Fluids and Electrolytes
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Calcium good for? NV?
- 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
Intra and Extracellular fluids
- 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.
Lab finding and fluid imbalances
Fluid Volume deficit --> ↑ ht, BUN, serum osmolality, serum sodium, urinary specific gravity
Fluid Volume Excess -->↓ht, BUN, serum osmolality, serum sodium, urinary specific gravity
What is Isotonic overhydration and its causes?
- hypervolemia --> excessive fluid in extracellular
- fluid compartment
- can cause CHF or Pulm edema
- Causes: inadequate control of IV therapy, renal failure, LT steroids therapy
Hypertonic overhydration? causes?
- 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.
Hypotonic overhydration? Causes?
- 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
Hyponatremia - Causes
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
Hyponatremia - SS?
- 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
Hypernatremia - causes?
- Steroids use
- Cushing Syndrome
- Renal failure
- 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
Hypokalemia - cause
ex use of diuretics, steroids, high aldosterone ( Cuching syndrome), v, d, diaph
others: when K move from outside cell to in --> alkalosis, hyperinsulinism.
- 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
How to take K? PO and liquid
How to administer K?
- 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/mlMake 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 fqBefore 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
Hyperkalemia - SS?
- 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
Hypocalcemia - causeS?
- Malabsorption syndrome --> Celiac sprue, Crohns's disease
- end stage renal failure
- alkalosis / acute pancreatitis
- No parathyroid gland
Aministration of calcium?
Other meds that help w/ hypocalcemia
- 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
Causes of hypercalcemia
- Use of thiazide diuretics
- Inc bone resorption of Ca --> hyperparathyroidism, hyperthyroidism
SS of hypercalcemia
- and what to monitor for?
- 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
Meds to treat hypercalcemia
- prostaglandin synthesis inhibitor ( aspirin, NSAIDS)
Causes - hypomagnesemia
- Celiac and Crohns --> malabsorption
- mg going into cell
- insulin admin
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
Hpermg - causes and treatment
CG: antidote for mg toxicity
- Cause: excessive laxatives and antacids
- Treatment: calcium gluconate or calcium chloride
- 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
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