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I. INTRODUCTION
Potassium is the major intracellular electrolyte, 98% of the bodys potassium is inside
the cells. The remaining 2% is in the ECF, and it is this 2% that is important in
neuromuscular function. Potassium influences both skeletal and cardiac muscle activity. The
normal serum potassium concentration ranges from 3.5 to 5.0 mEq/L and even minor
variation are significant. Potassium imbalances are commonly associated with various
diseases, injuries, medications and special treatment, such as parenteral nutrition and
chemotherapy. Alterations in potassium concentration result in electrical signal that interrupt
normal cardiac rhythm, muscle activity and nerve conduction.
Hypokalemia is serum K concentration < 3.5 mEq/L caused by a deficit in total body
K stores or abnormal movement of K into cells. The most common cause is excess losses
from the kidney or GI tract. Most of the bodys potassium is stored inside various cells and
organs, with only a small amount found in the blood. The body maintains a balance of
potassium in the blood by matching the amount of potassium taken in with the amount
excreted (put out) by the kidneys. Hypokalemia occurs when the body releases too much
potassium, such as through severe vomiting, diarrhea, or sweating during intense exercise. It
also can be caused by a disease that affects kidney function the kidneys may excrete too
much potassium, or may not be able to match their output to the bodys potassium intake.
Certain drugs called diuretics increase the bodys urine output, which can also cause
Hypokalemia. Hypokalemia can be caused by overuse of laxatives; by eating disorders such
as bulimia, which involves self-induced vomiting; and by prolonged fasting and starvation.
Symptoms of hypokalemia include irregular heartbeat, which can range from mild to
severe. Severe cases can result in cardiac arrest and paralysis of the lungs. Other symptoms
can include muscle weakness, cramping, or flaccid paralysis (limpness); leg discomfort;
extreme thirst; frequent urination; and confusion. Infants and young children with
gastrointestinal illnesses that cause prolonged vomiting and diarrhea can die from cardiac
arrest when potassium levels become dangerously low.
Hypokalemia is diagnosed by measuring the potassium levels in a blood sample. To
determine the cause of hypokalemia, your doctor may also check potassium levels in a urine
sample. The doctor may also order a test called an electrocardiogram (ECG or EKG), which
measures the electrical activity of the heart.
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Sever hypokalemia is treated in a hospital with intravenous (IV) potassium. In most
cases, however, this condition can be treated by increasing the amounts of potassium-rich
foods in the diet, drinking electrolyte replacement fluids during intense exercise or for severe
vomiting or diarrhea, or by taking a potassium supplement in a dosage recommended by your
doctor. It is important to have the potassium levels in the blood checked regularly if you are
taking diuretics or other medications that affect potassium
II. Patient Profile
Ward: Room 304
Date of Admission: February 05, 2010
Patient Name: Mrs. A
Address: 159 Reyes Street Silang, Cavite
Age: 29 yrs old
Gender: Female
Birth Date: December 08, 1980
Educational Status: College Graduate
Religion: Roman Catholic
Nationality: Filipino
Civil Status: Single
Occupation: Accountant
Health Care Financing: Independent Consultant
Informant: Patient
Reliability: The primary source of data is the patient itself
Admission Data
Chief Complaint: Numbness of both upper and lower extremities
Admitting Diagnosis: t/c hypokalemia periodic paralysis r/o anxiety disorder
Attending Physician: Dr. Antonio Barroso III
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III. Patient History/ Nursing History
History of Present Illness
Prior to admission, the patient was in her office and suddenly she felt numb on her
upper and lower extremities, she was scared so they went to the hospital. Upon admission, the
patient has a chief complaint of numbness of both upper and lower extremities.
Past Medical History
The patient is allergic to any seafood. She had experience numbness before and last
few days before she was admitted to the hospital she had diarrhea.
Family Health History
According to the patient, her father was hypertensive. On her father side, her
grandfather was also hypertensive.
Legend:
- Male - Female - deceased
Personal and Social History
The patient is an accountant working on private company. She has to travel a couple
of hours to face different clients everyday. She wasnt able to eat on time due to her work.
+HPN
+HP
N
Mrs.
A
+HP
N
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IV. Gordon's Functional Health Pattern
Level Of Functioning Before Hospitalization During Hospitalization Analysis/Inference
Health Perception/ Health
Management
She was aware that when she felt
numb, she is just hypoventilating
The patient is now aware that she
is hypokalemic
The patient is knowledgeable
about her condition
Nutritional and Metabolic Pattern She wasnt able to eat on time and
most of the time she brought food
on fast-food chain.
