[4.1] RENAL FABS Part I (Fluid and Electrolytes)

From Sir Keith Garino's Lecture last July 23, 2025

a. Solvent

High amount in blood; H2O

a. Solvent
b. Solute

b. Solute

Electrolytes (can be protein, sugar)

a. Solvent
b. Solute

Osmolality

Changes in the quantity and quality of solvent and solute lead to changes to concentration or _____________.

TRUE

• They only differ in the units used

TRUE or FALSE: Osmolality and osmolarity are the same concepts

a. Hypertonic
e. High osmolality
g. High concentration
i. High osmolarity

SATA: Low H2O

a. Hypertonic
b. Hypotonic
c. Isotonic
d. Low osmolality
e. High osmolality
f. Low concentration
g. High concentration
h. Low osmolarity
i. High osmolarity

a. Hypertonic
e. High osmolality
g. High concentration
i. High osmolarity

SATA: High Electrolytes

a. Hypertonic
b. Hypotonic
c. Isotonic
d. Low osmolality
e. High osmolality
f. Low concentration
g. High concentration
h. Low osmolarity
i. High osmolarity

b. Hypotonic
d. Low osmolality
f. Low concentration
h. Low osmolarity

SATA: High H2O

a. Hypertonic
b. Hypotonic
c. Isotonic
d. Low osmolality
e. High osmolality
f. Low concentration
g. High concentration
h. Low osmolarity
i. High osmolarity

b. Hypotonic
d. Low osmolality
f. Low concentration
h. Low osmolarity

SATA: Low electrolytes

a. Hypertonic
b. Hypotonic
c. Isotonic
d. Low osmolality
e. High osmolality
f. Low concentration
g. High concentration
h. Low osmolarity
i. High osmolarity

c. Isotonic

SATA: High H2O and High Electrolytes

a. Hypertonic
b. Hypotonic
c. Isotonic
d. Low osmolality
e. High osmolality
f. Low concentration
g. High concentration
h. Low osmolarity
i. High osmolarity

c. Isotonic

SATA: Low H2O and Low Electrolytes

a. Hypertonic
b. Hypotonic
c. Isotonic
d. Low osmolality
e. High osmolality
f. Low concentration
g. High concentration
h. Low osmolarity
i. High osmolarity

Osmosis

This is the movement of H2O

a. Low concentration to high concentration

Osmosis

a. Low concentration to high concentration
b. High concentration to low concentration

a. High Concentration

IV Fluids: Hypertonic

a. High concentration
b. Low concentration
d. Same concentration to blood

b. Low concentration

IV Fluids: Hypotonic

a. High concentration
b. Low concentration
d. Same concentration to blood

d. Same concentration to blood

IV Fluids: Isotonic

a. High concentration
b. Low concentration
d. Same concentration to blood

a. Cellular dehydration and thirst

IV Fluids: Hypertonic

a. Cellular dehydration and thirst
b. Cellular edema, e.g., cerebral edema
d. Fluid resuscitation

b. Cellular edema, e.g., cerebral edema

IV Fluids: Hypotonic

a. Cellular dehydration and thirst
b. Cellular edema, e.g., cerebral edema
d. Fluid resuscitation

a. Hypertonic

IV Fluids: Removes H2O from the cells

a. Hypertonic
b. Hypotonic
c. Isotonic

b. Hypotonic

IV Fluids: Adds water to the cells

a. Hypertonic
b. Hypotonic
c. Isotonic

c. Isotonic

IV Fluids: Refills the blood vessels

a. Hypertonic
b. Hypotonic
c. Isotonic

a. Hypertonic; and
b. Hypotonic

IV Fluids: Slow infusion

a. Hypertonic
b. Hypotonic
c. Isotonic

1. 0.9% NaCl (Normal Saline)

2. Lactated Ringer’s

3. D5W (in the bag) [5% dextrose in water]

What are the isotonic IV fluids?

