Disorders of Fluid, Electrolyte, and Acid-Base Balance in Anorexia Nervosa

  Case Study Evaluation: Disorders of Fluid, Electrolyte, and Acid-Base Balance in Anorexia Nervosa Identification of the Protein and Its Role In Amanda's case, the nurse was likely referring to albumin, a key protein produced by the liver that plays a crucial role in maintaining oncotic pressure in the blood. A deficiency in albumin can lead to reduced oncotic pressure, which is the force that helps retain fluid within the blood vessels. When albumin levels are low, fluid can leak into the interstitial spaces, resulting in edema—the abnormal accumulation of fluid in tissues. Contribution of Albumin Deficiency to Edema In Amanda's scenario, her anorexia nervosa has likely led to malnutrition, which can result in low serum albumin levels. When albumin is deficient: 1. Oncotic Pressure Decreases: The lower concentration of albumin in the bloodstream reduces the osmotic gradient that normally pulls water into the vascular system. 2. Fluid Leakage: Consequently, fluid shifts from the intravascular space to the interstitial space, causing swelling (edema) in various parts of the body, which Amanda perceives as "fat hands and feet." Pitting vs. Nonpitting Edema The distinction between pitting and nonpitting edema is significant: - Pitting Edema: This type occurs when excess fluid accumulates in the interstitial tissues, and when pressure is applied to the swollen area (e.g., with a finger), it leaves an indentation (pit) that persists for a brief period. It is usually associated with conditions such as heart failure, renal dysfunction, or liver disease. - Nonpitting Edema: In contrast, nonpitting edema does not leave an indentation when pressure is applied. It is often seen in cases of lymphatic obstruction or conditions like hypothyroidism. The tissue is typically firmer and more fibrous. In Amanda's case, the edema may likely present as pitting due to her nutritional state and potential fluid overload. Effects of Wheelchair Mobility on Edematous Tissues Moving Amanda around the ward in a wheelchair has implications for her edematous tissues: 1. Pressure Redistribution: While in a wheelchair, her body weight is distributed differently compared to lying flat. This can help alleviate some pressure on specific areas, potentially reducing localized edema. 2. Reduced Circulation: However, prolonged inactivity or immobility can lead to venous stasis, where blood pools in the lower extremities due to gravity. This could exacerbate edema in her legs and feet if she remains seated for extended periods. 3. Limited Muscle Contraction: The lack of active muscle contraction while seated can hinder lymphatic drainage and venous return, further contributing to fluid accumulation. 4. Promoting Fluid Shifts: If Amanda’s position is not changed frequently, it could lead to further fluid shifts within her body, aggravating existing edema. Conclusion Amanda's case highlights how alterations in homeostasis due to anorexia nervosa affect fluid balance and contribute to edema. Factors such as gender (young female), genetic predispositions to eating disorders, ethnic sensitivities toward body image, and temporal variables like age all play roles in her condition. Addressing nutritional deficiencies and understanding the physiological mechanisms at play are vital for her recovery and overall health improvement. References - Kearney, P. M., & O'Brien, M. (2019). Fluid and Electrolyte Balance. In Medical Physiology (pp. 329-350). New York: Academic Press. - Wong, R. (2020). Understanding Edema: Types and Treatment Options. Journal of Clinical Nursing. DOI:10.1111/jocn.15230.

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