DAT and requires to eat at least 1
banana per day
Her eating pattern may caused her
diarrhea
Elimination Pattern Her regular bowel elimination
was 1x a day before bedtime.
Urinates 3 times a day
Past few days before admission
she had diarrhea
(-) Bowel movement
Urination 7x
Her diarrhea may caused her
hypokalemia
Activity - Exercise Pattern Walking is her main exercise. She
also does household chores.
She can't do some exercises, even
walking is limited. Most of the
time, she just sit doing her paper
works with her laptop.
Due to hospitalization her
activity-exercise pattern is limited
Sleep Rest Pattern The patient usually sleeps less The patient cant sleep well. She The patient might be fatigue due
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than 6 hours verbalized hindi ako sanay
matulog sa ibang bahay kaya
hindi ako makatulog ng maayos.
to lack of sleep and she is not used
to the place.
Cognitive Perceptual Pattern She consults the doctor everytime
she felt something wrong with
herself. She is well educated and a
college graduate.
The patient can express her
feelings clearly.
The patient shows security with
herself.
Self perception and Self
concept Pattern
She is concern with regards to her
health.
She is not comfortable due
numbness of her lower extremities
She is conscious that she needs
high potassium diet
Role Relationship Pattern The patient supports the financial
needs of her brother; she is living
on her own.
The patient can still support the
financial needs of her brother.
The patient loves her brother so
she still does her job even at the
hospital.
Sexuality Reproductive Pattern Her menstruation is irregular. She
is single.
Her menstruation is irregular She might feels disturb due to
irregular menstruation.
Coping Stress Tolerance
Pattern
She eats ice cream when she feels
stressed and through the help of
her bestfriends advice she can
cope problems
She is always visited by her
bestfriend to the hospital and able
to express her feeling to her.
When she needs help her
bestfriend is always beside her.
Value Belief Pattern Roman Catholic
Always consulting a doctor
everytime she's not feeling well
Roman Catholic
Always consulting a doctor
everytime she's not feeling well
There will be no problem in terms
of medical assistance due to her
belief
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V. PHYSICAL ASSESSMENT:
AREAS FINDINGS
1. PHYSICAL
1.1 Head Normocephalic, (-) headache, (-) dizziness, (-) head injury
1.2 Eyes Symmetrical, (-)periorbital edema, (-)blurring of vision, (-) discharge,
uses eye glasses1.3 Ears Symmetrical, (-) discharge
1.4 Nose Symmetric and straight, (-) discharge, (-) nosebleeds
1.5 Mouth and Throat (-) dentures, (-) bleeding gums, tongue in central position, tongue
moves freely, (-) halitosis
1.6 Neck Head centered, (-) lumps, (+) stiffness in neck, (-)lesions
1.7 Breast and Auxiliary (-) pain, (-) lumps
1.8 Chest Chest symmetric, skin intact, (-) pain
1.9 Abdomen (-) abdominal pain (-) DOB
1.10 Extremities (-) deformities, (-) joint pain, (-) no swelling, weakness on both lower
extremities
1.11 Skin (-) edema, (+) bruises on IV site
1.12 Hair hair evenly distributed, curly
1.13 Nails short fingernails, smooth texture
1.14 Respiratory (-) cough, (-) asthma, (-) DOB1.15 Cardiovascular BP 100/70, (-) chest pain
1.16 Gastrointestinal Tract (-) bowel movement on day of PE
1.17 Urinary Frequently urinating 7 a day
1.18 Musculoskeletal (+)weakness on lower extremities
1.19 Neurologic Recognizes common object
1.20 Cranial Nerves
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1.20.1 Olfactory Can identify different smell such as alcohol and orange
1.20.2 Optic Uses reading eyeglasses
1.20.3 Occulomotor Eyes can move freely
1.20.4 Trochlear Eyes can move freely. Can look upward and downward
1.20.5 Trigeminal Patient was able to clench her teeth and determine different sensation
applied on her face
1.20.6 Abducen Eyes can move laterally
1.20.7 Facial Can smile, lift eyebrows, close eyes
1.20.8 Auditory She was able to repeat words accurately, able to hear
1.20.9 Glosopharyngeal Able to swallow, gag reflex present
1.20.10 Vagus Able to swallow
1.20.11 Accesory Can rotate the head
1.20.12 Hypoglossal Able to move her tongue
Glasgow coma Test
Eye Opening Response Verbal Response Motor Response
Score
4- Open spontaneously 5-oriented & converses 6- obey verbal command
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VI. ANATOMY & PHYSIOLOGY
Nephron
o The nephron is the structural and functional unit of the kidney. It consists of a specialized
tubular structure and closely associated blood vessels. Responsible for the formation of urine.
o Each kidney contains 1,000,000 nephrons that filter the blood and form urine. About 99%
of the initial filtrate from the glomerulus is reabsorbed by the nephron and returned to the
blood in the peritubular capillaries.
o Glomerulus each nephron contains one of these clumps of capillaries. These capillaries
are highly porous and allow large amounts of solute-rich, virtually protein-free fluid
FILTRATE to pass from the blood into the glomerular capsule.
