Solutions, Acid Base Balance, and Electrolytes

Hypertonic

Contains higher concentration of solutes. Water moves from the cells into the ECF (causes cell shrinking).

3% NaCl

Used as a volume expander for emergent replacement of solutes, cerebral edema, and symptomatic hyponatremia.

0.45% NaCl, 5% Dextrose

Maintenance IV fluid and treats hypovolemia. Monitor fluid overload.

0.9% NaCl, 5% Dextrose

Provides electrolytes (sodium and chloride).

Lactated Ringers, 5% Dextrose

Provides calories, electrolytes, and water; treats metabolic acidosis.

10% Dextrose (in water)

Treats hypoglycemia, provides calories and water; use a central line; can cause phlebitis or thrombosis; infuse slowly to prevent hyperglycemia, fluid overload, or pulmonary edema. Monitor for LOC or confusion.

Contraindications for Hypertonic Solutions

Cardiac or renal disease.

Isotonic

Solutions that have the same osmotic pressure as body fluids.

0.9% NaCl (Isotonic)

Most common, promotes hydration in vomiting, diarrhea, hemorrhage, and shock; is the only solution used with blood product administration.

Lactated Ringers (Isotonic)

Used for burn and trauma clients; hypovolemia, acute blood loss, electrolyte imbalances, metabolic acidosis; use with caution in clients with renal failure.

5% Dextrose (in water) (Isotonic)

Treats hypernatremia; limited nutrition; contraindicated in resuscitations, early pre-op, renal and cardiac issues, increased ICP.

Hypotonic

Water moves by osmosis into the cells from the vascular system causing cells to swell and burst. Useful for rehydrating cells and treating dehydration.

0.45% NaCl (Hypotonic)

Used for hypernatremia and diabetic ketoacidosis; contraindicated in clients with burns, liver disease, increased intracranial pressure, and trauma. Monitor for hypotension.

Potassium (K+)

Normal range 3.5-5 mEq/L; functions to support electrical impulses of the body's nerves and muscles; conduction of nerve cells within the heart.

RDA for Potassium

3,400 mg (males); 2,600 mg (females).

Hypokalemia

K+ < 3.5 mEq/L; causes flat T waves, dysrhythmias.

Signs/Symptoms of Hypokalemia

Muscle weakness, cardiac arrhythmias, constipation, fatigue.

Complications of Hypokalemia

K+ < 2.5 can lead to respiratory paralysis, failure, paralytic ileus, hypotension, tetany, rhabdomyolysis, and cardiac arrhythmias.

Treatment for Hypokalemia

Oral supplements, potassium-sparing diuretics, increase diet in potassium-rich foods.

Hyperkalemia

K+ > 5 mEq; causes peaked T waves, weakness.

Signs/Symptoms of Hyperkalemia

Cardiac arrhythmias, muscle weakness, or paralysis; heart failure (K+ > 7 mEq); death can occur if left untreated.

Muscle weakness

A condition characterized by a decrease in muscle strength.

Urinary Output (little to none)

A significant reduction in the amount of urine produced.

Respiratory Failure

A medical condition where the respiratory system fails to maintain adequate gas exchange.

Decreased cardiac contractility

A reduction in the heart's ability to contract and pump blood.

Early muscle twitching / cramps

Involuntary muscle contractions that occur early in the onset of certain conditions.

Rhythm: tall peaked T waves, prolonged PR intervals

Electrocardiogram findings indicative of certain electrolyte imbalances.

Hemodialysis

A treatment method for hyperkalemia resulting from renal failure.

Calcium gluconate

A medication used in the treatment of hyperkalemia.

Diuretics

Medications that promote the elimination of excess fluid from the body.

Loop and thiazide diuretics

Types of diuretics that are commonly used to manage fluid balance.

Resin medications (sodium polystyrene)

Medications that help excrete potassium through stool.

Insulin

A hormone that causes potassium to enter cells, lowering serum potassium levels.

Hypoglycemia

A condition characterized by abnormally low blood glucose levels.

Sodium (Na+)

An electrolyte with normal levels of 135-145 mEq/L, reabsorbed in the kidneys.

