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Fluid & Lytes
| Question | Answer |
|---|---|
| Fluid regulators (water retention) | ADH, aldosterone, natriuretic peptides and renin |
| ADH | Released from pituitary, changes osmolality & promotes water retention |
| Aldosterone | Released from adrenals, promotes sodium & water retention, causes K+ loss |
| Natriuretic peptides | Decreases blood volume, causes sodium & water excretion |
| FVD (hypovolemia) | Loss of ECF exceeds intake, loss can be seen ex. Vomiting, diarrhea |
| 5 Causes of FVD | Vomiting, diarrhea, GI Suctioning, sweating & decreased intake |
| 5 Risk factors of FVD | GI disorders, third spacing (ascites), diabetes, coma, age |
| Major sign of FVD in ELDERLY | Change in mental status |
| 10 FVD symptoms | Weight loss, oliguria, postural hypotension, tachycardia, weak pulse, cool skin, decresed temperature, thirst, nausea & muscle weakness |
| 4 FVD labs | INCREASED Hct, BUN, hgb & positive serum electrolytes |
| IV treatment of FVD | Isotonic fluids ex. NS |
| 9 FVD management | PUSH FLUIDS, Monitor I&O, daily wieghts, vitals, oral care, assess: URINARY OUTPUT, mental status, skin/tongue turgor & mucosa |
| What is urine output when FVD occurs? | Less than 30 ml per hour |
| Chronic stimulation of aldosterone result in? | FVE (hypervolemia) |
| 5 FVE risk factors | CHF, renal failure, cirrhosis, excess hypertonic IV & excess sodium intake |
| 10 FVE signs | EDEMA, distended neck veins, dyspnea, crackles, BOUNDING PULSE, tachycardia, INCREASED: BP, pulse pressure, CVP and weight |
| Pulse pressure | Systolic minus diastolic (40mmHg) |
| 3 FVE labs | DECREASED sodium, BUN & Hct |
| Chest X-ray of FVE patient | Pulmonary congestion |
| 13 Management of FVE | FLUID RESTRICTION, LOW SODIUM DIET, diuretics, hemodialysis, turning & positioning, semi fowlers, rest, compression device, monitor: IV, I&O, daily weights, lung sounds & edema |
| Sodium level | 135-145 |
| 3 Functions of sodium | Nerve impulse transmission, skeletal muscle & heart contraction |
| Loss or gain of sodium = | Loss or gain of water |
| Hypernatremia | DEHYDRATION (FVD) |
| 2 types of hypernatremia | Water deprivation & sodium gained |
| Water deprivation hypernatremia | Client unable to respond to thirst due to altered mental status or disability |
| Sodium gained hypernatremia is caused by | Excessive salt intake or hypertonic IV, hypertonic tube feeding or concentrated infant formula |
| 4 Common victims of hypernatremia | Unconscious, elderly, infants & cognitively impaired clients |
| 14 Symptoms of hypernatremia | Initial thirst, mild temp, flushed skin, depressed fontanel, dry mucus membranes, altered neurologic function, lethargy, restlessness, twitching, DARK URINE, SWOLLEN TONGUE, seizure, coma & death |
| 5 Treatment hypernatremia | HYPOTONIC IV ex. 0.45% NaCl or D5W (for diabetics) given SLOWLY Orally give water, assess: I&O, mental status & vitals Give water with tube feedings |
| What disease can develop from hypernatremia? | Diabetes |
| Hypernatremia serum sodium level | Above 145 |
| Hyponatremia | Sodium deficit, sodium less than 135, affects CNS |
| 5 Causes of hyponatremia | Loss of sodium, gain of more water than sodium, CHF, liver/renal failure, excessive hypotonic IV |
| Dilutional hyponatremia | Gain of more water than sodium, ECF volume high but no edema pesent, HOLD FLUIDS |
| 6 Ways sodium is lost resulting in hyponatremia | Through urine (diuretics or kidney disease), vomiting, diarrhea, GI suction, sweating, irrigation with water instead of NS |
| Ways water is gained causing dilutional hyponatremia | Renal failure, CHF, hypotonic IV, SIADH, tap water enemas or excessive intake of water during exercise |
| EARLY Symptoms of hyponatremia | SODIUM LESS THAN 125, muscle & abdominal cramps, weakness, fatigue GI: anorexia, vomiting, diarrhea, nausea, LOW BP |
| LATE signs of hyponatremia | SODIUM LESS THAN 120, CEREBRAL EDEMA, headache, depression, personality changes, lethargy, muscle twitch, tremors, convulsions & coma |
| Lab results of hyponatremia | Serum osmolality down & urine specific gravity increased |
| Treatment of hyponatremia caused by loss of sodium | Assess: weight, I&O, CNS changes Isotonic IV ex. Ringers lactate, normal saline Increase sodium rich foods |
| Sodium rich foods | Processed & preserved foods, condiments |
| Treatment of dilutional hyponatremia | FLUID RESTRICTION, hypertonic IV ex. 3% NaCl for severe cases (USED IN ICU ONLY) |
