Electrolytes

Sodium

135-145 mEq/L

Potassium

3.5-5.0 mEq/L

Chloride

98-106 mEq/L

Bicarbonate

24-31 mEq/L

Calcium

8.5-10.5 mg/dL

Phosphorus

2.5-4.5 mg/dL

Magnesium

1.8-3.0 mg/dL

Blood pH

7.35-7.45

What are the 5 major Cations?

Sodium, Potassium, Calcium, Magnesium, Hydrogen

What are the 4 Major Anions?

Chloride, Bicarbonate, Phosphate, Sulfate

Intracellular Fluid

fluid in cells

Extracellular Fluid

Fluid outside of the cells (includes intravascular, interstitial, trancellular)

What is Osmosis

Diffusion of Water caused by a concentration gradient along a semipermeable membrane

Hydrostatic pressure

Exerted on walls of blood vessels (fluid OUT of the capillary toward ICF)

Osmotic Pressure

Exerted by protein in plasma (Fluid INTO capillary from ICF)

Loss of Fluid from Kidneys (calculation)

1mL/kg/hr (1-2L loss/day)

Fluid volume deficit (FVD)

hypovolemia (loss of ECF volume exceeds intake of fluid)

Fluid Volume Excess (FVE)

Hypervolemia (expansion of ECF caused by abnormal retention of water and sodium)

Causes for FVD (4 with examples)

Abnormal fluid losses(vomit, diarrhea, sweating, GI suctioning); Decreased intake (nausea, lack of access to fluids); Third-space fluid shifts (due to burns, ascites); Additional causes(diabetes insipidus, adrenal insufficiency, hemorrhage)

Signs/ Symptoms of FVD (up to 11)

acute weight loss, decreased skin tugor, oliguria, concentrated urine, prolonged cap refill, decreased BP, dizziness, weakness, thirst and confusion, muscle cramps, increased pulse rate

Signs/Symptoms of FVE (up to 9)

acute weight gain, peripheral edema, ascites, crackles, shortness of breath, increased BP, bounding pulse and cough, increased RR, Increased urine output

Management of FVD

Oral route preferred (IV for acute or severe loss- short term - Isotonic, Hypotonic, Hypertonic, Colloid)

What is an Isotonic Solution

Expands ECF : 0.9% NaCl, LR(Na, Cl, K, Ca, Lactate), D5W(water + dextrose)

What is a Hypotonic Solution

Can cause fluid shifts from vascular system to cells (increased ICP): 0.45% NaCl - half normal saline)

What is a Hypertonic Solution

Increased ECF volume, decrease cellular swelling (3% or 5% NaCl, mannitol(

What is a Colloid solution

It affects coagulation

What are some causes of FVE

Fluid overload, diminished homeostatic mechanisms, HF, Kidney injury, Cirrhosis of liver, consumption of excessive amounts of salt or other sodium salts, excessive admin of sodium-containing fluids)

Diagnostic findings of FVE

Edema, Distended neck veins, Crackles, BUN, HCT

Management of FVE

Diuretics, Dialysis, Restriction of sodium

What are 4 major Electrolyte imbalances?

Sodium (hyponatremia, hypernatremia); Potassium (hypokalemia, hyperkalemia); Calcium (hypocalcemia, hypercalcemia); Magnesium (hypomagnesemia, hypermagnesemia)

What is Hyponatremia

Serium sodium less than 135 mEq/L

What can cause Hyponatremia

imbalance of water, vomitting, diarrhea, sweating, diuretics, adrenal insufficiency, certain medications

Clinical Manifestations of Hyponatremia

poor skin turgor, dry mucoas, headahce, decreased salivation, decreased BP, nausea, abdominal cramping, neurological changes

What is Hypernatremia

Serium sodium greater than 145 mEq/L

What can cause Hypernatremia

fluid deprivation, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions

Clinical manifestations of Hypernatremia

thirst, elevated temperature

What is Hypokalemia

Potassium less than 3.5 mEq/L

What can cause Hypokalemia

GI losses, medications, intestinal suctioning, dietary intake (MORE WITH BOWEL)

Clinical Manifestations of Hypokalemia

ECG changes, dysrhythmias, dilute urine, excessive thirst, fatigue, anorexia, muscle weakness, decreased bowel motility, paresthesia

What is hyperkalemia

serium potassium over 5.0 mEq/L

What can cause Hyperkalemia

impaired renal function, rapid admin of Potassium, medications, tissue trauma, acidosis, hypoaldosteronism

Clinical Manifestations of Hyperkalemia

cardiac changes, dysrhythmias, muscle weakness, paresthesias, anxiety, GI manifestations (cardiac arrest frequently associated)

What is Hypocalcemia

Serium Calcium less than 8.6 mg/dL

What causes Hypocalcemia

hypoparathyroidism, malabsorption, osteoporosis, pancreatitis, alkalosis, transfusion of citrated blood, kidney injury, medication

Clinical Manifestations of Hypocalcemia

Neuromuscular focused! (tetany, cramps, seizures, numbness, paresthesias, dyspnea)

What is Hypercalcemia

Serum level greater than 10.4 mg/dL

What causes Hypercalcemia

malignancy and hyperparathyroidism, bone loss related to immobility, diuretics

Clinical manifestations of Hypercalcemia

polyuria, thirst, muscle weakness, nausea, abdominal cramps, constipation, diarrhea, peptic ulcer, bone pain , ECG changes, dysrhythmias

What is Hypomagnesemia

Serum level less than 1.8 mg/dL

What causes Hypomagnesemia

alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid admin of citrated blood

Clinical Manifestations of Hypomagnesemia

apathy, depressed mood, psychosis, neuromuscular irritability, ataxia, insomnia, confusion, muscle weakness, tremors, ECG changes, dysrhythmias (CARDIAC AND NEUROMUSCULAR)

What is Hypermagnesemia

Serum level greater than 2.6 mg/dL

What causes Hypermagnesemia

kidney injury, diabetic ketoacidosis, excessive admin of magnesium, extensive soft tissue injury

Clinical Manifestations of Hypermagnesemia

ECG changes, hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, dysrhythmias, cardiac arrest