• > 0.9% NaCl

• > D5W (5% dextrose in water)

• Dextrose in other solution than water

Explain the technique in identifying hypertonic IV fluids

< 0.9% NaCl (Saline)

< D5W (5% Dextrose in Water)

Explain the technique in identifying hypotonic IV fluids

Isotonic

• Give isotonic

Type of FVD: Hypovolemia. What type of IV fluid should you give?

• Water loss = Electrolyte loss

Hypertonic

• Hypotonic

Type of FVD: Increased concentration (cellular dehydration). What type of IV fluid should you give?

• Water loss > Electrolyte loss

Hypotonic

• Hypertonic

Type of FVD: Decreased concentration. What type of IV fluid should you give?

• Water loss < Electrolyte loss

b. Hypertonic FVD (Dehydration and Increased NaCl)

Diabetes insipidus

a. Isotonic FVD
b. Hypertonic FVD
c. Hypotonic FVD

c. Hypotonic FVD (Electrolyte wasting)

Diuretic Use

a. Isotonic FVD
b. Hypertonic FVD
c. Hypotonic FVD

Diuretics (kahit ano)

Type of FVE: Hypervolemia. What is the drug of choice?

MGT: Na and H2O restriction

• “Wherever sodium goes, water follows”

DOC: Loop/Thiazide diuretics (e.g., Furosemide)

• To remove Na and H2O

Type of FVE: High concentration. What is the management and the drug of choice?

UKNaMg

• Up Uric Acid

• K Wasting

• Na Wasting

• Mg Wasting

What is the mnemonic for the effects of Loop and Thiazide diuretics? Explain.

MGT: H2O Restriction (800-1000 mL/day)

DOC: Osmotic diuretics (ex. Mannitol)

Type of FVE: Low concentration. What is the management and the drug of choice?

1. High/Gain

2. Edema

3. N/A

4. Distended

5. Crackles/Rales

6. Diarrhea

7. Weakness (same as FVD)

8. Altered (same as FVD)

9. High BP, High HR, High RR

Identify the expected findings from the following assessment parameters if the patient has Fluid Volume Excess:

1. Body weight

2. Skin

3. Eyes

4. Neck Vein

5. Lung Sound

6. GIT

7. Muscle

8. Level of consciousness

9. Vital Signs

1. Low/loss

2. Dry and poor skin turgor = “tenting”

3. Sunken

4. Flat

5. N/A

6. Constipation

7. Weakness (same as FVE)

8. Altered (same as FVE)

9. Low BP, High HR, High RR (Hypo Tachy Tachy)

Identify the expected findings from the following assessment parameters if the patient has Fluid Volume Deficit:

1. Body weight

2. Skin

3. Eyes

4. Neck Vein

5. Lung Sound

6. GIT

7. Muscle

8. Level of consciousness

9. Vital Signs

FALSE

• Directly proportional

TRUE or FALSE: H2O and Pressure are inversely proportional

1. Serum osmolality = 275 - 295 mOsm/kg

2. Hematocrit = M: 42% - 52% / F: 35% - 47%

3. Serum sodium = 135 - 145 mEq/L

4. Creatinine = 0.6 -12 mg/dL

5. BUN = 10-20 mg/dL

6. Urine output = 800 to 2000 mL/day

7. Urine specific gravity = 1.010 - 1.025

8. Urine osmolality = 500 to 850 mOsm/kg

9. Central venous pressure = 8 -12 mmHg

Identify the normal values of the following lab values:

1. Serum osmolality

2. Hematocrit

3. Serum sodium

4. Creatinine

5. BUN

6. Urine output

7. Urine specific gravity

8. Urine osmolality

9. Central venous pressure

1. Urine output

2. Central venous pressure

What lab values are directly proportional to the fluid imbalance (high = excess; low = deficit)?

1. Creatinine and BUN (ex. AKI or CKD)

2. Urine specific gravity (ex. DI)

What lab values related to fluid im/balance reverse when there are renal disorders?

Body weight

What is the best parameter of fluid balance?

