Fluids and Electrolytes

• bone formation-
• coagulation of blood-
• excitation of cardiac and skeletal muscle- maintenance of muscle tone -
• conduction of neuromuscular impulses-
• synthesis and regulation of the endocrine and exocrine glands-
• NV: 8 to 10mg/dl

• maintain osmotic pressure and acid base balance- transmit nerve impulse-
• NV: 135-145

• concentrated in bone cartilage and w/in cell itself
• rqd for use of ATP as source of energy
• nec for action of carb metabolism, protein and nucleic acid synthesis, contraction of muscle tissue-
• NV: 1.6 - 2.6

• - inverse relationship w/ calcium - when one is inc, the other one dec-
• needed for generation of bone tissue - maintenace of acid base,
• tranfer of energy from one site in the body to the other.-
• functions in metabolism of glucose and lipids- NV: 2.7-4.5

• needed for nerve conduction-
• muscle function, -
• acid base balance-
• osmotic pressure - with calcium and mg,
• control the rate and force of contraction of the heart → CO-
• NV: 3.5 - 5.1

• Intracellular = inside cells
• Extra = interstitial ( fluid in between cells - also called 3rd spacing) and intravascular ( fluid in blood vessels)

trapped extracellular fluid in a actual or potential body space as a result of disease or injury.

equal amount of water and electrolytes are lost = hypovolemia  --> dec circulating blood volume and inadequte tissue perfusion

• More water loss than electrolytes → fluid move from inside the cell into the plasma and the intracellular space causing cells to dehydrate and shrink.
• Causes: excessive perspiration, hyperventilation, ketoacidosis, prolonged fevers, diarrhea, early-stage renal failure, and diabetes insipidus

• More electrolyte loss than water → fluid move from plasma and interstitial fluid spaces into the cells, causing cell to swell while causing a plasma volume deficit.
• Causes: chronic illnesses, excessive water replacement (hypotonic), renal failure, chronic malnutrition.

Fluid Volume deficit --> ↑ ht, BUN, serum osmolality, serum sodium, urinary specific gravity

Fluid Volume Excess -->↓ht, BUN, serum osmolality, serum sodium, urinary specific gravity

• hypervolemia --> excessive fluid in extracellular 
• fluid compartment
• can cause CHF or Pulm edema
• Causes: inadequate control of IV therapy, renal failure, LT steroids therapy

• Excessive sodium intake
• fluid drawn from intracell fluid compartment - more extracellular fluid, intracellular fluid contract.

Causes: rapid infusion of hypertonic saline, excessive sodium bicarbonate therapy.

- water intoxication --> excessive fluid moves into the intracellular space, and all body fluid compartments expand.  => electrolyte imbalance as a result of dilution

Causes: early renal failure, CHF, SIADH, inadequately controlled IV therapy, replacement of isotonic fluid with hypotonic fluid, irrigation of wounds with hypotonic fluid

Causes: excessive diaphoresis, diuretics, v,d, wound drainage, renal disease, low aldosterone ( increasing reabsorption of ions and water in the kidney, to cause the conservation of sodium, secretion of potassium, increased water retention, and increased blood pressure) , ingestion of hypotonic fluid, fresh water drowning, SIADH, hyperglycemia, CHF

• CV: depends on volume of fluid 
• Resp: shallow resp - late sign of resp muscle weakness
• Neuro: gen skeletal muscle weakness worse in ext, low DTR
• CNS: HA, pers change, confusion, seizures, coma
• GI: inc motility and BS, n,d, abdo cramps
• Renal: Inc urinaty output, dec urinary sp. grav.
• Skin: dry - muc memb too

• Steroids use
• Cushing Syndrome
• Renal failure
• Hyperaldosteroidism
• dec water intake- h20 loss - fever, DI, d,v, diaphoresis, hyperventilation

