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F& E

fluid and electrolytes

QuestionAnswer
Na+ Values 135-145 mEq/L
Na+ Significance Important for body volume regulation
Distinguishing Characteristics of Na+ #1 extracellular cation; Inverse relationship with K+ and direct with Cl-
Abnormally low values of Na+ Hyponatremia <135 mEq/L
Causes of Abnormally low values of Na+ ↓ Na+ intake; Diuretics; GI suctioning; ↑sweating; ↓aldosterone; ↑ fluid intake; ↓excretion; Metabolic Alkalosis
Clinical Manifestations of Abnormally low values of Na+/Hyponatremia Poor skin turgor; Dry mucosa; ↓ saliva; Ortho BP; Lethargy; Confusion; Seizures; Muscle cramps; Twitching
Treatment for Hyponatremia Na+ replacement; Fluid restrictions; High Na+ foods; Seizure precautions
Nutritional Considerations(Foods with high content) of Na+ Processed foods; Canned foods and vegetable juices;Convenience foods
Abnormally high values of Na+/ Hypernatremia Hypernatremia > 145 mEq/L
Causes of Abnormally high values of Na+/ Hypernatremia ↓ fluid intake; ↑ H20 loss; ↑Na+ intake; ↑ Na+ retention r/t ↑ aldosterone
Clinical Manifestations of Abnormally high values of Na+/ Hypernatremia Restlessness; Weakness; Disorientation; Delusions; Hallucination; Thirst; Dry/swollen tongue; ↑ muscle tone/DTRs
Treatments for Abnormally high values of Na+/ Hypernatremia Hypotonic IVFs; Na+ restriction; Prevent- hydration
K+ Values 3.5-5.5 mEq/L
K+ Significance Important for neuromuscular fx
Distinguishing Characteristics of K+ #1 intracellular cation; Inverse relationship with Na+
Abnormally low values of K+ Hypokalemia < 3.5 mEq/L
Causes of Abnormally low values of K+ ↓ K+ intake; GI suctioning; Vomiting; Diuretics; ↑ aldosterone; ECF K+ shifts to ICF caused by Alkalosis and Insulin; Digoxin toxicity
Clinical Manifestations of Abnormally low values of K+/Hypokalemia Anorexia; N/V; Ileus; Muscle weakness; Paresthesias; Muscle cramps; Tachycardia; EKG changes; Dysrhythmias; Arrest
Treatments for Abnormally low values of K+/Hypokalemia K+ replacement; High K+ foods; Salt substitutes; Hold Digoxin
Nutritional Considerations(Foods with high content) of K+ Fruits (Raisins, Apricots,Bananas, Oranges); Vegetables (potatoes, tomatoes, green vegetables); Whole grains; Milk Meat; Fish
Abnormally high values of K+ Hyperkalemia > 5.5 mEq/L
Causes of Abnormally high values of K+ ↑intake; ↓ losses; K shift from ICF to ECF (hemolysis, tissue injury, acidosis)
Clinical Manifestations of Abnormally high values of K+ N/V; Diarrhea; Abd. Cramps; Muscle weakness; ↓ DTR; Paresthesias; Paralysis; Acidosis; Insulin deficit; EKG changes; Dysrhythmias
Treatments for Abnormally high values of K+ Redraw K+; K+ restriction; Cation exchange resins (kayexolate); IV Calcium Gluconate; IV NaHCO3-; IV insulin; B2 agonists; Dialysis
Ca++ Values 8.5-10.5 mg/dL
Ca++ Significance Important to muscle and vascular contraction; clotting; CNS fx and nerve transmission; Stored primarily in bones
Distinguishing Characteristics of Ca++ Inverse relationship with P-; pH affects level; Affected by protein levels
Abnormally low values of Ca++ Hypocalcemia < 8.5 mg/dL
Causes of Abnormally low values of Ca++ ↓ Ca++ intake; Laxative abuse; Diarrhea; Malabsorption caused by ↓ Vit D; ↓ PTH, or ↑ P-; Diuresis; Pancreatitis; Alkalosis; ↓ protein (albumin)
Clinical Manifestations of Abnormally low values of Ca++ Paresthesias; Tetany; Chovostek’s; Trousseau’s; ↑ DTRs; ↓ memory; Confusion; Delirium; Hallucination; Seizures; Laryngeal stridor; Irritability; Anxiety; ↓ clotting; ↑ HR; Dysrhythmias; Alkalosis
Treatments for Abnormally low values of Ca++ Ca++ replacement; High Ca++ foods; Correct pH; Phosphate binders; Seizure precautions; Monitor airway