Afferent arterioles feed into the glomerular capillary bed. Has a larger diameterthan the efferent arteriole (this is one of the reasons that blood pressure is so high in
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the glomerulus. The elevated blood pressure is needed to force fluid out of the
bloodstream and into the nephron).
Efferent arterioles carry the newly filtered blood away from the glomerulus.
Narrower diameter than the afferent vessels keeps glomerular pressure high.
o Glomerular capsule/ Bowmans capsule a cup-shaped structure (a blind pouch) thatencloses the glomerulus. It is the first portion of the nephron pathway that moves fluid out of
the body.
o Proximal convoluted tubule (PCT) extends off of Bowmans capsule, it is formed by a
single layer of cuboidal epithelium. These actively absorb substances (glucose, amino acids,
65% of the sodium, Cl-, and water) from the filtrate and dump them into the peritubular
capillaries. These cells also secrete substances back into it (nitrogenous wastes, ammonium
ions). The cells have what is known as a brush borderof microvilli that greatly increases theabsorptive surface area that they have to work with. Filtrate has been reduced by 65% once it
leaves the PCT.
o Nephron loop (of Henle) the proximal partion that is connected to the proximal tubule
contains the same types of cells in its walls. The rest of the descending limb is thinner (the
thin segment) and is made of simple squamous epithelium that are freely permeable to
water (salt cannot permeate the cells of this portion of the tubule, so, it becomes more
concentrated in the filtrate). After we enter the ascending limb which becomes thicken with
cuboidal/low columnar cells and is known as the thick segment. The ascending limb is
permeable to salt and Cl-(and K+) and impermeable to water. Therefore, since water is left
behind and solutes are being removed, the filtrate is now dilute.
o Distal convoluted tubule (DCT) the next segment of the nephron after the ascending
loop of Henle, it contains cubiodal epithelial cells in its walls, but, unlike the proximal tubule,
they rarely contain microvilli. This hints at the tubes function: secretion of solutes back into
the filtrate as opposed to a lot absorption (some sodium and Cl- are reabsorbed here). Further
down the distal tubule, the walls contain intercalated cells (with villi) that play a role in pH
balance andprincipal cells that help maintain the bodys sodium/water balance (they lackvilli).
o Collecting duct collects urine from several nephrons distal tubules and carries it through
the medulla pyramids to the minor calyces. Some reabsorbtion and secretion does happen.
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Regulation of Kidney Function (Extrinsic Mechanisms)
Kidney function is subject to a number of regulatory influences from both extrinsic (outside
the kidney) and intrinsic (within the kidney) sources. Those mechanisms acting from outside
the kidney include:
(1) Systemic blood pressure
(2) Aldosterone
(3) Antidiuretic Hormone (ADH)
1. The role ofsystemic blood pressure in controlling kidney function is obvious. The
glomerular capillaries are located between the afferent and efferent arterioles. Any
change in the diameter of these will affect hydrostatic pressure. Since the rate of
glomerular filtration is directly related to the hydrostatic blood pressure in glomerular
capillaries, any increase in blood pressure results in a corresponding increase infiltration rate and urine output. Since this process ultimately decreases blood volume,
the kidneys are a powerful means of controlling long term blood pressure.
Conversely, drops in blood pressure have the opposite effect. This mechanism is
important because it illustrates how circulatory and renal systems interact as blood
pressure changes affect kidney function and vice versa.
2. The steroid hormone, aldosterone, released from the adrenal cortex in response to
elevated levels of potassium, causes nephrons to secrete potassium into the urine. But,
since potassium and sodium share the same transport carrier, as potassium is excreted
the sodium is retained (reabsorbed). Chloride ions and water follow the retained
sodium to cause an increase in fluid retention and expansion of blood volume with
corresponding increases in blood pressure. Fluid retention is a common side effect ofsteroid hormone activity.