• CV: depending on vasc volume status
• Resp: pulm edema if hypervolemic
• Neuro: Early --> muscle twitches, irregular muscle contraction. Late -->skeletal muscle weakness, dtr low or absent
• CNS: hypervolemic --> lethargy, stupor, coma
• Hypovolemic --> agitation, confusion, seizures
• GI: thrist
• Renal: dec UO, inc usg
• Skin: dry eurrthing

ex use of diuretics, steroids, high aldosterone ( Cuching syndrome), v, d, diaph

others: when K move from outside cell to in --> alkalosis, hyperinsulinism. 

water intoxication

• CV: weak and thready pulse, irregular, ortho BP
• Resp: shallow, abs of BS
• Neuro: anxiety, lethargy, confusion, coma, paresthesia, dtr hyporeflexia
• GI: dec motility, hypoactive or absent BS, n,v, const, abdo distention, paralytic ileus
• EKG changes: st depression, inverted t wave and prominent u wave

• PO: do not take on empty stomach
• Liquid - ( KCL) nasty taste, give w/ juice

• Never given IV push, IM or subcu.
• IV K always diluted NEVER w/ dextrose but normal saline and admin using an infusion device!!!!
• Dilution of no more 1mEq/ml
• Make sure that K is well distributed in bag
• Max: 5-10 mEq/hr 
• > 10 mEQ --> put pt on ht monitor
• Risk for phlebitis/infiltration: inspection of IV site fq
• Before admin: assess renal function - and monitor intake and output.

• Addison's disease - low aldosterone
• mvt of K in cell out of cell --> tissue damage, acidosis, hyperuricemia, hypercatabolism

• CV: bradycardia, low BP
• Resp: weakness of resp muscle - resp failure
• Neuro: Early --> muscle twitches, paresthesia, cramps. Late --> profound weakness, flaccid arms, etc ...
• GI: inc motility, high BS, d
• EKG changes: tall T waves, flat p waves, widened QRS complexes, prolonged PR intervals

• Malabsorption syndrome --> Celiac sprue, Crohns's disease 
• end stage renal failure 
• alkalosis /  acute pancreatitis
• hyperphosphatemia
• No parathyroid gland

• warm solution to room temp, admin slowly.
• aluminum hydroxide - dec phos
• 10% calcium gluconate - for acute calcium deficiency

• CV: low HR, BP, per pulses
• Resp: muscle tetany or seizures can cause resp arrest
• Neuro: tetany, seizures, muscle cramps, + Trousseau ( carpal spasm induced by inflating a BP cuff) and Chovstek (contraction of facial muscle when tap in front of ear on facial nerve -cheek area-) SIGNS, hyperactive DTR, anxiety, irritability
• GI: cramping fiarrhea, high BS, inc motility
• EKG changes: prolonged ST and QT interval

• Use of thiazide diuretics 
• Inc bone resorption of Ca --> hyperparathyroidism, hyperthyroidism

• CV: inc hr, bp, pulses
• Resp: muscle weakness - low resp
• Neuro: profound muscle weakness, low/no dtr, disorientation, lethargy, coma
• EKG changes: shortened ST segment, widened T wave

• Monitor for signs of pathologic fractures - move pt slowly, carefully, assist w/ ambulation
• Monitor for abdo cramp or pain, flank pain
• Check urine for presence of urinary stones

• phosphorus
• calcitonin
• prostaglandin synthesis inhibitor ( aspirin, NSAIDS)

• Celiac and Crohns --> malabsorption
• sepsis
• mg going into cell
• insulin admin
• hypocalcemia

IV magnesium sulfate - IM injection causes pain and tissue damage

• CV: tachycardia, htn
• Resp: shallow
• Neuro: same for hypocalcemia
• CNS: confusion, irritability
• EKG changes: tall T waves, depressed ST segments

• Cause: excessive laxatives and antacids
• Treatment: calcium gluconate or calcium chloride

CG: antidote for mg toxicity

• CV: low HR, dysrhythmia, low bp
• Resp: low
• Neuro: low DTR, skeletal msucle weakness
• CNS: drowsiness, lethargy, confusion
• EHG chnages: prolonged pr interval, widened qrs complex