Fluid & Electrolytes

Fluid Volume Excess / Hypervolemia

Too much fluid in the vascular space

Fluid Volume Excess / Hypervolemia causes

• Heart failure

  • Heart is weak, Cardiac Output down, Kidney perfusion down, Urinary Output down

  • The volume stays in the vascular space

• Renal failure

• Increased sodium

Things with a lot of sodium

• Effervescent soluble medications

• IV fluids with sodium

• Canned/Processed food

Where is aldosterone stored?

In the adrenal glands above the kidneys

Aldosterone normal action

Causes the body to retain sodium and water in the vascular space

When blood volume gets low > Aldosterone is secreted

Diseases with too much aldosterone

• Cushings (too much of all steroids)

• Hyperaldosteronism (Conn’s syndrome)

Disease with not enough aldosterone

Addison’s disease

Anti-Diuretic Hormone (ADH)

Cause the body to retain water

Syndrome of Inappropriate ADH Secretion (SIADH)

• Too much ADH

  • Too many letters

  • Too much water

• Retain water

• Fluid volume excess

• Urine will be concentrated

• Blood will be diluted

Diabetes Insipidus (DI)

• Not enough ADH

• Lose water

• Fluid volume deficit

• Urine will be diluted

• Blood will be concentrated

• DI = Diuresis

Key words to make you think potential ADH problem

• Craniotomy

• Head injury

• Pituitary tumor

• Sinus surgery

• Transsphenoidal hypophysectomy

• Increased intracranial pressure!!

Transsphenoidal hypophysectomy

Going through the sinus to the pituitary to remove it

Fluid Volume Excess symptoms

• Distended neck (JVD) & peripheral veins

• Peripheral edema & third spacing

• Central Venous Pressure (CVP) goes up

• Crackles in lungs

• SOB

• Pulmonary edema

• Increased UOP

• Increased/Bounding HR

• Increased BP

• Increased weight (acute)

• Confusion

• Fluid retention think heart problems first

Another name for anti-diuretic hormone (ADH) is

Vasopressin

Fluid Volume Excess treatment

• Low sodium diet and restrict fluids

• I & O and daily weights

• Diuretics (Furosemide, Bumetanide, Hydrocholorthiazide, Spironolactone-K+sparing)

• Bedrest > Releases ANP > Diuresis > Na & H2o to go down > ADH goes down

• Give IV fluids slowly (Elderly, Very young, Heart/Kidney problems)

• High fowlers position

• Focus

Fluid Volume Deficit causes

• Loss of fluid (Surgery, Trauma, Suction, Vomiting, Diarrhea, etc…)

• Third spacing (Fluid in a space that does no good (tissue/ascites)) (Fluid in vascular space goes elsewhere)

  • Burns

  • Ascites

• Diseases with polyuria (Diabetes Mellitus)

• Diuretics

• Dehydration

Fluid Volume Deficit symptoms

• Decreased weight

• Decreased skin turgor

• Dry mucous membrane

• Decreased UO

• Decreased BP

• Tachycardia

• Weak/Thready Pulse

• Increased RR

• Decreased Central Venous Pressure (CVP)

• Vasoconstriction

• Cold, Clammy skin

• Cool extremities

• Increased urine specific gravity

• Confusion

Fluid Volume Deficit treatment

• Prevent further loss of fluid

• Replace the volume

• Safety precautions

• Watch for falls

• Monitor for fluid overload

Isotonic solutions

• Fluid where stay where you put it

• Increases BP

• Normal Saline

• Lactated Ringers

• D5W

• D5 ¼ NS

Isotonic solution uses

The client that has lost fluids through nausea, vomiting, burns, sweating, traums

Do not use isotonic solutions in clients with

• Hypertension

• Cardiac disease

• Renal disease

Hypotonic solutions

• Rehydrate vascular space then moves out into the cell

• D2.5W

• ½ NS or 0.33% NS

• Watch for cellular edema

  • Fluid is moving out to the cells which could cause fluid volume deficit and decreased BP

Hypotonic solution uses

The client who has hypertension, renal, or cardiac disease and needs fluid replacement because of nausea, vomiting, burns, hemorrhage