Hyponatremia

A condition characterized by low sodium levels, leading to symptoms like lethargy and seizures.

Causes of Hyponatremia

Medications, chronic vomiting/diarrhea, excess water intake, and certain health problems.

Signs/Symptoms of Hyponatremia

Nausea, cerebral edema, lethargy, confusion, headache, restlessness, irritability, muscle twitching, decreased LOC, seizures, and coma.

Fluid restriction

A treatment approach for hyponatremia caused by excess water intake.

IV fluids

Intravenous fluids used to treat electrolyte imbalances.

Hypernatremia

A condition characterized by high sodium levels, leading to symptoms like thirst and confusion.

Causes of Hypernatremia

Body water loss exceeding solute loss, medications, vomiting, and diabetes insipidus.

Signs/Symptoms of Hypernatremia

Confusion, lethargy, irritability, muscle twitching, seizures, and coma.

Treatment for Hypernatremia

IV fluids and gradual decrease of sodium levels to prevent cerebral edema.

Calcium (Ca)

9-10.5 mg/dL

Functions of Calcium

Mineralization of bone, muscle contraction, nerve transmission, clotting of blood, hormone secretion, and normal functioning of the heart.

Hypocalcemia

Symptoms include tetany, Chvostek's sign, Trousseau's sign, chest pain, dysrhythmias, heart failure, syncope, numbness, tingling of fingers and toes, muscle cramping/spasms, confusion, depression, psychosis, dementia, lethargy, seizure, personality changes, wheezing, spasms of the larynx and airway, dysphagia, voice alteration, coarseness of hair, alopecia, brittle nails, dry skin, and itching.

Causes of Hypocalcemia

Medications that decrease the body's absorption of calcium, inadequate amount of vitamin D, menopause, hypoparathyroidism, renal disease, multiple blood transfusions, electrolyte imbalances of magnesium or phosphate, sepsis, low albumin levels, pancreatitis, alkalosis.

Signs of Hypocalcemia

Confusion, reflexes increased, arrhythmias, muscle spasms (tetany), seizures, positive Trousseau's/Chvostek's sign, sensation of tingling (paresthesia).

Treatment for Hypocalcemia

Can resolve on its own, vitamin C and D supplements, dietary changes, calcium injections.

Hypercalcemia

Symptoms include constipation, kidney stones, abdominal pain, nausea, vomiting, anorexia, confusion, behavioral changes, thirst, polyuria, bone pain, muscle weakness, arrhythmias, delirium, coma, and renal failure.

Causes of Hypercalcemia

Cancer, hyperparathyroidism, vitamin D toxicity, medications (calcium, vitamin D and A supplements, thiazide diuretics, lithium carbonate, biphosphonates), renal failure, prolonged bed rest, malignant bone disease, thyroidectomy.

Signs of Hypercalcemia

Abdominal groans, painful bones, kidney stones, psychiatric moans, fatigue overtones, weakness of muscles, EKG changes (shortened QT interval), absent reflexes, kidney stone formation (cholelithiasis).

Treatment for Hypercalcemia

Phosphate PO (for mild hypercalcemia), IV saline bolus with loop diuretic, hemodialysis (severe).

Magnesium (Mg)

1.3 to 2.1 mEq/L

Functions of Magnesium

Regulation of nerve and muscle function, blood pressure, blood sugar levels, and making DNA, protein, and bone.

RDA of Magnesium

400-420 mg/day (males); 310-320 mg/day (females).

Hypomagnesemia

Symptoms include tremors, hyperreflexia, nausea, vomiting, decreased appetite, fatigue, weakness, muscle cramps, spasticity, numbness/tingling, seizures, tetany, personality changes, cardiac dysrhythmias.

Causes of Hypomagnesemia

Medications, decreased intake, decreased absorption in intestines, increased excretion, excessive alcohol use, diabetes mellitus type 2, undernutrition, severe burns, hypokalemia, hypocalcemia, diabetic ketoacidosis, prolonged gastric suction.

Signs of Hypomagnesemia

Seizures, tetany, anorexia, arrhythmias, rapid heart rate, vomiting, emotional lability, deep tendon reflexes are increased.