B. Monitor I and O

(Body weight should be monitored DAILY)

Choose.

a. Monitor weight every week
b. Monitor I and O

1. Daily monitoring “1 KG = 1 L”

2. Every shift or as ordered. I>O = Retention

3. Decrease

4. Low Na or Low salt to reduce H2O retention

Identify what intervention to be done based on the following parameters if the patient has Fluid Volume Excess

1. Body weight

2. Intake and output

3. Fluid intake

4. Diet

1. Daily monitoring “1 KG = 1 L”

2. Every shift or as ordered. I<O = Loss

3. Increase

4. N/A

Identify what intervention to be done based on the following parameters if the patient has Fluid Volume Deficit

1. Body weight

2. Intake and output

3. Fluid intake

4. Diet

135-145 mEq/L

• “Magic 35-45” → PCO2 (35-45), Blood (7.35-7.45), Na (135-145)

What is the normal value of sodium?

Na

What is the major determinant for concentration of blood

Direct

The direction of proportion of Serum Na and osmolality/concentration

FALSE: Sodium and water are not mutual

TRUE or FALSE: Sodium and water are mutual

a. Increased water
b. Decreased Na
c. Decreased water
d. Increased Na

Describe what will happen under the following circumstances, in relation to blood concentration:

a. Increased Na (1st)
b. Increased water (1st)
c. Decreased Na (1st)
d. Decreased Water (1st)

Fluid imbalance

What is the S/Sx and Management of Na imbalance based on?

1. Cerebral Edema (Increased ICP = ALOC, Seizure, Headache)

2. Decreased Na = Decreased H2O retention, Polyuria

3. FVD = Dry; FVE = Edema

Identify the expected findings from the following if the patient has Hyponatremia:

1. CNS

2. Renal

3. Skin

FALSE

• Ang may HTN, kahit taasan ang H2O, okay lang basta okay ang kidney

TRUE or FALSE: Hypertensive patients should have fluid restriction even if they do not have renal problems

1. Cellular dehydration (ALOC, Seizure, Thirst)

2. Increased Na = Increased Retention = Oliguria

3. FVD = Dry; FVE = Edema

Identify the expected findings from the following if the patient has Hypernatremia:

1. CNS

2. Renal

3. Skin

Central Nervous System (esp. the brain)

What body system is considered as “classic” when it comes to the effects of sodium imbalances?

1. FVE = Decrease/Restrict; FVD = Increase/Replace

2. FVE = Osmotic Diuretics; FVD = Hypertonic Fluids

3. High

Identify the expected interventions to the following if the patient has Hyponatremia:

1. Fluid intake

2. Medications

3. Sodium diet

1. None

2. FVE = Loop diuretics; FVD = Hypotonic fluids

3. Low

Identify the expected interventions to the following if the patient has Hypernatremia:

1. Fluid intake

2. Medications

3. Sodium diet

Potassium

“Pota Arte”; Highest priority electrolyte; Most fatal when there is an imbalance

3.5 - 5 mEq/L

• If there is Magic 35-45, there is KAlbumin

What is the normal value of Potassium?

1. Hyperkalemia

2. Hypokalemia

Identify what type of potassium imbalance is present in the following:

a. K(cells) → Blood
b. K(blood) → Cells

1. Hyperkalemia (nasunog ang cells, leak K to the blood)

2. Hypokalemia (bumabalik sa cell ang K)

Identify what type of potassium imbalance is present in the following:

1. Burns

2. Increased insulin

1. DIRECT = “Promotes” (Muscles and GIT)

2. LOW READING = HR and BP

   1. Increased or decreased K → Damage to heart → Cardiac Arrhythmia

What is the effect of Potassium in the following?

1. Musculoskeletal contraction

2. Cardiovascular system

1 and 2. LOW

3 and 4. HYPOACTIVE

• Constipation (GIT)

• Weakness (Muscle)

Identify the expected findings from the following if the patient has Hypokalemia:

1. Heart Rate

2. Blood Pressure

3. GIT

4. Muscle

1 and 2. LOW

3 and 4. HYPERACTIVE

• Diarrhea (GIT)

• Twitching [with paresthesia] (Muscle)

Identify the expected findings from the following if the patient has Hyperkalemia:

1. Heart Rate

2. Blood Pressure

3. GIT

4. Muscle

Paralysis

Both hypokalemia and hyperkalemia ends in _________.