Also used for dilution when a client has hypernatremia and cellular dehydration

Hypertonic solutions

• Draw fluid into the vascular space from the cell

• Packed with particles

• D10W

• 3% NS

• 5% NS

• D5LR, D5 ½ NS, D5 NS

• TPN

• Albumin

• Watch for fluid volume excess

Hypertonic solution uses

The client with hyponatremia or a client who has shifted large amounts of vascular volume to a 3rd space or has severe edema, burns, or ascites

Magnesium (Mg) and Calcium (Ca)

• Act like sedatives

• Think muscles first

Magnesium is excreted by

The kidneys

Hypermagnesemia causes

• Renal failure

• Antacids

Hypermagnesemia symptoms

• Flushing & Warmth

• Decreased BP

• Decreased DTR

• Weak and Flaccid muscle tone

• Arrhythmia

• Lower LOC

• Decreased pulse

• Decreased RR

Hypermagnesemia treatment

• Ventilator

• Dialysis

• Calcium gluconate (Antidote for Mg toxicity)

• Safety precautions

Hypercalcemia causes

• Hyperparathyroidism (Too much PTH)

• Thiazides

• Immobilization

Hypercalcemia symptoms

• Brittle bones

• Kidney stones

• Flushing & Warmth

• Decreased DTR

• Weak and Flaccid muscle tone

• Arrhythmia

• Lower LOC

• Decreased pulse

• Decreased RR

Hypercalcemia treatment

• Encourage mobility

• Fluids

• Increase phosphorus

• Steroids

• Safety precautions

• Calcitonin

Hypomagnesemia causes

• Diarrhea

• Alcoholism

  • Alcohol suppresses ADH

Hypomagnesemia symptoms

• Rigid and tight muscle

• Possible seizure

• Stridor/Laryngospasm

• Positive Chvostek’s (cheek)

• Postive Trousseau’s (bp cuff)

• Arrhythmia

• Increased DTRs

• Mind changes

• Swallowing problems

Hypomagnesemia treatment

• Give Magnesium

  • Check kidney function before

• Seizure precautions

Hypocalcemia causes

• Hypoparathyroidism

• Radical neck

• Thyroidectomy

Hypocalcemia symptoms

• Rigid and tight muscle

• Possible seizure

• Stridor/Laryngospasm

• Positive Chvostek’s (cheek)

• Postive Trousseau’s (bp cuff)

• Arrhythmia

• Increased DTRs

• Mind changes

• Swallowing problems

Hypocalcemia treatment

• PO/IV Calcium

  • Must be on a heart monitor

• Vitamin D

• Phosphate binders (Hydrochloride, Calcium acetate)

Hypernatremia

Dehydration

Hypernatremia causes

• Hyperventilation

• Heat stroke

• Diabetes Insipidus

• N/D

• Dehydration

Hypernatremia symptoms

• Dry mouth

• Thirsty

• Swollen tongue

• Neuro changes

• Restless

• Confusion

• Irritable

Sodium think

Neuro changes

Hypernatremia treatment

• Restrict sodium

• IV fluids

• Daily weights / I & O

• Lab work

Hyponatremia

Dilution

Hyponatremia causes

• Too much water

• D5W

• SIADH

• Diuretics

Hyponatremia symptoms

• Headache

• Seizure

• Coma

Hyponatremia treatment

• Sodium

• No water

• Hypertonic solution (3% or 5% NS)

• Monitor neuro status

Hyperkalemia causes

• Kidney trouble

• Spironolactone

Hyperkalemia symptoms

• Muscle twitching

• Muscle weakness

• Flaccid paralysis

• Arrhythmias

Hyperkalemia treatment

• Dialysis

• Calcium gluconate

• Glucose & Insulin (Carries glucose and potassium into the cell)

• Kayexalate

Hypokalemia causes

• Vomiting

• NG suction

• Diuretics

• Not eating

Hypokalemia symptoms

• Muscle cramps

• Muscle weakness

• Arrhythmias

Hypokalemia treatment

• Give K+

• Eat more K+

Potassium Info

• Always give PO K+ with food to prevent GI upset

• Assess UO before/during IV K+

• Always put IV K+ on a pump

• Never give IV push

• Burns during infusion? Yes

ECG changes with hyperkalemia

• Bradycardia

• Tall and peaked t waves

• Prolonged PR intervals

• Flat or absent P waves

• Widened QRS

• V Fib

ECG changes with hypokalemia

• U waves

• PVCs

• Ventricular tachycardia