CRITICAL THINKING INCIDENTProblem In order to treat the dehydration the patient arrived with, doctors gave him normal saline solution to increase fluid levels. The patient ended up with fluid overload. The patient arrived dehydrated and during his hospital stay acquired fluid overload, how could this happen? Background An 85-year-old woman was admitted to hospital due to a fall. The patient was diagnosed with syncope due to rhabdomylosis, which is the breakdown of muscle fibers that leads to kidney damage (Rhabdomyolysis - PubMed Health). The patient has a past medical history of Wegener's granulomatosis, which is a disorder in which blood vessels become inflamed, making it difficult for blood to flow (Wegener's granulomatosis - PubMed Health). The patient also has a past medical history of atrial fibrillation, glaucoma, hypothyroidism, thoracic spine pain, and confusion. The patient has undergone cataract surgery in the past. After evaluation, the patient had a total output of 320 ml. The patient had generalized edema and appeared to have gained weight. The patient showed signs of restlessness and change in mental status. Laboratory values ​​significant for this therapeutic problem: • High WBC 11.0 (normal: 3.8-10.5 K/uL) • Low hemoglobin 10.3 (normal: 13-17 g/dL) • Low hematocrit 31, 8 (normal: 39-50 %)• RBC low 3.63 (normal: 4.2-5.8 M/uL)• BUN high 26.0 (normal; 7-23 mg/dL)• Creatine kinase 702 high ( normal: 60-400 IU/L)• Sodium 160 high (normal: 135-145 mEq/L) Drugs:• Latanoprost (Xalatan): Treats ocular hypertension and open-angle glaucoma • Levothyroxine (Synthroid): Treats l hypothyroidism and prevents goiter.• Iosartan (Cozaar): is an angiotensin II and is a powerful vasoconstrictor• Spironolactone......in the center of the sheet......n evaluation of the patient's lungs I have not seen either felt any form of breathing problem. The patient did not have any shortness of breath (dyspnea). The patient did not have persistent cough or any form of wheezing. Usually patients with heart problems have an increased need to urinate at night, which the patient did not need. The patient showed no signs of chest pain which is another sign of CHF and HF. Since the patient did not show the main signs of heart problems, I was able to exclude fluid overload due to heart problems. Overall patients may receive fluid overload for many reasons. The three main reasons why fluid overload may develop are high volume of intravenous fluids, heart problems, or kidney failure. In my patient's case, the main reason she developed fluid overload was kidney failure.