Nutritional Considerations (Foods with high content) of Ca++ Dairy products; Green vegetables; Sardines
Abnormally high values of Ca++ Hypercalcemia > 10.5 mg/dL
Causes of Abnormally high values of Ca++ ↑ Ca++ release from bones; ↑ GI Ca++ absorption; ↓ excretion by kidneys; Acidosis; ↓ P-
Clinical Manifestations of Abnormally high values of Ca++ Anorexia; N/V; Abdominal pain/cramping; Ileus; Constipation; Confusion; Lethargy; Coma; ↓ DTR; ↑ BP; Bone pain; ↓ urine output with thirst; ↓ P-; EKG changes; Muscle weakness/loss of tone; Risk of digoxin toxicity; Acidosis
Treatments for Abnormally high values of Ca++/Hypercalcemia Hydration; Diuretics (no thiazides) Limit intake; Mobilization; Monitor constipation; Check digoxin level; Monitor cardiac status; Dialysis
Mg+ Values 1.5-2.5 mEq/L
Mg+ Significance Important in neuromuscular fx; Stored in bones and soft tissue
Distinguishing Characteristics of Mg+ #2 intracellular cation; Needed for K+ absorption/utili-zation; Affected by protein levels
Abnormally low values of Mg+ Hypomagnesemia < 1.5 mEq/L
Causes of Abnormally low values of Mg+ ↓ Mg+ intake (malnutrition r/t alcoholism is most common cause); ↓ bowel absorption (Crohn’s); ↑ GI loss(diarrhea, vomiting); or renal loss (diuretics, diabetes, alcoholism)
Clinical Manifestations of Abnormally low values of Mg+ Muscle weakness; Twitching; Tremors; Tetany; Dysphagia; Confusion; Hallucinations; Seizures; ↑ DTR; Chovostek’s; Trousseau’s; ↑ HR; EKG changes; ↓ K+; ↓ Ca++
Treatments for Abnormally low values of Mg+ Mg+ replacement; Monitor heart and airways; High Mg+ foods; Seizure precautions
Nutritional Considerations (Foods with high content)of Mg+ vegetables; nuts; seeds; whole grains
Abnormally high values of Mg+ Hypermagnesemia > 2.5 mEq/L
Causes of Abnormally high values/Hypermagnesemia Renal failure; ↑ intake; Antacids with Mg+ (Maalox, Mylanta); Hemolysis; Hypothermia
Clinical Manifestations of Hypermagnesemia N/V; Muscle weakness; Paralysis; ↓ DTR; Confusion; Lethargy; Coma; Respiratory depression; ↓HR; ↓BP
Treatments for Hypermagnesemia Hydration; Diuretics; ↓ intake; Monitor neuro; resp and cardiac status; Dialysis
P- Values 2.5-4.5 mg/dL
P- Significance Important to ATP production; neuromuscular fx; oxygen release from Hgb; acid-base balance; Stored primarily in bones
Distinguishing Characteristics of P- #1 intracellular anion; Inverse relationship with Ca++; Affected by protein levels
Abnormally low values of P- Hypophosphotemia < 2.5 mg/dL
Causes of Abnormally low values of P-/Hypophosphotemia ↓ P- intake or absorption r/t protein; malnutrition (anorexia, alcoholism); ↑ loss (renal, burns, DKA); ↑ metabolic P- use to produce ATP; Intracellular shift of P- caused by respiratory alkalosis
Clinical Manifestations of Abnormally low values of P-/Hypophosphotemia Lethargy; Irritability; Apprehension; Confusion; Respiratory and Cardiac Muscle weakness; Ileus; Hyperglycemia; ↑ infection risk; ↑ bruise/bleed
Treatments for Abnormally low values of P-/Hypophosphotemia P- replacement; High phosphorus foods; Check use of OTC antacids and laxatives
Nutritional Considerations (Foods with high content) of P- Chocolate drinks; Dark colas; Canned ice teas; Milk products; Organ meats; Oysters; Sardines; Beans and peas; Whole grain products; Nuts; Seeds
Abnormally high values of P- Hyperphosphatemia > 4.5 mg/dL
Causes of Abnormally high values of P- Impaired P- excretion, ↑ P-intake, P- shift from ICF to ECF due to cell damage (chemo, muscle necrosis), ↓ Ca++; Acidosis
Clinical Manifestations of Abnormally high values of P- Dry, itchy skin, Tetany, Anorexia, N/V, Muscle weakness, ↑ DTR, ↑ HR, ↓ Ca++
