Problem
M.J. is an obese (BMI of 36.5) 36-year-old woman is seen in her primary care physician's office after suffering from a weekend of nausea, vomiting, and diarrhea. She is slightly febrile, complains of feeling dizzy when going from a sitting to a standing position, and remains nauseated. She has not vomited or had any loose stools since the previous evening. According to the history provided, she did not keep any food or liquids down for more than 48 hours. Based on initial clinical observations and reported history, the clinician assumes that the woman is suffering from dehydration and hypovolemia.
I. What would be the expected laboratory values for dehydration and hypovolemia? What is the rationale for your response? What additional signs or symptoms would you look for to confirm these conditions?
II. Explain the pathophysiology associated with the changes in moving from a sitting to a standing position. What is the rationale for this phenomenon? What other signs or symptoms would you expect?
III. How does her BMI affect both dehydration and orthostatic hypotension problems? What is the rationale for your response?
IV. What type of IV fluid resuscitation would the clinician order? Why is this the primary choice?
V. What additional medications or treatment would you anticipate for your patient?
VI. What teaching points would you address with her?