignment 1.

Type of assignment: Group.

Clue:
- Explain the clinical reasoning in discussing from the clinical scenario to explain disorder of acid base
imbalance.
- Upload your assignment over the google groups to have a chance other give comment and discussion

Clinical Scenario

A 56-year-old male veteran is seen in consultation in the renal clinic at a Veteran’s Administration
(VA) hospital. He has a long history of hyponatremia, with transient decreases in serum sodium [Na + ] (see Table).
He has been admitted 50 times to the local VA since 1998, most frequently for alcohol withdrawal or alcohol related
problems, but also for various medical and psychiatric issues. In the past year, he has been admitted several times to
the psychiatric campus of the local VA, with suicidal ideation, depression,and suicidal attempts; during his most
recent admission, citalopram was stopped in response to hyponatremia, and bupropion and lamotrigine were
initiated for management of his depression.
He discharged 2 weeks prior to this outpatient evaluation, and has been living at home since that time. Current
medications include bupropion SA 300 mg PO daily, lamotrigine 100 mg PO daily, and quetiapine 200 mg PO daily.
On review of systems, he denies lightheadedness, dizziness, headache, blurry vision, chest pain, cough productive of
sputum, nausea, or vomiting. In addition to six or eight beers a day, he states that he drinks six glasses of orange
juice a day. He also states that he maintains an adequatediet, with at least two large meals a day. Past medical
history includes hypertension, atrial flutter, cerebrovascular event in 1998, alcoholism, cocaine abuse, Barrett’s
esophagus, and a diagnosis of bipolar disorder. He has no history of congestive heart failure, with an unremarkable
echocardiogram 2 years prior to this evaluation. He was treated for pulmonary tuberculosis (TB) in 1991, with
residual granulomata and apical scarring on chest imaging. He was briefly treated again with four agents in 2005 for
a new cavitary lesion. This regimen was stopped after bronchoscopy cultures were negative for TB; the cavitary
lesion resolved with antibiotics.

Social history is notable for intermittent homelessness; he currently lives in a cabin in Maine with no telephone and
minimal amenities. He has a long history of alcohol abuse, drinking as much as 30 beers a day in the past. He also
has a history of cocaine abuse, recently inactive. A longtime smoker, he quit in 2002. Physical exam is notable for
moderate truncal obesity. Heart rate and blood pressure are 72 and
100/60 supine, 72 and 100/60 standing. He has no peripheral edema, with jugular venous pressure
(JVP) seen at 7 cm. Chest is clear, heart sounds are normal with no murmurs. Neurological exam is non-focal.
Bloodwork in clinic shows serum sodium concentration ([Na + ]) of 124 mM, [K + ] 4.8 mM, [Cl − ] 93 mM, bicarbonate
concentration ([HCO 3 − ]) 20 mM, urea 5 mg/dL, and creatinine 0.8 mg/dL. Selected serum and urinary sodium
values, etc., are shown in Table. A recent thyroid-stimulating hormone (TSH) was 1.7 IU/mL (0.3–5.5) and a recent
cosyntropin test increased cortisol from 5.64 to 22.48 and 28.50 m [mu]g/dL at 30 and 60 min. A recent head
computed tomography (CT) scan was unremarkable, with a recent chest X-ray that showed stable evidence of his
prior TB.
The selected laboratories data of case

Assignment 2

Type: Individual task

Clue:
1. Each student must be go online over website to study more independently. The website is:
https://quizlet.com/38176027/chapter-8-disorders-of-fluid-electrolyte-and-acid-base-balance-flash-cards/
2. Each student then take a test independently, no discussion with others, by online ever website
https://quizlet.com/38176027/test.
3. Check your test until you get more than 60%. In case you don’t get yet the required number, you must take
retest until you get more than 60%.
4. Print your test and download save as, please submit to the lecturer on Wednesday, 29th March 2017 at
13.00 p.m. late.

GOOD LUCK