Failure to Diagnose & Delay in Treatment of Dehydration (Electrolyte Imbalance)

Evaluate breaches in the standard of care

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms of dehydration did the patient present? (Choose all that apply)
    Fatigue/loss of appetite
    Heat intolerance/increased thirst
    Muscle spasm/numb skin
    Headache/ lightheadedness/clumsiness/delirium/lethargy
    Absence of tears/sunken eyes/dim vision
    Dry mouth/eyes
    Burning sensation in stomach
    Dark urine/painful urination/less urination
    Difficulty swallowing
    None of the above
    Not elicited
    Answer unknown
    Why is this important?
    Early symptoms of dehydration include headache, fatigue, loss of appetite, heat intolerance, light-headedness, dry mouth and eyes, burning sensation in the stomach and dark urine with a strong odor.
    (1999) 99 JNLADA 2 200-206

  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.
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  • Was a medical history obtained? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's examination, enables the clinician to make educated evaluations, and be better equipped to advise the patient.
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  • Was a medication history obtained? Why is this important?
    Answer this question
    Medication regimen, especially diuretics; and nephrotoxic drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs), aminoglycosides, cisplatin, radiocontrast, and pentamidine can cause dehydration.
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  • Was a physical examination performed? Why is this important?
    Answer this question
    A complete and carefully focused physical examination serves as the core of the diagnostic process Decreased blood pressure, postural change in blood pressure and heart rate on standing, tachycardia, dry mucous membranes, decreased skin turgor, sunken eyes, increased respiratory rate, elevated body temperature, and axillary dryness are all signs of dehydration which should be assessed during physical examination.
    (2008) 47 EARGER 3 340-355

  • With which of the following physical signs of dehydration did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Dehydration increases physiologic strain as measured by core temperature, heart rate, and perceived exertion responses during exercise heat stress. The greater the body water deficit, the greater the increase in physiologic strain for a given exercise task.
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  • Was a daily assessment for dehydration performed? Why is this important?
    Answer this question
    Human hydration assessment is a key component for prevention and proper treatment of fluid and electrolyte imbalances. Fluid balance monitoring needs to be performed daily.
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  • Which of the following diagnostic laboratory investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    Routine laboratory studies can provide important clues to diagnosis.
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  • Were fluids offered regularly to prevent dehydration? Why is this important?
    Answer this question
    The risk of dehydration occurs when increased fluid losses are coupled with decreased fluid intake.
    (2008) 9 JLAMDA 5 292-301

  • Was a fluid intake/output chart maintained? Why is this important?
    Answer this question
    Weight loss, malnutrition and dehydration can be detected at an early stage when a resident's intake and output is monitored closely. The intake and output must be documented and kept on the patient’s medical record.
    (2001) 2 JLAMDA 4 175-182

  • With which of the following type of dehydration was the patient diagnosed? Why is this important?
    Answer this question
    Classification of dehydration as mild, moderate and severe is important for determining the rate of fluid replacement in the patient.
    (2008) 47 EARGER 3 340-355

  • Was gradual oral rehydration therapy performed? Why is this important?
    Answer this question
    Mild volume depletion can be treated by gradual oral rehydration or via a feeding tube.
    (2002) 3 JLAMDA 6 371-376

  • Were intravenous fluids administered? Why is this important?
    Answer this question
    Moderate volume depletion must be treated by more rapidly. Severe volume depletion should be treated rapidly via the intravenous route.
    (2002) 3 JLAMDA 6 371-376

  • Was immediate treatment for severe dehydration initiated? Why is this important?
    Answer this question
    Medical management of severe acute dehydration includes fluid rehydration, electrolyte replacement, diet alteration, and symptomatic therapy.
    (2003) 32 EGASCN 4 1249-1267

  • Was the patient’s underlying cause of dehydration addressed? Why is this important?
    Answer this question
    It is necessary to identify the causes of an individual's fluid and electrolyte imbalance so treatment can begin.
    (2002) 3 JLAMDA 6 371-376

  • Which of the following were not monitored during rehydration therapy? (Choose all that apply) Why is this important?
    Answer this question
    During fluid rehydration, the vitals of the patient and the urine output need to be closely monitored to assess signs of fluid overload.
    (2003) 32 EGASCN 4 1249-1267

  • On which of the following aspects of hydration therapy was the patient educated? (Choose all that apply) Why is this important?
    Answer this question
    Alleviating dehydration should involve a combination of strategies that include assessment, education, and inclusion of practices that encourage fluid intake. Education is a vital component to help individuals maintain hydration before, during, and after activity. The factors of hydration program include diet, clothing, gender-based factors; age related blunting of thirst, exercise related education, increased caffeine use, alcohol consumption and situational factors.
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  • Was excessive hypertonic fluid administered to the patient? Why is this important?
    Answer this question
    Common causes of hypernatremia include excess hypertonic fluid administration: • Intravenous infusion of hypertonic fluid or excessive administration of intravenous normal saline with inadequate free water intake in hospitalized, critically ill patients • Total parenteral nutrition or enteral feedings
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  • Was the patient monitored for diabetes insipidus? Why is this important?
    Answer this question
    Inadequate or inappropriate treatment of diabetes insipidus is a contributory factor for development of hypernatremia.
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