RL is a 52 year old male (weight 172 lbs) diagnosed with severe congestive heart failure. He has excessive edema in both ankles and legs. He is currently receiving diuretics (spironolactone 200mg/day and furosemide 80mg/day). His lab values are as follows: Na 120, K 3.5, BUN 40, serum creatinine 1.2, glucose 70. The patient visits his physician and complains of feeling tired and that he has not urinated much in the past 24 hours. The physician discovers that he has been taking too much of his diuretic medication (exactly double the amount prescribed above). BP is 90/50, HR 165. A urinary catheter was placed and he was found to excrete 15ml/hour. Answer the questions that follow and provide answers in the space provided.

1. This patient should receive :

a. More diuretic medication to treat his edema so that his heart failure can improve

b. NaCl 0.9% infusion (if this is selected, indicate how much in the explanation space and explain why)

c. Restrict extra fluid to avoid problems with edema

d. A and C

Explanation:







2. This patient is:

a. Dehydrated

b. Hyperosmolar

c. Hypertonic

d. A and C

Explanation:











3. Which of the following is true concerning the spironolactone?:

a. It can antagonize substances released in heart failure to treat edema

b. It should never be used in patients with creatinine clearances less than 30

c. It is only used in the treatment of euvolemic hyponatremia.

d. A and B

Explanation:

















LK is a 84 yo male who has been admitted to the hospital with a potassium of 7.2. Serum creatinine is 2.2 and his weight is 88 lbs. He has been taking KCL tablets with a diuretic for hypertension. His serum sodium is 115, BUN 18, serum creatinine 1.1, glucose 70 and he has had a seizure this morning. Chest X Ray revealed a mass in his lung presumably cancer. On physical examination, he was found to have normal BP, normal heart rate and is urinating the proper amount each day. Answer the following:

4. Which of the following should be avoided in this patient?

a. Salt substitutes in his diet

b. Furosemide

c. Spironolactone

d. A, C

Explanation:







5. Which of the following is true?

a. This patient could receive NaCl 3%

b. Alterations in lab values could be due to inability to excrete properly

c. The cancer may cause part of this patient’s problem

d. All of the above

Explanation















6. Which of the following is true?

a. This patient should have edema even though it was not stated

b. This patient should not have edema

c. This patient should have an elevated blood pressure

d. None of the above

Explanation:













7. A patient with diarrhea has the following labs: Na 116, K 3.0, BUN 45, serum creatinine 1.5 with a glucose 70. This patient should receive 1000ml NaCl 0.9% with 100meq KCL to infuse at a rate of 250ml per hour immediately.

A. True

B. False (if disagree, provide correct method and amount when explaining)

Explanation













8. A patient has Diabetes Mellitus with a glucose of 840. BUN 20, serum creatinine 1.8 and Na 119. Which of the following is true?

a. This patient is hypertonic

b. This patient is hyperosmolar

c. This patient should receive insulin to correct the glucose

d. A, B and C



Explanation:









9. Which of the following will not require treatment?

a. Pseudohyponatremia

b. Euvolemic hyponatremia

c. Hypovolemic hyponatremia

d. None of the above



Explanation:

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