Fluids and Electrolytes
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- 135-145 mEq/l
- Cation-in ECF and body secretions
- Regulated by renal system and aldosterone increases Na absorption
- Regulates water balance, maintains blood volume, transmits nerve impulses, and contracting muscles
What is hyponatremia?
- <135 serum, osmolality <280
- Causes: Na loss (gi, sweat, diuretics,) wound drainage, decreased aldosterone secretion, h2o gain, hypotonic tube feedings, decreased intake,
- S/Sx: Confusion, muscle twitching, ++DTR, hypotension, tachycardia, flat veins, N&V, headache, seizures and coma, cramps.
- Interventions: I&O, neuro checks, safety, encourage Na, limit water, oral care
What is hypernatremia?
- >145 serum, osmolality >300
- Causes: Na excess (renal failure, corticosteroids, Na intake), insensible fluid losses, diarrhea, normal saline infusions, tube feedings that are hypertonic without adequate water flushes, diabetes insipidus, heat strokes, drugs (kayexelate)
- S/Sx: Restless, seizures, coma, muscle twitch, thirst, red-swollen tongue, postural hypotension, decreased LOC.
- Skin flushed
- Low grade fever
- Interventions: I/O, restrict Na, increase fluids, safety, reality orientation, seizure pre, daily weights, serum Na levels
T or F
Chloride follows and reflects Na changes.
What is the serum level for potassium?
What are the symptoms of hypokalemia?
- Muscle weakness, leg cramps, fatigue, N&V, decreased bowel sounds and motility, cardiac dysrhythmias, depressed dtrs, ABG alkalosis.
- Skeletal muscle weakness
- U wave on EKG
- Constipation or ileus
- Toxicity of dig
- Irregular, weak pulse
- Orthostatic hypotension
What are the symptoms of hyperkalemia?
GI hyperactivity, diarrhea, irritability, confusion, cardiac dysrhythmias, muscle weakness, no reflexes, paresthesias or numbness in extremeties
What is the serum level for calcium?
What are the symptoms of hypocalcemia?
- Numbness, tingling of extremeties and around mouth, muscle tremors and cramps,
- Severe: tetany, seizures, cardiac dysrhythmias, confusion, Positive Trousseau's and Chvostek's signs
What are the symptoms of hypercalcemia?
Lethargy, weakness, depressed dtrs, N&V, anorexia, constipation, polyuria, flank pain (kidney stones), dysrhythmias and heart blocks.
What is the serum level for magnesium
What are the symptoms of hypomagnesemia?
- Cardio: dysrhytmias, ekg changes, hypertension
- Neuro; twitch, cramps, chvostek & trousseaus, tetany, seizures
- Resp: hypoventilation due to muscle weakness
- CNS: agiatation, phsychosis, confusion, coma
- Anorexia and arrhythmias
- Rapid HR
- Emotional lability
- Deep tendon reflexes increased
What are the symptoms of hypermagnesemia?
- Neuro: depressed dtr, resp depression, arrest
- Cardio: bradycardia and heart blocks
- Hypotension, flushing
- CNS: lethargy, confus, somnolen, coma
- Metabolic: hypocal, hyper k
- Reflexes decreased, plus weakness and paralysis
- Ecg changes
- Nausea & vomiting
- Appearance flushed
- Lethargy plus drowsy and coma
What is the serum level for chloride?
What are the symptoms of hypochloremia?
Agitation, irritable, hyper reflexes, Twitching, tetany, seizures, alkalosis
What are the symptoms of hyperchloremia?
Weakness, lethargy, dysrhythmias, acidosis: deep rapid resp, tachypnea, edema, tachy, dyspnea, fluid retention
What is the serum level for phosphate?
- 3-4.5 mEq/l
- Has inverse relationship with calcium
What are the symptoms of hypophosphatemia?
- Muscle weakness, malaise, anorexia, slurred speech, dysphagia, resp failure, rhabdomyolisis, patho fxs,
- CNS=confusion, paresthes, irritable
- Cardiac= decreased contractility, dec co, hypotension, cardiomegaly
- Low atp= suscept to infection, less oxygen to tissues, hemolytic anemia-rbc wbc
What are the symptoms of hyperphosphatemia?
- Anorexia, dec mental staus, paresthesia, muscle weakness, cramps, n & v, popular eruptions, chvostek and trousseaus, tetany visual impairments
- Phos + calcium = deposits of calcium phosphate (heart, lungs, kidneys, cornea or soft tissue)
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