NCLEX-PN® ExaminationPhysiological AdaptationMedium
A client is experiencing an acute exacerbation of Crohn's disease, with severe diarrhea and abdominal pain. The nurse notes a blood pressure of 90/60 mmHg, heart rate of 110 bpm, and reports increased thirst. The client's last urine output was 15 mL in the last hour. Which of the following fluid and electrolyte imbalances is the client most likely experiencing?
- AHypokalemia and metabolic alkalosis
- BHypernatremia and fluid volume excess
- CHypovolemia and metabolic acidosis
- DHypercalcemia and respiratory acidosis
Show answer & explanationAnswer & explanation
Correct answer: C. Hypovolemia and metabolic acidosis
Severe diarrhea leads to significant loss of fluid and bicarbonate, resulting in hypovolemia (evidenced by hypotension, tachycardia, thirst, oliguria) and metabolic acidosis. The loss of bicarbonate in stool causes the acidosis.
Why the other options are wrong
- A. Diarrhea causes loss of potassium (hypokalemia is possible), but also loss of bicarbonate, leading to acidosis, not alkalosis.
- B. Diarrhea causes fluid loss, leading to hypovolemia, not fluid volume excess. While hypernatremia can occur with fluid loss, the primary fluid imbalance is hypovolemia.
- D. There is no information to suggest hypercalcemia, and diarrhea typically causes metabolic acidosis, not respiratory acidosis.
Diarrhea Fluid & Electrolyte Imbalances
Severe diarrhea can lead to significant fluid and electrolyte disturbances, primarily hypovolemia and metabolic acidosis due to loss of bicarbonate-rich fluids.
- Diarrhea causes loss of water, sodium, potassium, and bicarbonate.
- Hypovolemia results from fluid loss, leading to hypotension and tachycardia.
- Loss of bicarbonate leads to metabolic acidosis.
Memory trick: Diarrhea's drain makes volume low, acid high, a fluid woe!