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Fluid & lytes M5
| Question | Answer |
|---|---|
| Posterior Pituitary | ADH stored here (antidieuritic hormone, ADH=water conserving hormone, End result=decreased urine output |
| Adrenal | Locate at the top of the kidneyAdosterone, a mineralcorticoid is released from the adrenal cortex. Target tissue-kidney. Reabsorbs Na (creating water retention), secretes K & H. End result – decreased urine output |
| Parathyroid | Releases Calcium. Target tissue-Bone, kidney & small intestines. Causes increase breakdown of bone by the osteoclasts, increased reabsorption of Ca by the kidney & increased absorption of Ca by the small intestine and increased ca absorption |
| Barorecptors | Monitor pressure changes resulting in sympathetic nervous system stimulation, vasoconstriction & release of aldosterone. Low pressure-left artia. High pressure-aortic arch & nephron |
| Renin-angiotensin Aldosterone system | responds to low kidney perfusion related to low ECF volume. cx. Vasoconstriction & increased flow to the kidneys improves perfusionSym. nerv. sys. stimulation releases ALD if K levels increase. Result: kidney reabsorb Na & excrete K. |
| ADH/thirst mechanism | High na causes release of ADH from the posterior pituitary signaling kidneys to reabsorb water. Reabsorbed water dilutes the ECF & returns the compartment to normal |
| Osmoreceptors | Located on the surface of the hypothalamus, continually sense changes in Na concentration and The thirst mechanism is triggered |
| ANP | Released by cardiac cells when there is high atrial pressure. Low BP volume. Elevated in acute heart failure. Normal 20-77. Inhibits thirst. Low output with high Na content causing decreased circulating blood volume & decreased blood osmolarity |
| What are signs and symptoms of fluid volume excess? | Weakness, JVD, Edema, Crackles and Confusion |
| Sodium | Major cation of the ECF &Controls water balance. Normal 135-145 |
| K | Major cation in the ICF. Regulates metabolic activities, nerve conduction, heart conduction & skeletal muscle. Normal 3.5-5 |
| Ca | Stored in bone, plasma & body cells. Bone & teeth formation, nerve impulses, muscle contraction & blood clotting. Normal 8.5-10 |
| Mag | Needed for enzyme activities, neuro, heart & muscle activites. Normal 1.5-2.5 |
| What is Hyponatremia? | A loss of Na without a loss of fluid; body decreases water excretion. Water moves into the cell |
| How do you become hyponatremic? | GI fluid loss, Diuretics, Sweating, Gain water without Na:Drinking H2O, and Excessive IV fluid (D5W). |
| What are the symptoms of hyponatremia? | Mild to severe:Nausea, Muscle cramps, Disorientation, Slurred speech, Confusion, Inappropriate behavior, As the condition progresses: Seizures, Coma, Death |
| How is hyponatremia treated? | Limit H2O, encourage salty foods, and hypertonic fluids (DW...) |
| How does Hypernatremia develop? | Water moves out of the cell. From dehydration, Fluid loss r/t fever, hyperventilation, diarrhea, infusion of salt water (NS), not enough H2O (heat stroke), excessive Na intake, hypertonic tube feeding without enough H2OOver use of salt |
| What are the symptoms of hypernatremia? | Thirst, Dry mucous membranes, Low BP, Fatigue, Altered LOC, Disorientation, Convulsions (seizures) |
| How is hypernatremia treated? | Fluids, No more salt, Pt restricted to 250mg/day (normal 6-15g). Hypertonic IV fluids as ordered. |
| How does Hypokalemia develop? | Potassium wasting diuretics, Use of laxitives, Loss of intestinal contents (diarrhea, ileostomy, internal suctioning), Vomitting, Heavy prepespiration, Use of steroids, Loss of Magnesium |
| What are the symptoms of hypokalemia? | Muscle weakness, leg cramps, Anorexia, Decreased bowel sounds, Flattened T wave & ST segment, Depression on EKG, V wave |
