A 70 kg 68 y/o male sees his cardiologist for a follow-up following his myocardial infarction 3 months earlier. He has been taking digoxin and LisinoprilTM since his MI. At the follow-up, he complains of shortness of breath and has to sleep sitting up in his recliner. He also complains of fatigability and swelling of his ankles and hands. A physical examination finds that he has distended jugulars and pitting edema in the lower legs. His breathing was rapid 22 breaths/min) and rales were heard in the both sides at the base of the lungs. He does not have a fever, but his pulse is 116 bpm and his blood pressure is 110/80. The physician immediately admits him and orders a blood and urine analyses with the results as follows:
Blood
Urine
[Na+]
128 mEq/L
[Na+]
150 mEq/L
[K+]
3.0 mEq/L
[K+]
65 mEq/L
[Cl-]
98 mEq/L
[Cl-]
120 mEq/L
[HCO3-]
21 mEq/L
[HCO3-]
15 mEq/L
Creatinine
1.2 mg/dl
Creatinine
128 mg/dl
PCO2
24 mmHg
24 hr volume
750 ml
pH
7.51
Osmolality
600 mOsm
The physician orders an infusion of 2L of 3% saline with 40 mg of Lasix® given twice a day for three days. CALCULATE how this treatment would impact the Pxâs symptoms assuming the osmolarity of the urine dropped to 400 mOsm?
A 70 kg 68 y/o male sees his cardiologist for a follow-up following his myocardial infarction 3 months earlier. He has been taking digoxin and LisinoprilTM since his MI. At the follow-up, he complains of shortness of breath and has to sleep sitting up in his recliner. He also complains of fatigability and swelling of his ankles and hands. A physical examination finds that he has distended jugulars and pitting edema in the lower legs. His breathing was rapid 22 breaths/min) and rales were heard in the both sides at the base of the lungs. He does not have a fever, but his pulse is 116 bpm and his blood pressure is 110/80. The physician immediately admits him and orders a blood and urine analyses with the results as follows:
| Blood | Urine | |||
| [Na+] | 128 mEq/L | [Na+] | 150 mEq/L | |
| [K+] | 3.0 mEq/L | [K+] | 65 mEq/L | |
| [Cl-] | 98 mEq/L | [Cl-] | 120 mEq/L | |
| [HCO3-] | 21 mEq/L | [HCO3-] | 15 mEq/L | |
| Creatinine | 1.2 mg/dl | Creatinine | 128 mg/dl | |
| PCO2 | 24 mmHg | 24 hr volume | 750 ml | |
| pH | 7.51 | Osmolality | 600 mOsm | |
The physician orders an infusion of 2L of 3% saline with 40 mg of Lasix® given twice a day for three days. CALCULATE how this treatment would impact the Pxâs symptoms assuming the osmolarity of the urine dropped to 400 mOsm?
