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Fluid and Lytes 102
Based on LU lytes notes, Kozier and Adams
| Question | Answer |
|---|---|
| Serum Magnesium Levels | 1.5-2.5 ICF, excreted by kidneys |
| Hypomagnesmia | cause: low intake, malnutrition, alcoholism, absorption issues, diarrhea, vomiting Sypmtoms: hyperactive reflexes (DTR's), irritability, seizures tx: magnesium supps |
| Hypermagnesmia | cause: kidney failure, excess intake sypmtom: hypoactive DTR's, decreased rate and depth of resp, hypotension treatment: treat with calcium gluconate, hypotonic fluids |
| Serum Potassium levels | 3.5-6 ICF, renal excretion, |
| Hypokalemia | cause: diarrhea, vomiting, K wasting diuretics Sypmtoms: weakness, weak irregular pulse, EKG changes tx: potassium supps, be careful of K infusion max rate 20mEq/hr, rapid rate can cause MI because of excess |
| hyperkalemia | cause:kidney failure, burns, use of K sparing diuretics, trauma Symptoms: anxiety, weakness, HR Irregular Tx: hypotonic fluids, buffers, dietary restrict. |
| serum calcium level | 9-11 ECF, redistributes between bones and ECF |
| hypocalcemia | cause: blood transfusion (give 1-2g Ca Gluconate for 5 units), vitamin D deficiency symptoms: numbness of fingers & circumoral, muscle cramps, tetany, positive trousseaus and chvostek's sign, ekg changes tx: calcium supps, vit D |
| hypercalcemia | cause:bone cancer, immobilization, osteoporosis, hyperparathyroidism signs: anorexia, n/v, MI treatment: fluids to dilute ECF Hypotonic, calcitonin |
| Serum Sodium levels | 135-145 ECF, renal excretion |
| hyponatremia | cause: GI loss, diuretic use, SIADH (retains fluid) Signs: dizziness, n/v, tachycardia tx: hypertonic fluid or Na supps |
| hypernatremia | cause:excessive intake, water deprivation, diabetes insipidus Signs: thirst, fever, dry skin and oral membranes, confusion tx: limit salt intake, diuretics |
| ICF | intercellular fluid (inside the cells) 2/3 of body fluid |
| amount of fluid in body | 60% in healthy adult |
| ECF | extracellular fluid (outside cells)- intravascular (plasma), interstitial (surround cells), and lymph and transcellular (ie: cerebrospinal fluid) |
| Isotonic Fluids | same osmolality as body fluids, does not cause fluid to shift |
| hypotonic fluids | less concentrated (more diluted, thinner) than body fluids, causes fluid shift from ECF to ICF causes cells to swell |
| hypertonic fluids | more concentrated (less diluted, thicker) than body fluids, causes fluid shift from ICF to ECF, rapid bounding pulse, causes cells to shrink |
| Symptoms of FV changes | confusion, irritability, change in LOC |
| Osmosis | movement of water, passive attempt to equalize osmolality |
| Diffusion | movement of solutes, passive attempt to equalize osmolality |
| active transport | solutes move from lower concentration to higher, requires metabolic energy (NaK pump) |
| Capillary Bed | location of exchange of O2, nutrients, and waste take place. Oxygenated blood comes in arterioles, deoxygenated goes back out through venules |
| Hydrostatic pressure | pumping pressure of heart, force that pushes blood through arteries and out into the capilliary bed |
| Oncotic Pressure | (aka colloid osmotic pressure) force that pulls the fluid out of the capillary bed and into the venules, dependent on protein (albumin), decreased oncotic pressure can cause edema |
| Filtration | normally dynamic, fluid in (hydrostatic) = fluid out (oncotic) |
| First space | intravascular (plasma) |
| second space | extravascular |
| third space (syndrome) | places where fluid doesn't normally accumulate (peritoneal and pleural cavities). Liver failure can cause, third space fluids are either reabsorbed (causing FVE) or need to be drained |
| Daily weight | best indicator of fluid status (+ or - 2lbs is = to + or - 1L of fluid) |
| Methods of evaluating patients hydration | hx: chronic disease (cancer, cushings), meds, developmental level, enviroment Daily wt Vital Signs: BP and P up (FVE), BP and P down (FVD) I&O: discrepancy between the two Labs: Na, K, Ca, Mg, Hematocrit (high FVD, low FVE), Urine Specific Gravity |
| what follows Na | Cl levels tend to follow |
| respiratory acidosis | pH and PaCO2 both acidotic, compensating system metabolic alkalosis Resp less than normal (COPD, Asthma, Sedation, Narcs) |
| metabolic acidosis | pH and HCO3 are acidotic, compensating systen respiratory alkalosis (renal failure, diabetic ketoacidosis) Problems below waist, diarrhea |