| How is hypokalemia treated? | Replace it. If given IV be sure kidneys are making urine (atleat 30ml/hr).Administer IV no faster than 20-40 mEq/hr. (Monitor for buring at IV site,Watch for phlebitis. |
| How does hyperkalemia develop? | Renal failure, Potassium Sparing diuretics, Salt substitute, K shifting out of cell, (Burns, infections, acidosis) |
| What are the symptoms of hyperkalemia? | Gi hyperactivity (hyperactive bowel sounds, diarrhea), Classic peaked T wave, QRS widens, Cardiac arrest, Loss of reflexes, Paresthesia and numbness in the extremities |
| How is hyperkalemia treated? | Get rid of it, Through diuretic theraphy, Use of glucose & insulin (DSO), kaexylate. Hold any meds/IVs with K or K sparing abilities. Possible dialysis |
| How does Hypomagnesemia develop? | Loss from GI tract, Drug therapy with diuretics, antibiotics, Alcoholism |
| What are symptoms of hypomagnesemia? | Confusion, Seizures, Increased reflexes, Tremors, Positive Trousseau’s sign, Cardiac arrhythmias, (esp. premature ventricular contraction), Tachycardia, High BP, Increased susceptibility to digoxin toxicity |
| How is hypomagnesemia treated? | replace it |
| How does hypermagnesemia develop? | Too much mag replacement and renal failure |
| What are symptoms of hypermagnesemia? | Respiratory or cardiac arrest, Flushing, Muscle weakness, Low BP, Low heart rate, Drowsy, Depressed reflexes |
| how is hypermagnesemia treated? | No more mag, Ventilator, IV Ca to offset the neuro-muscular symptoms, Hemodialysis, Loop diuretic if kidneys are ok |
| Chloride | Major anion of the ECF. Follows NA, Found more in intestine than in blood.Chloride shift occurs in the rbc’s, bicarb moves out of the rbc-Chloride moves in, reverse occurs in the lungs bicarb in, Cl out |
| Chloride normal ranges | 95-105 |
| Bicarb | Major buffer in the ECF & ICF |
| Bicarb normal ranges | Arterial 22-26 & Venous 24-28 |
| How does Hypochloremia develop? | Lost from: GI tract, Kidneys, Sweating Kidneys retain Na & bicarb to balance the loss of Cl this leads to metabolic alkalosis |
| What are symptoms of hypochloremia? | Risk for alkalosis. May have signs of low K, Na & metabolic alkalosis. Muscle cramps, Weakness, Twitching, Hyperactive reflexes |
| how is hyperchloremia treated? | Correct Cl deficit, NS or ½ NS IV. Evaluation of diuretic therapy. Tomatoe juice, salty broth, canned fruits or vegetables. |
| How does Hyperchloremia develop? | Commonly occurs in conjusction with sodium gain and loss of bicarb |
| What are the syptoms of hyperchloremia? | Risk for acisosis. High Na levels & fluid retention. Tachycardia, rapid breathing, HTN, weakness, lethargy, arrthmias |
| How is hyperchloremia treated? | Reverse acidosis. Lacted Ringers IV (liver converts lactate to bicarb). Sodium bicarb, Diuretics, Limit Na, Cl & fluids. |
| How does Bicarb Deficit develop? | DMRenal Failure, Diarrhea, Too much NS IV |
| What are symptoms of bicarb deficit? | Creates metabolic acidosis, PH & bicarb are too low, Confusion, Headache, Increased breathing, N/V, Flushing, Decreased cardiac output, Low BP, Cold, Clammy skin, Arrhythmias, Shock |
| How is bicarb deficit treated? | Careful administration of bicarbonate. Monitoring K shifts out of the cell creating hyperkalemia, pt may be in hypokalemic as K shifts back into the cell. Monitor cardiac status & ABG |
| how does bicarb excess develop? | Lost acid:Vomiting, Gastric suction, Too much bicarb:Antacids, IV bicarb, Creates metabolic alkalosis. PH & bicarb are too high. |
| What are the symptoms of excess bicarb? | Low ca causes: Tingling in the hands & feet, Drepressed respirations, Tachycardia, Low K, Decreased intestinal mobility – paralytic ileus |
