During the summer, a 27-year-old construction worker presents to the emergency room with complaints of flank pain, extreme fatigue, and decreased urination. Initial assessment reveals a temperature of 100.3 F, blood pressure of 88/40, respirations of 22, and a heart rate of 116 beats per minute. Laboratory values reveal a potassium level of 5.4 and a sodium level of 150. The nurse recognizes that these findings likely indicate which of the following? 

Heat exhaustion with possible acute renal failure

Explanation

•Heat exhaustion is a risk factor in people who work in the heat and do not adequately rehydrate for fluid replacement.

•The potential for heat exhaustion to result in acute renal failure exists due to severe dehydration causing decreased renal perfusion. Acute renal failure may cause elevation of serum electrolytes if the kidneys are unable to produce enough urine to filter out excess potassium and sodium.

•These patients require hydration with intravenous fluids using a hypotonic solution and be placed on an oral intake fluid restriction. The fluid intake by mouth is restricted to prevent fluid volume excess since the kidneys are not functioning adequately.

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