Respiratory depression

(Verify first): All electrolyte imbalances lead to _____________.

1. High K “Prutassium)

   1. ABC = Avocado, Banana, Citrus

2. HR; WOF=Irregular → Report

3. The following:

   1. Oral Potassium

   2. IV Potassium (“Never Push”)

   3. FVE: Spironolactone (K+ Sparing diuretics)

Identify the expected interventions to the following if the patient has Hypokalemia:

1. Diet

2. Priority Vital Signs

3. Medication

Potassium (IV bolus)

What electrolyte is used as lethal injection?

1. Low K / Avoid K

2. HR; WOF=Irregular → Report

3. Do It So Client Survives

   1. Diuretics (Loop, e.g., Furosemide)

   2. Insulin with Dextrose (to avoid hypoglycemia) → Return K(blood) to cells

   3. Salbutamol (Adrenergic) → Return K(blood) to cells

   4. Ca Gluconate → Blooks K+ in the heart

   5. Sodium Polystyrene (“Kayexalate” → “K+ Exit late”) → Na (Reabs.) and K (excretion) in the GIT)

Identify the expected interventions to the following if the patient has Hyperkalemia:

1. Diet

2. Priority Vital Signs

3. Medication

9-10 mg/dL (or 9-11)

• Calsyampo / Cal 9-11

What is the normal value of calcium?

Calcium

Electrolyte that is a major component of bones

TRUE

• Immobility causes Ca(Bones) leak to the blood leading to both hypercalcemia and hyperparathyroidism (verify this)

TRUE or FALSE: Being comatose leads to hypercalcemia

Calcitonin

What hormone is responsible for returning Ca in the blood to the bones?

TRUE: When there is increased bone resorption

TRUE or FALSE: Bones can be weak and still be hypercalcemic

1. INVERSE: “Blocks/Stops” (Muscle and GIT)

2. DIRECT: “Promotes” (BP and HR)

3. Affected by Hypercalcemia → Supersaturation → Renal Calculi

   1. → Osmotic Diuresis (Polyuria)

What is/are the effect/s of calcium in the following?

1. Musculoskeletal contraction

2. Cardiac muscle

3. Kidneys

1. LOW

2. LOW

3. INVERSE: TwiTChing SpaSm (Hyperactive)

   1. Tetany

   2. Trosseau’s (Braso → Brasseau)

   3. Chvostek (“Cheeks”)

   4. Spasm (Larynx and Bronchus → DEADLY)

   5. Seizure

4. INVERSE: Diarrhea

5. N/A

Identify the expected findings from the following if the patient has Hypocalcemia:

1. Heart Rate

2. BP

3. Neuromuscular

4. GIT

5. Renal

1. HIGH

2. HIGH

3. INVERSE: “Hypoactive”

   1. Weakness

   2. Reflex = Low (Hyporeflexia)

4. INVERSE: Constipation

5. Either polyuria or renal calculi

Identify the expected findings from the following if the patient has Hypercalcemia:

1. Heart Rate

2. BP

3. Neuromuscular

4. GIT

5. Renal

1. Increased Calcium (Milk and Dairy) and Vitamin D (to increase Ca absorption)

2. Basta may “Calcium”. The following:

   1. Calcium Gluconate

   2. Calcium Carbonate

   3. Calcium Chloride

Identify the expected interventions to the following if the patient has Hypocalcemia:

1. Diet

2. Medication

1. Low Calcium

2. “Ibalik ang calcium sa buto”

   1. Calcitonin: Ca(Blood) → Bones

Identify the expected interventions to the following if the patient has Hypercalcemia:

1. Diet

2. Medication

1.5 to 2.5 mEq/L

• “Mag-isa” kasi around 1 ang value

What is the normal value of magnesium?

1. Vasodilator = Decreased BP and Increased Blood Flow (Warm and Flushed)

2. INVERSE: Similar to those of calcium

MAGBALIKTARAN = MAGNESIUM

What is the effect of Magnesium in the following?

