Fluid & Electrolytes Slides Quiz

Causes/Clinical Manifestations/Treatments

Causes —> what is this linked to?

• Excessive Na+ containing isotonic fluids

• Oral intake of Na+ foods & water

• Renal retention of Na+ & H2O

  • HF

  • Cirrhosis

  • Acute/chronic oliguric renal disease

  • Aldosterone or glucocorticoid excess

Hypervolemia Causes

Clinical Manifestation —> what is this linked to?

• Mild:

  • Sudden weight gain (overnight)

  • Edema (dependent areas)

  • Full neck veins when upright or semi-upright

  • Crackles in lungs

• Severe:

  • Confusion

  • PE

    • Anxious appearance with labored breathing

    • Crackles on auscultation

    • Productive cough (pink-frothy)

Hypervolemia Manifestations

Treatment & Management —> What is this linked to?

• Restrict fluid intake

• Na+ restriction

• Promote excretion

  • Diuretics

  • Dialysis

• Assessment & Monitoring

  • Respiratory status — crackles in lungs, pulse oximetry

    • Acute pulmonary edema

  • I&O, daily weights

  • Diet management

Hypervolemia Treatment

Causes —> What is this linked to?

• Decreased oral intake (H2O, Na+)

• Increase GI output (V/D, laxative use, drainage tube)

• Increased renal output (diuretics, adrenal insufficiency)

• Loss of blood or plasma (hemorrhage, burns)

• Massive sweating without intake

Hypovolemia Causes

Clinical Manifestation —> What is this linked to?

• Mild/Compensated:

  • Weight loss (overnight)

  • Thirst

  • Postural hypotension

  • Tachycardia

  • Thready Pulse

  • Dry mucous membranes

  • Poor skin turgor

  • Flat neck veins

  • Dark yellow urine

• Severe/Decompensation: Hypovolemic shock

  • Weak thready pulse

  • Hypotension

  • Confusion/Altered mental status

  • Hypotension

  • Oliguria (output <30 mL/hr) or anuria

  • Cold & Clammy Skin

Hypovolemia Clinical Manifestation

Treatment & Management —> What is this linked to?

• Oral fluid replacement

  • Avoid sugary beverages (sodas, fruit juice)

  • Avoid caffeine

• Parenteral replacements

  • Isotonic fluid (D5W, 0.9% NaCl, NS, LR)

  • Hypovolemic Shock: Fluid bolus, vasopressors, ECG monitoring

• Assessment & Monitoring

  • Mental status/Neuro exams

  • Vital signs

  • Strict I&O, daily weights

  • Indwelling catheterization

  • Control N/V/D

  • Fever management

Hypovolemia Treatment & Management

Na+ normal range

135-145 mEq/L

K+ normal range

3.5 - 5.0 mEq/L

Ca2+ normal range

8.6 - 10.2 mEq/L

Mg2+ normal range

1.5 - 2.5 mEq/L

Causes —> What is this linked to?

• Loss H2O > Na+:

  • Diabetes insipidus (ADH insufficiency)

  • Osmotic diuresis

  • Large insensible perspiration w/o intake

  • Diarrhea

• Gain Na+ > H2O:

  • Tube feedings

  • Hypertonic parental fluids

  • No water intake (deliberate, inability to respond to thirst)

  • Dysfunction of thirst drive

Hypernatremia Causes

Clinical Manifestations —> what is this related to?

• Neuro:

  • Decrease LOC

  • Confusion

  • Seizures

  • Lethargy, weakness

  • Coma

• Skin:

  • Dry mucous membranes

• CV:

  • Postural hypotension

  • Tachycardia

  • HTN (mild) —> Hypotension

• Weight loss

• GI:

  • N/V

  • Thirst

Hypernatremia w/ Hypovolemia Clinical Manifestations

Clinical Manifestations —> what is this related to?

• Neuro:

  • Disorientation or confusion

  • Seizures

  • Coma

• Skin:

  • Flushed Skin

• CV:

  • JVD

  • S3 gallop

  • HTN

• Weight gain:

  • Thirst

• Resp:

  • Crackles

  • Dyspnea

  • Pulmonary edema

Hypernatremia w/ Hypervolemia Clinical Manifestation

Treatment & Management —> what is this related to?