| Chloride level | 97-107 |
| Chloride | Produced in stomach, major anion of ECF, found in interstitial fluid & lymph mostly, essential for acid base balance, primarily obtained from table salt |
| Hypochloremia | Chloride level below 97, accumulation of bicarbonate in ECF which in return causes pH to rise, associated with renal failure |
| Causes of Hypochloremia | GI loss by NG tube, fistula drainage, excess sweating, METABOLIC ALKALOSIS, steroids, diuretics, loss of chloride along with K+ or Na |
| Symptoms of hypochloremia | TETANY, irritability, weakness, muscle twitch, tremors, seizure & coma (same as sodium symptoms) |
| What does a chloride problem lead to? | An acid base problem |
| Hypochloremia management | I&O, vital signs, avoid free water, high chloride foods, monitor ABG & serum level |
| IV used to treat hypochloremia | Normal saline or 0.45% NS Also potassium chloride |
| Chloride rich foods | Table salt, canned vegetables, milk, egg, fish, bananas, cheese, processed meats, tomato juice & dates |
| Hyperchloremia | Chloride above 107, METABOLIC ACIDOSIS |
| Causes of Hyperchloremia | Head trauma, profuse perspiration, excess adrenocortical hormone, renal failure hypernatremia, dehydration & excessive admin of NS, 0.45% NS or lactated ringers |
| Symptoms of HYperchloremia | Weakness, lethargy, kussmaul respiration (deep & fast), high BP, METABOLIC ACIDOSIS |
| What happens if hyperchloremia is untreated? | Coma & decreased cardiac output |
| Treatment of HYPERCHLOREMIA | HYPOTONIC IV ex. 0.45%, NaCl & D5W Ringers lactate, diuretics, decrease chloride intake, I&O, educate client to avoid foods high in chloride |
| Potassium level | 3.5 - 5 |
| Potassium | Major ICF, 98% in cell & balance critical for generating action potential (sodium potassium pump), essential for NUEROMUSCULAR & CARDIAC function |
| Hypokalemia | Less than 3.5 K+, most hospital patients are at risk because of stress hormones or NPO |
| Types of Hypokalemia | Inadequate intake & loss of potassium |
| Inadequate potassium intake | Unable or unwilling to eat, NPO & alcoholism |
| Loss of potassium | Kidneys: because of drugs, steroids, insulin & DIABETES MELLITUS GI: vomiting, suction, diarrhea or ileostomy drainage ALKALOSIS: shift from ECF to ICF |
| Clients at risk of developing Hypokalemia | Debilitated elderly, alcoholic, anorexic & bulimic |
| Signs of Hypokalemia | Variable pulse, DYSRYTHMIA, pvc, DIMINISHED BOWEL SOUNDS, muscle weakness,leg cramps & paresthesias |
| What happens if there is too much acid in the blood? | H+ ions move into cell & K+ moves out resulting in acidosis & hyper kalmia |
| Hypokalemia prevention | Replace K+ losses through GI, assess NPO patients for replacement, diet teaching & K+ supplements with meds that predispose to Hypokalemia ex. Lasix, get client out of bed |
| Treatment of Hypokalemia | IV 10mEq KCl in 100ml D5W over 1 hour *3 (SLOWLY & ASSESS CITE) Oral KCl ( DO NOT TAKE ON EMPTY STOMACH) K+ rich foods |
| Potassium rich foods | Raisins, bananas, oranges, legumes, fruit juices & whole grains |
| Client at risk of hyperkalemia | Client with renal failure |
| Causes of hyperkalemia | IMPAIRED RENAL EXCRETION OF K+ Untreated: Renal failure & adrenal insufficiency Rapid admin of IV potassium TRANSFUSION OF AGED BLOOD Shift from ICF to ECF- burns, infection, trauma, ACIDOSIS |
| Sypmtoms of hyperkalemia | BRADYCARDIA, dysrythmia (may progress to heart attack), skeletal muscle irritability (progresses to paralysis), GI DISTURBANCES (colic, diarrhea, cramping) |
| Treatment of hyperkalemia | ECG, STOP ALL K+ supplements, give calcium gluconate, IV GLUCOSE & INSULIN, KAYEXALATE (if renal impairment), diuretics, dialysis, monitor ABG |
| Where is magnesium found? | In bone & soft tissues |
| How is magnesium eliminated? | By the kidneys |
| Magnesium regulates | Nueromuscular function |
| Normal magnesium level | 1.3 to 2.3 |
| Magnesium rich foods | Greens, legumes, whole grains, nuts, egg yolk, soy, peanut butter & chocolate |
| Effects of magnesium on nueromuscular junction | SEDATIVE |
| Substances in body affected by magnesium | Potassium, calcium & albumin |
| Effects of magnesium on cardiac | Vasodilation (decreased peripheral resistance) |
| What particular condition is magnesium used for? | Treatment of preeclampsia |
| Effects of magnesium on GI | DIARRHEA |
| Causes of Hypomagnesium | Loss of GI fluids (diarrhea, fistula), impaired nutrition, alcoholism, TPN, decreased K & Ca, chronic laxative use |
| Symptoms of hypomagnesium | Difficulty swallowing (check gag reflex), change in mood, depression, seizures, hyperactive reflexes (twitching), dysrythmia & sudden death |
| Treatment of hypomagnesemia | Mg rich diet, Mg containing antacid (DO NOT GIVE IF DIARRHEA PRESENT), IV Mg sulfate (slowly- can cause heart attack if too fast), assess for rebound hypermagnesium, loss of patella reflex |
| Hypomagnesemia serum Mg level | Below 1.3 |
| Causes of Hypomagnesemia | Loss of GI fluids ex. Fistulas & vomiting; ALCOHOLISM; impaired nutrition; TPN; chronic laxative use; decreased K+& Ca |
| Symptoms of Hypomagnesemia | DIFFICULTY SWALLOWING, changes in mood ex. Depression, TREMORS/ SEIZURES, sudden death, dysrythmia & TWITCHING (hyperactive reflex) |
| Treatment of Hypomagnesemia | High Mg diet, Mg containing antacids, IV Mg sulfate SLOWLY on pump, Assess for hypermagnesemia ( loss of patella reflex) |
| What happens if Mg is infused too quickly | Cardiac arrest |
| What 2 electrolyte imbalances are associated with Hypomagnesemia? | Hypocalcemia & Hypokalemia |
| What is a major side effect of Mg? | Diarrhea |
| Hypermagnesemia serum Mg level | Above 2.3 |
| Causes of hypermagnesemia | Renal failure & diabetic ketoacidosis |
| Symptoms of hypermagnesemia | Facial flush, weak reflexes, weakness, low BP, bradycardia(slow) |
| Treatment of hypermagnesemia | Dialysis, hold Mg meds for pt with renal failure, Ca gluconate to reverse heart & nerve effects, LASIX |
| Normal Calcium level | 8.6 to 10.2 |
| Where is calcium found? | In bones & teeth |
| How is calcium absorbed? | In the presence of normal GASTRIC ACIDITY & VITAMIN D |
| How is calcium regulated? | By PTH, calcitrol & calcitonin |
| 3 Functions of calcium | Nueromuscular, CARDIAC, BLOOD CLOTTING |
| Hypocalcemia calcium serum level | Below 8.5 |
| 10 Causes of Hypocalcemia | High phosphate intake, hypoparathyroidism, VITAMIN D DEFICIENCY, lactose intolerance, ALKALOSIS, massive transfusion, chronic diarrhea, pancreatitis, shock, massive hemorrhage |
| 7 symptoms of hypocalcemia | Laryngeal spasm, tetany, convulsions, numbness & tingling around mouth, CHVOSTEK & TROUSSEAU SIGNS, impaired clotting, osteoporosis |
| Who commonly has hypocalcemia? | Client with renal failure because of high phosphate |
| If given a choice between Calcium & phosphate, which will the body choose? | Phosphate |
| What 2 substances should never be used with Ca+ because of risk precipitation? | Bicarbonate & phosphate |
| 6 treatment of hypocalcemia | High calcium diet, Ca supplements with vitamin D, IV Ca if severe, treat alkalosis, avoid alcohol & caffeine, weight bearing activities |
| What solution is used to dilute Ca? | D5W |
| Major side effect of Ca on GI system | Calcium causes CONSTIPATION |
| What question should a patient be asked before given a Mg or Ca supplement? | What is your normal bowel status? |
| Parathyroid problem = | Calcium problem eg. Neck surgery |
| Hypercalcemia | Serum Ca above 10.2 High mortality |
| 6 Causes of hypercalcemia | Hyperparathyroidism, malignancies (cancer), decreased phosphate, renal impairment, prolonged bed rest & fractures |
| 8 symptoms of hypercalcemia | HEART BLOCK, muscle weakness, depression, anorexia, n/v, fracture, kidney stones, cardiac arrest |
| 4 treatments of hypercalcemia | Increase fluid volume (NS), diuretics, calcitonin & treat cancer |
| Phosphorus serum level | 2.5 to 4.5 |
| 4 functions of phosphorus | Formation of bones/ teeth, neuromuscular activity, releases oxygen from RBC, acid base balance |
| Hypophosphatemia serum level | Below 2.5 |
| 9 causes of hypophosphatemia | MALNUTRITION, alcoholism, pancreatitis, hyperparathyroidism, vitamin D deficiency, TPN, aluminum antacids, diuretics & alkalosis |
| 5 manifestation of hypophosphatemia | Muscle weakness/ tremors leading to resp dysfunction, SLOW WEAK PULSE, tissue hypoxia/ confusion, PLATELET DYSFUNCTION & BLEEDING |
| 4 treatment of hypophosphatemia | High phosphate diet, neutrophos po, IV potassium phosphate, stop drugs that promote phosphorus loss eg. Antacids & Ca supplements |
| 2 causes of hypophosphatemia | Renal insufficiency & hypoparathyroidism |
| 3 manifestation of hyperphosphatemia | Signs & symptoms hypocalcemia (tetany/chvostek & troussea), bone & joint pain, tachycardia |
| 3 Treatment of hyperphophatemia | Avoid high phosphorus foods, diuretics & IV fluidsz |
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