| respiratory alkalosis | pH and PaCO2 are both alkalotic compensating system is metabolic acidosis Resp above normal (sepsis, hyperventilate, high fever) |
| metabolic alkalosis | pH and HCO3 are both alkalotic, compensating system is respiratory acidosis GI issues above waist (vomiting, suctioning) |
| Tic Tac Toe setup | method for determining what type of fluid imbalance... pH on top (7.35-7.45), paCO2 (45-35), HCO3 (22-26) |
| Central Line System Needles | never use normal needle on self sealing system, must use a huber needle |
| Central Line and PICC | sterile technique to do dressing changes |
| selectively permeable | solutes and substances can pass through |
| solutes | substances dissolved in solution |
| crystalloids | salts that dissolve readily into true solutions |
| colloids | substances such as large proteins that do not readily dissolve into true solutions |
| solvent | component of a solution that can dissolve a solute |
| osmolality | concentration of solutes in body fluids (aka tonicity) |
| diffusion | continual intermingling of molecules in liquids gases or solids brought about by the random movement of the molecules |
| Factors that affect Diffusion | size of molecules, concentration of solution, temperature of the solution |
| insensible fluid loss | not measurable or noticed (skin and lung losses) |
| obligatory losses | certain fluid losses required to maintain normal body function (ie 500 mL to flush kidneys) |
| acid | substance that releases H ions |
| Base | accept H ion in solution |
| Regulation of Acid Base Balance | lungs (paCO2) blow off or draw in more to change balance kidneys - release or retain HCO3 |
| buffers | prevent excessive changes in pH by removing or releasing H ions |
| Factors that affect Body Fluid, electrolytes and acid base | Age, gender and body size, temperature and lifestyle |
| Fluid Volume Deficit | FVD - isotonic when the body loses both water and lytes from the ECF in similar proportions (aka hypovolemia) |
| common causes of FVD | abnormal losses through skin, GI tract or kidney: decreased intake of fluids: bleeding: third space syndrome |
| Third Space Syndrome | fluid shifts from Vascular Space int an area where it is not readily accessible as ECF |
| Fluid Volume Excess | FVE- body retains both water and sodium in proportion to normal ECF (aka hypervolemia), 2ndary to increase in total body Na content and increase in total body water |
| Causes of FVE | excessive intake of Na: administering IV fluids to quickly: disease processes that alter regulatory mechanisms |
| Edema | excess interstitial fluid, most apparent in areas where tissue pressure is low (eyes) and dependant tissues (feet, ankles etc) |
| Causes of Edema | increased capillary hydrostatic pressure, decreased oncotic pressure, increased capillary permeability |
| Pitting Edema | edema that leaves a small depression or pit after finger pressure is applied |
| Dehydration | (aka hyperosmolar imbalance) water is lost but Na is not. Serum osmolality and Na levels increase |
| Overhydration | (AKA hypoosmolar imbalance) water is gained in excess of lytes resulting in low serum osmolality and Na levels |
| Chvostek's sign | tapping on facial nerve in front of the ear. Causes contraction means low calcium |
| Trousseau's sign | inflating BP cuff to 20mm above Systolic pressure for 2-5 min. Causes lower arm spasm means low calcium |
| compensation | when healthy regulatory systems attempt to correct acid base imbalances |
| Normal Values on ABG's | pH 7.35-7.45 PaCO2 34-45 HCO3 22-26 |
| Specific Gravity | 1.005-1.030 good indicator of fluid issues if not in this range |
| Examples of Isotonic Solutions | 0.9% NS, Lactated Ringers, 5% Dextrose (D5W) *important to remember Dextrose is immediately metabolized and this becomes free water |
| Examples of Hypotonic Solutions | 0.45% NaCl (half normal saline), 0.33% NaCl (one third Normal saline) |
| Examples of Hypertonic Solutions | 5% Dextrose in NS (D5NS), D5 1/2NS, D5LR |
| Normal Osmolaltiy of Body Fluids | 275-295 |
| FVE what should you watch for | listen for crackles in lungs, one of first signs |
| Why are electrolytes essential? | for normal body function including nerve conduction, membrane permeability, muscle contractions, water balance, bone growth and remodeling |
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