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3. The posterior pituitary hormone, antidiuretic hormone (ADH), is produced by the
hypothalamus and released from the posterior pituitary when the osmotic pressure of
blood and body fluids increases. The increased in osmotic pressure correlates directly
with solute concentration, indicating that water retention and/or intake is required to
correct the situation. Distal convoluted tubules and the proximal collecting ducts are
the targets for ADH action. Membrane pores for water transport increase (increasedthe water permeability) in these target cells under ADH influence. Because of the high
sodium ion concentration in the kidney interstitial fluids, increasing the number of
these pores increases the rate of water reabsorption from the urine back into blood in
this distal region of the nephron. It is important to notice that only water is reabsorbed
from filtrate under ADH influence allowing this mechanism to fine tune the
osmolarity of body fluids and blood while concentrating or diluting the urine output.
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Renal tubular site of potassium reabsorption and secretion. Potassium is reabsorbed in
the proximal tubule and in the ascending loop of Henle, so that only about 8% of the filtered
load is delivered to the distal tubule. Secretion of the potassium into the late distal tubules
and collecting ducts adds to the amount delivered, so that the daily excretion is about 12% of
the potassium filtered at the glomerular capillaries. The percentages indicate how much of
filtered load is reabsorbed or secreted into different tubular segments.
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VII. PATHOPHYSIOLOGY
Diarrhea/Polyuria
Anxiety
Hypokalemia
Clinical Manifestation
Muscle weakness,
Paresthesia at both upper
and lower extremities
Potassium
(Fluid loss)
PERIODICPARALYSIS
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VIII. Diagnostic/Laboratory
HEMATOLOGY
TEST RESULT NORMAL VALUES ANALYSIS
WBC ct. 6.6 4.5 5.5 x 10 12/L
Hematocrit 0.38 0.37 0.47 Normal
Hemoglobin 122 110 150 G/L Normal
Thrombocyte Count adequate
Differential Count
Segmenters 0.65 0.50 0.70 Normal
Lymphocytes 0.35 0.20 0.40 Normal
BLOOD CHEMISTRY
TEST RESULT NORMAL VALUES
Sodium 144.6 mEq/L 135-145
Potassium 2.84 mEq/L 3.5-5.3
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URINALYSIS
Macroscopic Examination Microscopic Examination
Color dark yellow RBC - 35 40 / hpF
Transparency turbid Pus Cells - 10 15 / hpF
Reaction (PH) 7.5 Epithelial Cells - few
Specific Gravity 1.02 Mucus Threads -
Protein Trace A. urates / Phosphates - few
Glucose - Negative Bacteria moderate
HGT- 91 mg/dl
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X . NURSING CARE PLAN
Actual Problem
CUES DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
S: parang tinutusok ng
karayom ang mga
kamay at binti ko as
verbalized by the patient
O: -Paresthesia
-frequent urination
-weak pulse
-confusion
-irritability
-Facial grimace
Potassium level deficit
as manifested by
Paresthesia
Within the shift, the
patient will elevate
potassium level and
decrease discomfort
from its clinical
manifestation
-Monitor patients V/S
-Assess level of
consciousness and
neuromuscular function
-Encourage intake of foods
high in potassium
-Maintain accurate record
of urinary and gastric
losses
-Instruct not to use
potassium-wasting diuretics
-Discuss preventable
causes of condition
-Monitor laboratory studies
-administer I.V potassium
as ordered
-to obtain baseline data
- drowsiness, irritability,
paresthesia and coma
may occur
-potassium loss maybe
replace or maintain
through diet
-guide for potassium
replacement needs
-Provides opportunity
for patient to prevent
recurrence
After shift, the
patient was able to
increase potassium
level and decreased
discomfort
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CUES DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
S: "Hirap akong
matulog" as
verbalized by the
patient.
O: BP 100/70
T 37.2
P 70
R 22
(+) sleep
disturbance
(+) decreased
performance
-Haggard looking
-Restlessness
Sleep pattern
disturbance related to
environmental changes
Within 8 hours of
nursing intervention,
patient will:
-report improved
sense of energy
-in feeling rested
Monitor Patients V/S
-maintain environment
conducive to sleep rest
-instructed not to take
foods and beverages
containing caffeine
-provide soporifics such as
milks
-discourage pattern of
daytime nap
-Limit fluid before bedtime
-to obtain baseline data
-to promote Relaxation
-caffeine may delay
patient sleep
-to help promote sleep
-napping can disrupt
normal sleep pattern
-to reduce voiding
during night
After 8 hours of
nursing
intervention, patient
was able to:
-reported improved
sense of energy
-feel rested
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CUES DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
S: nanghihina itong
mga binti ko as
verbalized by the patient
O: -weakness in lower
extremities
-Minimized
movements
-Stays in bed most of
the time
Activity intolerance
related to
neuromuscular
impairment
Within 8 hours of
nursing intervention,
the patient will
regain strength
-Establish rapport
-Provided assistance for
range of motion exercise.
-Kept necessary utensils
within reach of the patient.
