July 4, 2012

Electrolytes and EDs and EDs

Happy Independence Day if you celebrate it, Happy Wednesday if you don't.

People, even other nurses, don't realize the severe physiological damage that an eating disorder can do.  They know the basics:  too thin isn't good, too fat isn't good.  And that's all they think there is to it.  They don't realize the stress that eating disorders can put on the body.

Electrolyte imbalances are a big one.   I remember sitting in Med/Surg 1 learning about electrolyte imbalances, thinking that they would be one of these things that I'd probably never use but had to learn anyway.  I did very well in it...perhaps it was hinting at my future specialty.

A lot of patients like to fluid-load in lieu of eating:  they drink massive amounts of water or soda (popular with the bulimics since the bubbles apparently aid in vomiting).  The problem is that fluid-loading results in dilutional hyponatremia, which causes decreased levels of consciousness and can even be fatal.  Remember the woman who died after participating in that "Hold Your Wee for a Wii?" contest?  Dilutional hyponatremia in action.

Then there's the kalemias:  hypo and hyper.  Hypokalemia from vomiting or diuretic use.  Hyperkalemia because patients decide to take supplemental potassium to counterbalance their vomiting or diuretic use.  Both screw with the heart and result in dysrhythmias.  If I had a quarter for every normal EKG that I've seen in a new admit...well, I could get a cup of coffee.  But that's the extent of it.

Hypomagnesemia from a poor diet...or perhaps it's the very common co-occurring alcohol addiction?  Either way, heart issues and muscle spasms.

Hypophosphatemia occurs when people starve themselves for extended periods and then start gorging on food...a.k.a. refeeding syndrome.  Can occur when you're trying to restart an anorexic/restricter back on a regular diet:  their system is so depleted that to take on a normal diet just shocks it.

And here you are thinking you don't use any medical knowledge in psych.  Silly you.

In other news...I went to the ED on Monday after work.  I had severe shoulder pain that woke me up in the middle of the night and would not let me get back to sleep.  It didn't respond to Tylenol, heat or massage.  So I slogged though work all day and was going to go home and take some cyclobenzaprine until I remembered one thing from Mother/Baby nursing classes:  shoulder pain could mean ectopic pregnancy and internal bleeding.  So after work I called my doctor who had me go to the ED.

Several hours of testing and waiting later...no ectopic pregnancy.  The embryo landed in the uterus, is on schedule as far as size, and had a heart rate of 124.  So the diagnosis is shoulder pain of unknown origin...best words I heard all night.

I did find it disturbing that not once did they make any attempt towards pain relief...in fact, only one person ever followed up on it.  I did tell them about the pain, but it was 5 hours into the ordeal that a LVN offered me something for it.  She asked what I wanted and I told her Tylenol.  I was offered stronger stuff but I told him that I don't do narcotics.

Side note:  if you show up to the ED wearing scrubs, it's kind of obvious you're a health care provider of some sort.  All of nurses I had asked where I worked.  I told them I worked as a psych RN.  All of them said, "I could never do that."  Which was kind of gratifying to hear.

So after a long night, I went home and had that Flexeril...which did help a bit.  Two days later, the pain is finally easing up.

The brighter side:  now that we had that heartbeat, we were able to tell the little one the good news.  The little one was so excited he's started telling strangers at the airport about the baby that his Mommy is having.  So we let him tell my family when they arrived...and they are overjoyed.  We haven't told his family yet because they weren't home when we called.

And that's about all we're telling for now...we're going to wait until all the genetic testing is done and things are good to go before we go really public with it.  The first appointment is still next week.

No comments: