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Causes of ECF volume defecit
- increases insensible water loss or perspiration (fever, heatstroke)
- osmotic diurese
- GI losses
- Inadequate intake
- Third spacing - burns, intestinal obstruction
Clinical manifestations of ECF volume loss
- Restlessness, drowsiness, lethargy, confusion
- Thirst, dry mucous membranes
- Decreased turgor/cap refill
- Postural hypotension, increased pulse
- decreased urine output, concentrated urine
- increased respiratory rate
- Weakness, dizziness
- Weight loss
- Seizures, coma
Causes of ECF volume excess
- Excessive isotonic or hypotonic fluids
- Heart or renal failure
- Primary polydipsia
- Cushing syndrome
- Long-term use of corticosteroids
Clinical manifestations of ECF volume excess
- H/a, confusion, lethargy
- Peripheral edema
- Bounding pulse
- Polyuria (with normal renal function)
- Dyspnea, crackles (rales), pulmonary edema
- Muscle spasms
- Weight gain
- Seizures, coma
More water than electrolytes, dilute ECF causing osmotic movement of water to ICF. Montifor for changes in mentation due to potential for cerebral edema from cellular swelling.
0.45% Saline, D5%
Draws water out of cells and into ECF, used for hypovolemic shock and hypontaremia. Monitor bp, lung sounds, serum sodium. Risk for volume excess.
D10%, 3.0% saline, D5 1/2, D5NS
Expands only ECF, ideal fluid for patient with ECF volume defecit. LR contraindicated in hyperkalmia and lactic acidosis due to inability to convert lactate to bicarbonate.
LR, NS, D5% in 0.225%, Ringer's,.
Causes of hypernatremia (Na+ > 145)
- Excessive sodium intake
- -hypertonic tube feeding w/o water
- Inadequate water intake
- Excessive water loss
- -heatstroke, fever, prolonged hyperventilation, osmotic -diuretic therapy, diarrhea.
- Disease states:
- diabetes insipidus, primary hyperaldosteronism, cushing syndrome, uncontrolled DM
Clinical manifestations of hypernatremia with decreases ECF volume
- restlessness, agitation, twitching, seizures, coma
- intense thirst, dry and swollen tongue, sticky mucous membrane
- postural hypotension, weight loss
- weakness, lethargy
Causes of hyperntremia with normal or increases ECF volume
- Restlessness, agitation, twitching, seizurse, coma
- Intense thirst, flushed skin
- Weight gain, peripheral and pulmonary edema, increased BP and CVP
Causes of hyponatremia
- Exessive sodium loss
- -GI losses - v/d, fistulas, NG suction
- -Renal losses, diuretics, adrenal insufficiency, Na+ wasting renal disease
- -Skin losses,, burns, wound drainage
- Inadequte intake
- Excessive water gain
- Disease states: SIADH, heart failure, primary hypoaldosteronism.
Clinical manifestation of hyponatremia with decreased ECF volume
- Irritability, apprehension, confusion, dizziness, personality change, tremors, seizures, coma
- Dry mucous membranes
- Postural hypotension, tachycardia, thready pulse
- Cold and clammy skin
Clinical manifestations of hyponatremia with normal/increased ECF volume
H/a, apathy, confusion, muscle spasms, seizures, coma, n/v/d, abd cramps, with gain, increased BP and CVP
Most common is renal failure
Common with massive cell destruction: burns or crush injuries.
Hyperkalemia causes cont...
- Excess potassium intake
- Shift of K out of cells by acidosis, tissue catabolism (fever, sepsis, burns)
- Crush injuries
- Tumor lysis syndrome
- ACE inhibitors
Hyperkalmia clinical manifestations
- Irritabilyt, anxiety, abd crmaping, diarrhea, weakness in LE, parasthesias, irregular pulse.
- Cardiac arrest if hyperkalemia is sudden or severe.
Hyperkalemia ECG changes
- Tall, peaked T wave
- Porlonged PR interval
- ST segment depression
- Loss of P wave
- Widening QRS
- Ventricular standstill
- GI losses, renal losses, skin losses, dialysis
- Shift of K into cells thourh increased insulin, alkalosis, tissue repair, increased epinephrine (stress)
- Lack of intake
Hypokalemie clinical manifestations
Fatigue, muscle weakness, leg cramps, n/v, paralyti ileus, soft/flabby muscles, paraesthesias, decreased reflexes, weak/irregular pulse, polyuria, hyperglycemia
Hypokalmia ECG changes
ST segment depression, flattened T wave, presence of U wave, ventricular dysrhythmias (PVC's), bradycardia, enhanced digitalis effect.
Multiple myeloma, malignancies with bone metastasis, prolonged immobilization, hyperparathyroidism, Viamin D overdose, thiazide diuretics, milk-alkali sydrome.
Increased ionized calcium from acidosis.
Hypercalcemia clinical manifestations.
Lethargy, weakness, depressed reflexes, decreased memory, confusion, personality changes, psychosis, anorexia, n/v, bone pain, fractures, polyuria, dehydration, nephrolithiasis, stupor, coma.
Hypercalcemia ECG changes
Shortened ST segment, shortened QT interval, ventricular dysrhythmias, increased digitalis effect
Kidney disease, elevated phosphorus, primary hypoparathyroidism, vitamin D deficiency, magnesium deficiency, acute pancreatitis, loop diuretics, chronic alcoholism, diarrhea, low serum albumin (asymptomatic due to normal inoized CA+ level)
Decreased ionized calcium from alkalosis or excess adminstration of citrated blood.
Hypocalemia clinical manifestations
East fatigability, depression, anxiety, confusion, numbness, tingling, hyperreflexia, muscle cramps, Chvostek's sign, Trouseaus's sign, laryngeal spams, tetany, seizures.
Hypocalcemia ECG changes.
Elongation of ST segment, prolonged QT interval, Ventricular tachycardia.
Normal Na+ range
Normal K+ range
Normal Cl range
Norma Ca+ range
Normal glucose range
Normal BUN range
Normal Mg range
Normal protein range
Normal specific gravity
Systolic dysfunction: heart no pumps
Diastolic dysfunction: heart no fills
Dysrythmias, structural problems (valvular stenosis or regurgitation, ventricular septal rupture, tensions pneumo).