Case Study

An 87-year-old man comes into the emergency department after fainting in church. He “came to” fairly quickly however EMS was called. When EMS arrived, BP was 100/60 with a pulse of 120 and regular. He was oriented to person but kept asking where he was. EMS was unable to get an IV in place – veins kept rolling. He arrived in the ED mildly confused but pleasant. He was asked to stand up and get on a bed and became very dizzy with standing. His daughter arrived and reported that her father had diarrhea for a few days after starting new medication for diabetes. His sugar has been very high over the past 2 weeks. He has been eating and drinking but a little confused over the last few days and laying in bed a lot.

On exam in ED:

BP 90/50

Pulse 128 regular

O2 sat 96

Mucous membranes dry, cracked lips

Chest clear

CV regular, tachycardia with no murmur or gallop

Abdominal soft, NT, Nl BS no mass

Ext no edema, cool

Labs:

Na 129

K 4.0

Chloride 103

CO2 34

BUN 40

Cr 2.0

ECG sinus tachycardia and left axis deviation otherwise normal CXR no cardiopulmonary abnormality

Answer the following questions:

1. What abnormal lab results do you find?
2. What do you conclude from the labs, physical exam, and patient presentation/medical history (as provided)?
3. What additional information do you need?
4. What physiological mechanism(s) is/are malfunctioning?