From the Guidelines
The patient's lab results indicate low sodium and chloride levels, which should be addressed by increasing daily fluid intake with electrolyte-containing beverages and moderately increasing salt intake in the diet, while continuing the blood pressure medication as prescribed. For a 72-year-old female on blood pressure medication, these electrolyte imbalances are notable and may be related to the medication itself, such as diuretics like hydrochlorothiazide or furosemide, which can cause electrolyte loss through increased urination 1. The patient should follow up with her physician within 1-2 weeks to recheck these electrolyte levels, especially if she experiences symptoms like dizziness, confusion, or weakness.
Key Findings
- Low sodium (133 mmol/L) and low chloride (92 mmol/L) levels
- Normal kidney function with appropriate eGFR (95 mL/min/1.73m2)
- Normal liver function tests
- Blood pressure medication may be contributing to electrolyte imbalances
Recommendations
- Increase daily fluid intake with electrolyte-containing beverages
- Moderately increase salt intake in the diet
- Continue blood pressure medication as prescribed
- Follow up with physician within 1-2 weeks to recheck electrolyte levels The carbon dioxide level is at the upper limit of normal (32 mmol/L), which, combined with the electrolyte abnormalities, suggests a possible mild metabolic alkalosis, a common pattern with certain diuretics that can be monitored by the physician 1. Overall, the patient's lab results suggest that the low sodium and chloride levels should be addressed, and the patient should be monitored for any symptoms or changes in her condition.
From the Research
Laboratory Results
- Glucose: 99 mg/dL (normal range: 65-99 mg/dL) 2, 3
- Urea nitrogen (BUN): 11 mg/dL (normal range: 7-25 mg/dL)
- Creatinine: 0.60 mg/dL (normal range: 0.60-1.00 mg/dL)
- eGFR: 95 mL/min/1.73m2 (normal range: ≥ 60 mL/min/1.73m2)
- BUN/creatinine ratio: 6-22 (calculated)
- Sodium: 133 mmol/L (low, normal range: 135-146 mmol/L)
- Potassium: 4.1 mmol/L (normal range: 3.5-5.3 mmol/L)
- Chloride: 92 mmol/L (low, normal range: 98-110 mmol/L)
- Carbon dioxide: 32 mmol/L (normal range: 20-32 mmol/L)
- Calcium: 9.8 mg/dL (normal range: 8.6-10.4 mg/dL)
- Protein, total: 7.3 g/dL (normal range: 6.1-8.1 g/dL)
- Albumin: 4.4 g/dL (normal range: 3.6-5.1 g/dL)
- Globulin: 2.9 g/dL (normal range: 1.9-3.7 g/dL, calculated)
- Albumin/globulin ratio: 1.5 (normal range: 1.0-2.5, calculated)
- Bilirubin, total: 1.2 mg/dL (normal range: 0.2-1.2 mg/dL)
- Alkaline phosphatase: 68 U/L (normal range: 37-153 U/L)
- AST: 17 U/L (normal range: 10-35 U/L)
- ALT: 15 U/L (normal range: 6-29 U/L)
Antihypertensive Medication and Renal Function
- The patient is a 72-year-old female on blood pressure medication, with normal renal function (eGFR: 95 mL/min/1.73m2) 3, 4
- Studies have shown that antihypertensive drugs, such as angiotensin-converting enzyme inhibitors and calcium entry blockers, can have beneficial effects on renal function in patients with hypertension 3, 4
- The patient's laboratory results show normal BUN and creatinine levels, indicating no significant impairment in renal function 2, 3
Hypertension Screening and Management
- The US Preventive Services Task Force recommends screening for hypertension in adults 18 years or older with office blood pressure measurement 5, 6
- The patient's blood pressure medication and normal renal function suggest that her hypertension is being managed effectively 3, 4
- Regular monitoring of blood pressure and renal function is essential to prevent cardiovascular disease and kidney damage 2, 3, 4, 5, 6