Basic blood tests could have shown risk of seizures
A slight, eighty year old woman was admitted to hospital after suffering a stroke. After spending several weeks of treatment, the doctors declared she was stable. She was then assessed for rehabilitation. The hospital desperately needed the bed. The woman was keen to get out of the ward.
However, her blood pressure was consistently on the low side. This issue would have to be resolved, before she could be accepted into rehab. Their guidelines were extremely strict. Every vital sign had to be within ‘normal’ limits, every test result stable.
The senior nurse asked the junior doctor to write up intravenous fluids, to quickly raise the patient’s blood pressure to normal. However, her blood pressure remained borderline. More fluids were given. Nurses also asked her to drink plenty of water.
No blood tests were done to check her fluid and electrolyte levels. Despite this effort, her blood pressure remained low and the rehabilitation team insisted that should couldn’t be accepted to rehab. Hospital staff continued to push fluids. Blood pressures were done every four hours.
A week later a nurse found the woman having seizures. A code blue was called, and the emergency team rushed in. Blood tests were quickly done. They revealed that her sodium levels were very low. Low sodium levels can increase the risk of seizures. The doctors diagnosed the cause of her low sodium as being related to excess fluids. The elderly woman was immediately put on a fluid restriction of 500 mls a day. All intravenous fluids were ceased. Rehabilitation was delayed. She was kept in hospital for yet another week.
Basic blood tests could have prevented cardiac arrest
A seventy year old women with chronic but well managed heart disease had a fall in her home. The ambulance were called, and took her to hospital. An x-ray revealed a broken hip. She went for surgery the following day. Several days after the operation, the woman developed difficultly breathing. When nurses checked her oxygen saturation they found it was low. The doctors were advised, and a chest x-ray was ordered. It turned out she had fluid in her lungs, possibly from a flair up of her chronic heart problem. The treatment prescribed was a drug called lasix. It pulls fluid out of the body, and passes it out through the kidneys. In order to get the fluid out of her lungs quickly, it was given via a vein.
After several days of this treatment, the fluid in her lungs disappeared. Her breathing became normal and her oxygen saturation levels were excellent. Every one was happy. However, no one checked her blood electrolyte levels. The women experienced a cardiac arrest, and went into ventricular fibrillation (a dangerous heart rhythm). A code blue was called, the emergency team arrived and she was taken to a coronary care unit.
Blood tests revealed she had a low blood potassium level. Low potassium levels were a well known side effect of the drug lasix. Her stay in hospital was extended, as she spent time in Coronary Care, then went back to the ward to be monitored. Her rehabilitation was slow, after spending over a month in hospital.
© Wikihospitals 2014