| How is excess bicarb treated? | Restore fluid volume with NS, Careful replacement of K, Monitor respiratory rate depression |
| What are the symptoms of Phosphorus Deficit? | Muscle weakness, Confusion, Seizures |
| What is the treatment for phosphorus deficit? | Prevent it. Prevent infection. Give it carefully,Not to exceed 10 mEq/L. Watch site for tissue necrosis with infiltration |
| What are the syptoms of Phosphorus excess? | Same as calcium, Numbness & tingling, Muscle spasms, Tetany |
| What is the treatment for Phosphorus excess? | Don’t give it. Phosphate binders, Calcium, Possible dialysis |
| Major/Life threatening symptoms you would like to remember regarding high Na | Thirst, Low BP, Convulsions |
| Major/Life threatening symptoms you would like to remember regarding high K | Hyper active bowel sounds, Widened QRS & Peaked T waves, Loss of reflexes, Muscle weakness, Numbness, Decreased heart rate, Cardiac arrest |
| Major/Life threatening symptoms you would like to remember regarding high Ca | Bone pain, Constipation, Flank pain (kidney stones), Heart block, Blood clot, hypotension |
| Major/Life threatening symptoms you would like to remember regarding high mag | Respiratory & cardiac arrest, Decreased heart rate, Low BP, Flushing, Cardiac arrest |
| Major/Life threatening symptoms you would like to remember regarding high chloride | Fluid retention, Tachycardia, Tachypnea, HTN, Arrhythmias, Decreased bicarb, Susceptible to acidosis |
| Major/Life threatening symptoms you would like to remember regarding high bicarb | Symptoms of decreased calcium, Depressed respirations, Tachycardia, Low K & ca, Decreased intestinal, motility – paralytic ilieus |
| Major/Life threatening symptoms you would like to remember regarding high phosphorus | same as low Ca. Bone pain, Constipation, Flank pain (kidney stones), Heart block, Blood clot, hypotension |
| Major/Life threatening symptoms you would like to remember regarding low Na | Coma, Muscle cramps, Disorientation, Slurred speech, Confusion, Seizures, Decreased BP |
| Major/Life threatening symptoms you would like to remember regarding low K | Muscle weakness, Leg cramps, Decreased bowel sounds, Increased heart rate |
| Major/Life threatening symptoms you would like to remember regarding low Ca | Numbness & tingling, Muscle cramps, Seizures , Trembling, Positive Troussou & Chvosteks sign, Cardiac arrhythmias |
| Major/Life threatening symptoms you would like to remember regarding low Mag | Seizures, Cardiac arrhythmias, Confusion, Increased reflexes, Tremors, High BP, Tachycardia, Increased susceptibility to Digoxin, Positive Troussou & Chvosteks sign |
| Major/Life threatening symptoms you would like to remember regarding low chloride | Muscle cramping, Shallow respirations, Twitching, Increased bicarb, Susceptible to alkalosis |
| Major/Life threatening symptoms you would like to remember regarding low bicarb | Confusion, Headaches, Tachypnea, Acidosis |
| Major/Life threatening symptoms you would like to remember regarding low phosphorus | Confusion, Seizures, Predisposed to infection, Impaired breathing, High blood glucose |
| How will a patient with not enough fluid appear? | Oliguria is typical. thirst, orthostatic tachycardia, hypotension, both are generally present. Skin turgor may be decreased, tachypnea, tachycardia, hypotension, confusion, poor capillary refill. functioning kidneys conserve Na |
| How will a patient with too much fluid appear? | Weight gain and weakness may occur before edema. Dyspnea on exertion,exercise intolerance, tachypnea, orthopnea and JVD. buildup of fluid in the lungs, cx SOB. blood in the arteries is also decreased. |
Created by:
angie030104
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