Treatments for Abnormally high values of P- Hydration, Diuresis, Phosphate binders, Limit intake
Cl- Values 96-106 mEq/L
Cl- Significance Important in acid-base balance
Distinguishing Characteristics of Cl- Major extracelluar anion; Direct relationship with Na+ and Inverse with HCO3-
Abnormally low values of Cl- Hypochloremia < 96 mEq/L
Causes of Abnormally low values of Cl- ↓ Cl- intake, ↓ Na+ or K+ levels, Metabolic alkalosis, GI suctioning, Vomiting, Diarrhea, Excessive sweating, Diuretics
Clinical Manifestations of Abnormally low values of Cl- Mental confusion, Slow breathing, Paralysis, Muscle tension or spasm
Treatments for Abnormally low values of Cl- Cl- replacement
Nutritional Considerations(Foods with high content) of Cl- Table salt (NaCl) and salt substitutes (KCl); Rye, Tomatoes, Milk, Lettuce, Celery, Olives
Abnormally high values of Cl- Hyperchloridemia > 106 mEq/L
Causes of Abnormally high values of Cl- Loss of HCO3 via kidneys or GI tract resulting in ↑ Na+ and Cl-;Acidosis
Clinical Manifestations for Abnormally high values of Cl- Weakness, Headache, Nausea, Cardiac arrest
Treatments for Abnormally high values of Cl- Lactated Ringers to ↑ HC03-,Diuretics to ↓ Cl-
Distinguishing Characteristics Value 7.35-7.45
Significance of pH (arterial) Indicates H+ concentration
Distinguishing Characteristics of pH (arterial) Reflects the acid or base levels of a fluid
Abnormally low values of pH (arterial) Acidosis< 7.35
Clinical Manifestations of Metabolic acidosis HA, Confusion, Drowsy, Lethargic, Weakness, ↓ HR,Anorexia, N/V,Diarrhea,Kussmaul,↓ CO,Vasodilation,↑ K+ ↑ Ca++
Clinical Manifestations of Respiratory acidosis Hypoventilation, ↑ HR/BP, Mental cloudiness, ↑ ICP, ↑ K+, & Ca++
Abnormally high values of pH (arterial) Alkalosis > 7.45
Clinical Manifestations of Abnormally high values of pH (arterial)/Metabolic Alkalosis ↓ respirations, Numbness, Tingling, Tetany, Seizures, Confusion, Dizziness, ↑ HR, ↓ GI motility (ileus), ↓ Ca++, ↓ K+
Clinical Manifestations of Abnormally high values of pH (arterial)/Respiratory Alkalosis Light-headed, Palpitations, ↓ LOC, ↓ Ca++, ↓ K+
HCO3- Values 22-26 mEq/L
HCO3- Significance Levels regulated by kidneys
Distinguishing Characteristics of HCO3- Inverse relation-ship with Cl-
Abnormally low values of HCO3- Metabolic Acidosis < 22 mEq/L
Causes of Abnormally low values of HCO3- Diarrhea, Diuretics, Renal insuffi-ciency, ↑ Cl- administration, DKA, Lactic acidosis, uremia, ASA poisoning
Treatments for Abnormally low values of HCO3-/Metabolic Acidosis Replace HCO3 if pH < 7.1 and HCO3 level <10; Dialysis; Monitor K+ & Ca++
Abnormally high values of HCO3- in Metabolic Alkalosis > 26 mEq/L
Causes of Abnormally high values of HCO3- Loss of H+ ions (loss of gastric fluids via vomiting/suction, ↑ aldosterone level, ↑ HCO3- intake via antacids or IV NaHCO3
Treatments for Metabolic Alkalosis Treat GI cause to prevent loss of H+
PaCO2 Values 35-45 mmHG
PaCO2 Significance Levels regulated by lungs
Abnormally low values PaCO2(Respiratory Alkalosis) < 35 mmHG
Causes of Abnormally low PaCO2 values(Respiratory Alkalosis) Hyperventilation caused by anxiety, hypoxia, ASA overdose, sepsis
Treatments for Abnormally low PaCO2 values(Respiratory Alkalosis) Inhale via paper bag, Sedation, O2 if hypoxic
Abnormally high PaCO2 values(Respiratory Acidosis) > 45 mmHg
Causes of Abnormally high PaCO2 values(Respiratory Acidosis) Inadequate excretion of CO2, hypoventilation
Treatments for Abnormally high PaCO2 values(Respiratory Acidosis) Improve ventilation with meds, pulm hygiene, or ventilator
Created by: jn study stop