• Treat underlying cause

• Na+ restriction

• Oral intake of H2O

• IV therapy

  • Hypotonic solution (0.45% NaCl)

  • Isotonic solution (D5W)

• Promote excretion

  • Diuretics

  • Desmopressing (DDAVP) for diabetes insipidus

• Assessment & Monitoring

  • Electrolytes

  • I&O, daily weights

  • Neurological status

    • Quickly removing Na+ can cause cerebral edema

  • Prevent seizure related injuries

    • Padded side rails, place patietns closer to nurses’ station

  • Note patient’s thirst level

Hypernatremia w/ Hypervolemia Treatment & Management

Causes —> What is this related to?

• Gain H2O > Na+

  • Excessive ADH

  • Psychogenic polydispsia or forced excessive water intake

  • Tap water enemas

  • Tap water enemas

• Loss Na+ > H2O

  • Replacement of large body fluid w/o Na+

Hyponatremia Causes

Clinical Manifestations —> What is this related to?

• Neuro:

  • Irritability

  • Headache

  • Confusion, behavioral changes, hallucinations

  • Coma

  • Seizures

• CV:

  • Othrostatic hypotension

  • Weak thready pulses

• Resp:

  • Crackles

  • Tachypnea

  • Dyspnea

  • Orthopnea

• GI:

  • N/V/D

  • Hyperactive bowel sounds

  • Abdominal cramping

Hyponatremia Clinical Manifestation

Treatment & Management —> What is this related to?

• Na+ administration

  • Oral, NG, IV

• H2O restriction

• Hypertonic solution IV **SHORT**

  • 2% or 3% NaCl (Central line) — ICU

• Medications

  • Conivaptan (Vaprisol)

    • Vasopressor receptor antagonist

    • Blocks ADH —> urination —> Na rises

• Assessment & Monitoring

  • Electrolytes

  • Mental status

  • Vital sign

  • I&O, daily weights

  • Manage source of loss & manage (vomiting, diarrhea)

  • Medication (lithium) — inverse relationship

  • Prevent seizure related injuries

    • padded side rails, place patient closer to nurses’ station

Hyponatremia Treatment & Management

Causes —> What is this related to?

• increase K+ intake

  • IV or oral intake

• Shift K+ from cells into ECF

  • Massive cellular damage (crushing trauma, cytotoxic chemotherapy)

  • Insufficient insulin (DKA or acidosis)

• Decreased K+ output

  • Oliguria (ESRD)

  • K+ sparing diuretics (aldosterone)

  • Adrenal sufficiency

Hyperkalemia Causes

Clinical Manifestations —> What is this related to?

• CV:

  • Dysrhythmias (changes in EKG)

  • Hypotension

  • Tachycardia

  • Irregular pulse

  • Cardiac arrest

• GI:

  • Abodminal cramps

  • Diarrhea

• Neuro:

  • Anxiety

  • Nerve irritability

• Musculoskeletal

  • Muscle weakness starting in quadriceps & extending to respiratory muscles

Hyperkalemeia Clinical Manifestations

Treatment & Management —> What is this related to?

• Cardiac & electrolytes monitoring

• K+ restriction (oral or parenteral)

  • Avoid: fruits (bananas), potatoes, molasses, Brazil nuts

• Increase elimination of K+

  • Diuretics or dialysis

  • Kayexalate

• Force K+ from ECF to ICF (Na/K pump)

  • Insulin

  • Na Bicarb

• Prevent cardiac effects of elevated ECF K+

  • IV Ca gluconate

Hyperkalemia Treatment & Management

Causes —> What is this related to?

• Decreased K+ intake

  • Excessive use of K+ free IV fluids

• Shift of K+ into cells

  • Alkalosis

  • Treatment of DKA with insulin

• Increase K+ output

  • GI losses

    • Vomiting, diarrhea, NG drainage

  • K+ wasting diuretics (Lasix)

  • Polyuria

  • Glucocorticoid therapy

Hypokalemia Causes

Clinical Manifestation —> What is this related to?

• CV:

  • Dysrhythmias

  • Hypotension

  • Weak pulse

• Resp:

  • Muscle weakness = respiratory arrest

• Gastrointestinal

  • Decrease GI motility = constipation

• Musculoskeletal

  • Muscle weakness starting in quadriceps & extending to respiratory muscle

Hypokalemia Clinical Manifestations

Treatment & Management —> What is this related to?

