Which factors play a role in the degree of fluid and or electrolyte imbalances?

Case Scenario

A 65 year-old male went hiking with two friends up in the
mountains. The week before, Mr. C had the flu but he was determined to make the
five hour climb. Mr. C’s wife packed some chocolate covered- dried cranberries
for his snack since she believed the “fruit” would be healthy. She
was concerned because Mr. C. had been a little depressed over the last year
since the NP could not get his blood pressure under control. Mr. C. was put on
a thiazide diuretic for his Hypertension. He has been taking Celexa for a few
months. Although Mrs. C. was concerned about her husband’s condition, she
thought the hike might be good for him.
When the group got to the top of the mountains, the temp was
75 degrees. As they descended, the air was hot and humid. Mr. C drunk all of
his water from the snack box prepared by his wife. He stated he was
“feeling dehydrated and wanted to stay hydrated” since he had the flu
last week.
Mr. C told his friends that he was seeing spots in his eyes
and feeling dizzy. The friends asked if he wanted to take a break and he
refused. About 20 minutes later, he yelled “Run there is a lion”. The
friends became very concerned at this time since they thought Mr. C. was
talking “out of his head”. A few minutes later, Mr. C. complained of
feeling dizzy and fell down. He said “I must still be weak and dehydrated
from the flu that I had last week. I can’t think straight”. “I wonder
if this could be a side of effect of my meds?”
The friends rushed him to the nearest clinic. As the NP, you
sent his lab work to the on-site clinical laboratory which provided the
following electrolyte test results:

Na+ = 128 meq/L
K+ = 4.5 meq/L
Cl- = 95 meq/L
Ca++ = 1 mmol/L
CO2 Total = 26 meq/L
Anion gap =9.6 mEq/L
glucose = 120
HCT = 33%
BUN= 5
Cr+ .9 mg/dL
AST/SGOT = 32
Albumin = 3.3
Protein, total = 5.3g/dL

Based on the information presented:

Which lab values are
abnormal? Identify if elevated or decreased and state the rationale for the
abnormality.
Identify Mr. C
diagnosis. (Include both electrolyte and fluid alterations).
What is the most
likely cause of this problem?
What are the physical
symptoms of this problem?
What would you as the
NP tell Mr. C how to prevent the problem?
What information
should Mr. C. report to the NP when he arrived at the clinic? Why is this
important?
Is it better to
measure calcium level by the amount of ionized calcium or total calcium? Discuss
the rationale for your answer.
Identify the signs
and symptoms you would expect to see for the abnormal fluid volume.
Which factors play a
role in the degree of fluid and or electrolyte imbalances? Explain in detail.
Discuss what would
happen to the cells if these clinical problems are not corrected. i.e would
they shrink, swell etc.
Did Mr. C’s snack
impact his condition? Explain your answer.
Why was the K+ level
normal?
What other factor
could have contributed to Mr’s C’s condition?
What is the
appropriate treatment by the NP for the fluid and electrolyte imbalances?