Treatment for Hypomagnesemia

Oral supplements, PN, dietary sources include cooked spinach, pumpkin seeds, black beans, cooked soybeans, cashews, dark chocolate, avocados, tofu, salmon, and bananas.

Hypermagnesemia

Symptoms include drowsiness, nausea, dizziness, weakness, confusion, sleepiness, blurred vision, headache, decreased reflexes, bladder paralysis, flushing, constipation, muscle flaccid paralysis, decreased respiratory rate, hypotension, bradycardia, dysrhythmias.

Causes of Hypermagnesemia

Kidney disease, excessive intake, medications (opioids, anticholinergics, laxatives, antacids), trauma, acidotic states, hypothyroidism, adrenal insufficiency, excess replacement.

Signs of Hypermagnesemia

Seizures, coma, cardiac arrest, and death can occur if left untreated.

IV calcium gluconate

Calcium chloride

IV diuretics + IV saline

Prevents other imbalances from occurring

Dehydration

In dehydration, serum osmolality is increased as well as specific gravity (1.005-1.030). Treatment includes fluids PO (if the patient is alert) and IV dextrose 5% (performed slowly to prevent cerebral edema).

Hypervolemia

Characterized by fluid overload; the body has too much water and sodium in the extracellular space.

Causes of Hypervolemia

Heart failure, kidney failure, nephrotic syndrome, cirrhosis, or end-stage liver disease, pregnancy alters the balance of a woman's hormones.

HTN

Hypertension, characterized by elevated blood pressure.

Bounding pulse

A pulse that feels strong and forceful.

Pale, cool skin

Skin that appears lighter in color and feels cool to the touch.

Edema

Swelling caused by excess fluid trapped in the body's tissues.

Ascites

Accumulation of fluid in the abdominal cavity.

Crackles

Abnormal lung sounds heard during inhalation, indicating fluid in the airways.

Distended neck veins

Enlarged veins in the neck, often a sign of increased central venous pressure.

BMP

Basic Metabolic Panel, a blood test that measures glucose, calcium, and electrolytes.

CMP

Comprehensive Metabolic Panel, a blood test that includes BMP plus additional proteins and liver enzymes.

Diet restrictions

Limitations on sodium and water intake as part of treatment.

Daily weights

Regular monitoring of body weight to assess fluid retention.

Fluid removal through dialysis

A treatment for kidney failure that removes excess fluid and waste from the blood.

Paracentesis

A procedure to remove fluid from the abdominal cavity.

Hypovolemia

A condition characterized by decreased blood volume.

Causes of hypovolemia

Blood loss, GI losses, severe burns, third spacing, excessive sweating, fever, medications, trauma.

Signs/Symptoms of hypovolemia

Thirst, dryness of mucous membrane, decreased skin turgor, decreased urine output, lethargy, muscle weakness, orthostatic hypotension, tachycardia, confusion, tachypnea, chest pain with palpitations, oliguria, hypotension, hypovolemic shock.

BUN/CR > 20:1

A laboratory finding indicating a lack of blood flow to the kidneys.

Oral supplements

Nutritional aids taken by mouth to replenish nutrients.

0.9% normal saline

An isotonic solution used for fluid replacement.

Ringer's lactate

A sterile solution used for fluid and electrolyte replenishment.

Hypophosphatemia

A condition characterized by low phosphate levels, leading to weakness.

Hyperphosphatemia

A condition characterized by high phosphate levels, often associated with hypocalcemia.

Respiratory Acidosis

A condition caused by CO2 retention due to hypoventilation.

Causes of Respiratory Acidosis

CNS depression, pneumonia, atelectasis, pulmonary embolism, COPD, chest wall injury.

Signs/Symptoms of Respiratory Acidosis

Anxiety, confusion, fatigue, shortness of breath, sleepiness, lethargy.

Bronchodilators

Medications that relax and open the airways.

Corticosteroids

Anti-inflammatory medications used to treat respiratory conditions.

Supplemental oxygen

Oxygen provided to patients to improve oxygen saturation.

Signs/Symptoms of Hypervolemia

HTN, bounding pulse, pale cool skin, edema/ascites, crackles, distended neck veins.

Diagnostics for Hypervolemia

BMP or CMP.