• Cardiac & electrolytes monitoring

• Oral or IV K+ replacement

  • Fluids

  • K+ rich foods

    • Fruits (banans)

    • Potatoes

    • Brazil nuts

      • NEVER BOLUS POTASSIUM (no IV Push)

Hypokalemia Treatment & Management

Cause —> What is this related to?

• Increased Ca2+ intake & absorption

  • Milk-alkali syndrome

• Shift Ca2+ out of bone

  • Prolonged immobilization

  • Hyperparathyroidism

  • Bone tumors

• Decreased Ca2+ output

  • Thiazide diuretics

  • Acute renal failure

Hypercalcemia Cause

Clinical Manifestation —> What is this related to?

• CV:

  • Cardiac Arrest

• Neuro:

  • Lethargy

  • Decrease LOC

  • Confusion

  • Personality changes

  • Decreased reflexes

• GI:

  • Anorexia

  • N/V

  • Constipation

Hypercalcemia Clinical Manifestation

Treatment & Management —> What is this related to?

• Excretion of Ca2+

  • Loop diuretics

• IV therapy

  • Isotonic therapy (LR, NS)

• Restrict Ca2+ intake

  • Avoid dairy, canned fish with bones, broccoli, oranges, avoid vitamin D

• Mobilization & Exercise

• Medication

  • Calcitonin

  • Bisphosphate

Hypercalcemia Treatment & Management

Causes —> What is this related to?

• Decreased Ca2+ intake & absorption

  • Ca2+ deficient diet

  • Vitamin D deficiency (ESRD)

  • Chronic diarrhea

  • Laxative use

• Shift Ca2+ into bone or inactive forms

  • Hypoparathyroidism

  • Hypoalbuminemia

  • Alkalosis

  • Pancreatitis

  • Citrated blood transfusion

• Increased Ca2+ output

  • Chronic diarrhea

Hypocalcemia Causes

Treatment & Management —> What is this related to?

• Cardiac & electrolyte monitoring

• Monitor for bleeding

• Oral replacements

  • Ca Gluconate IV

  • Ca Cl IV

  • Ca Carbonate Oral

• Increased Ca rich foods

  • Dairy, broccoli, vitamin D intake, canned fish with bones

• Treatment of pain & anxiety

• Prevent respiratory alkalosis from hyperventilation

Hypocalcemia Treatment & Management

Causes —> What is this related to?

• Increased Mg2+ intake & absorption

  • Excessive use of Mg2+ containing laxatives & antacids

  • Parenteral overload of Mg

• Decreased Mg2+ output

  • Oliguria, ESRD

  • Adrenal sufficiency

Hypermagnesemia Causes

Clinical Manifestations —> What is this related to?

• CV:

  • Hypotension

  • Bradycardia

  • Cardiac arrest

  • Dysrhythmias

• Respiratory

  • Decreased rate & rhythm (respiratory depression)

• Neurological

  • Lethargy

  • Hypoactive DTR

Hypermagnesemia Clinical Manifestations

Treatment & Management —> What is this related to?

• Cardiac & electrolyte monitoring

• Avoid Mg2+ containing medications & foods

  • Dark leafy vegetables, whole grains

• Increase renal excretions

  • Dialysis

  • Diuretics

• Administer Ca gluconate IV

Hypermagnesemia Treatment & Management

Causes —> What is this related to?

• Decreased Mg2+ intake & absorption

  • Malnutrition

  • Chronic alcoholism

  • Chronic diarrhea

  • Laxative misuse

  • Steatorrhea

• Shift of Mg2+ into inactive form

  • Rapid administration of citrated blood

• Increased Mg2+ output

  • Chronic diarrhea

  • Steatorrhea

  • Other GI losses (vomiting/NG drainage)

  • Loop diuretics

Hypomagnesemia Causes

Clinical Manifestations —> What is this related to?

• CV:

  • Tachycardia

  • HTN

  • Dysrythmias

• GI:

  • Dysphagia

• Neuro:

  • Positive Chvostek’s sign

  • Hyperactive DTR

  • Muscle cramping & twitching

  • Seizures

  • Tetany

  • Insomnia

Hypomagenesemia Clinical Manifestations

Treatment & Management —> What is this related to?

• Cardiac & electrolyte monitoring

• Increase Mg2+ rich foods

• Administer oral or IV Mg2+

  • Administer Mg2+ before K+ replacements (if both hypokalemia & hypomagnesemia), think N/K Pump

    • K+ follows Mg2+

Hypomagnesemia Treatment & Management