-Encouraged patient to do
self care activities such as
oral care, walking exercise.
-keeps side rails up
- To gain the patient
trust and cooperation
during the entire
procedure.
-Maintains mobility and
functions of joints
alignment of extremities
and reduces venous
stasis.
-Keeping all in reach,
can greatly reduce the
risk of accident to the
patient.
-This is to enable the
patient to regain muscle
strength and keeping
himself clean, and will
gain independence.
To promote safe
environment
After 8 hours of nursing
intervention, the patient
was able to regain
strength
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Potential Problem
CUES DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
S: mayat maya ihi
ako ng ihi as
verbalized by the patient
O: BP 100/70
T 37.2
P 70
R 22
-frequent urination
-dry lips and dry mouth
-restlessness
-weakness
Risk for Fluid volume
deficit related to active
fluid loss
Within 8 hours of
nursing intervention, the
patient will prevent
dehydration andnormalize elimination
pattern
-Monitor patients V/S
-Encouraged patient to
increase fluid intake
-Instructed to provide oral
hygiene
-Monitor I&O, being
aware of altered intake &
output
-Limit fluids that tend to
exert a diuretic effect
-Promote intake of High-
water content foods and
electrolyte replacement
replacement drinks
-To obtain baseline data
-to avoid dehydration
-to maintain fluid
electrolyte in the body
-To ensure accurate
picture of fluid status
After 8 hours of nursing
intervention, the patient
prevented dehydration
and normalizedelimination of pattern
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XI. DRUG STUDY
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Name of
Drug
Classification Dosage and
Frequency
Course of
Action
Contra-
indication
Adverse
Reaction
Nursing
Responsibilites
ENERIC
FLOXACI
RAND
NOLON
Anti Infective/
Fluoroquinolone
40 mg BID DNA gyrase
inhibitor,
ofloxacin
interferes
with converse
ofintermediate
DNA
fragments
into high
molecular
weight DNA
in bacteria.
hypersensitivit
y to drug or
other
fluoroquinolon
es
> increased
intracranial
pressure,
seizures,
dizziness,
headache,insomia, acute
psychoses,
confusion,
tremors,
hallucination
> pseudomem-
branous colitis,
nausea, diarrhea
> leucopenia,
eosonophilia
>tendonitis,
tendon rupture,joint pain, back
pain
>steven Johnson
syndrome
> anaphylaxis
> patient should be
monitored for allergic
reactions
> encouraged patient to
maintain fluid intake ofat least 1,500 ml daily to
prevent crystalluria
> tell patient to
immediately report
fever and diarrhea
specially if the stool
contains blood, pus or
mucus. Caution him not
to treatdiarrhea without
consulting the
prescribers.
> instruct the patient to
immediately report rash
or tendon pain or
inflammation.
Name of
Drug
Classification Dosage and
Frequency
Course of
Action
Contra-
indication
Adverse
Reaction
Nursing
ResponsibilitesENERIC
ECOBAL
MINE
RAND
ETHYL
OBAL
Nootropics and
Neurotronics
500 mg 1 tab
TID
Tab:
treatment of
peripheral
neuropathies.
Inj:
megaloblastic
anemia due to
vit B12
deficiency,
peripheral
neuropaties
Patients whose
occupation
requires the
handling of
mercury or
mercury
compounds.
In frequently:
anorexia,
nausea,
vomiting,
diarrhea, pain
and indurations
at IM injection
site
Rarely: skin,
rash, headache,
sweating or hotsensation
Obtain patients history
of medical condition
before starting the
therapy.
Inform the patient about
the adverse reaction.
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IX. Course in the ward
Prognosis of the Patient
The patient was admitted at the hospital with a chief complain of numbness of both
upper and lower extremities. She is conscious and responsive in every interaction. The next
day, her feeling of numbness on upper extremities relieved and she feels weak on lower
extremities.
New Medications
PNSS 1L + 40mEq of KCl
Ofloxacin
New Order
Continue meds. On DAT and have to eat at least 1 banana per day
Reasons for New Meds. And Orders
To increase her potassium intake.
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XII. DISCHARGE PLANNING
MEDICATION Instruct the patient that diuretics can cause
hypokalemia.
DIETInstructed on diet to take foods rich in
potassium such as avocado, potato, banana,
meat, squash, carrots and beans.
EXERCISE Exercises are mostly appropriate to promote
proper circulation of the blood in the body.
ACTIVITY / LIFESTYLE CHANGES
Patient should continue to live a healthy
lifestyle and to be able to rest more to gain
her strength.
.
FOLLOW-UP Emphasized the importance of follow-up
check-up to monitor his condition
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