1. BP and Blood Flow

2. Neuromuscular

1. HIGH

2. HIGH

3. HYPERACTIVE: TwiTChing SpaSm

Identify the expected findings from the following if the patient has Hypomagnesemia:

1. Heart Rate

2. BP

3. Neuromuscular

1. LOW

2. LOW

3. HYPOACTIVE: Weakness and Hyporeflexia

Identify the expected findings from the following if the patient has Hypermagnesemia:

1. Heart Rate

2. BP

3. Neuromuscular

1. High Magnesium (Nuts, Seeds, Greens, and Fish like Salmon)

2. Magnesium Sulfate

Identify the expected interventions to the following if the patient has Hypomagnesemia:

1. Diet

2. Medication

1. Low Magnesium

2. The following:

   1. Calcium gluconate and Loop Diuretics (UKNaMg)

Identify the expected interventions to the following if the patient has Hypermagnesemia:

1. Diet

2. Medication

2.5-4.5 mg/dL

What is the normal value of Phosphorus?

Calcium

Phosphorus is inversely proportional to what electrolyte?

DIRECT

• “Letter P” → Potassium and Phosphorus → Muscle ”Direct”

What is the effect of Phosphorus in the following?

1. Muscles

1. HYPOACTIVE: Weakness and Hyporeflexia

Identify the expected findings from the following if the patient has Hypophosphatemia:

1. Muscle

1. HYPERACTIVE: TwiTChing SpaSM

Identify the expected findings from the following if the patient has Hyperphosphatemia:

1. Muscle

1. Increase P

   1. P = Protein and Processed

2. IV Phosphorus

Identify the expected interventions to the following if the patient has Hypophosphatemia:

1. Diet

2. Medication

1. Low P

2. Aluminum Hydroxide

   1. “AmPHOjel”

      1. Phosphate Binder (Bababa)

      2. Blocks Absorption in the GIT

Identify the expected interventions to the following if the patient has Hyperphosphatemia:

1. Diet

2. Medication

Aluminum hydroxide + Magnesium hydroxide

• To lessen the side effects of Aluminum hydroxide (ALang tae + MAGtatae)

What is the combination of Kremil S?

1. FVE in Hyponatremia

2. FVE in Hypernatremia (UKNaMg), Hyperkalemia (Do It So Client Survives; UKNaMg), Hypermagnesemia (UKNaMg)

3. FVD in Hyponatremia

4. FVD in Hypernatremia

5. Hypokalemia

6. Hyperphosphatemia (AmPHOjel)

7. Hyperkalemia (Do It So Client Survives), Hypermagnesemia, Hypocalcemia

8. Hyperkalemia (K+ exit late)

9. Hypocalcemia

10. Hyperkalemia (Do It So Client Survives)

11. Hypercalcemia

12. Hyperkalemia (Do It So Client Survives)

13. Hypomagnesemia

14. Hypophosphatemia

15. Counter the side effects of Aluminum Hydroxide

16. Hypokalemia

17. Hypocalcemia

Identify what electrolyte imbalances the following medications are indicated:

1. Osmotic diuretics

2. Loop diuretics

3. Hypertonic fluids

4. Hypotonic fluids

5. Oral and IV Potassium

6. Aluminum Hydroxide

7. Calcium Gluconate

8. Sodium Polystyrene

9. Calcium Chloride

10. Insulin with dextrose

11. Calcitonin

12. Salbutamol

13. Magnesium Sulfate

14. IV Phosphorus

15. Magnesium Hydroxide

16. Spironolactone

17. Calcium Carbonate

hypUkalemia depreST flaT

• U wave

• ST Depression

• Flat T Wave

ECG Changes: Hypokalemia

Wide, PRolonged, Tall, but Plat

• Wide QRS

• Prolonged PR Interval

• Tall T wave

• Flat P Wave

ECG Changes: Hyperkalemia

ST QT long, Calcium low

• Prolonged ST

• Prolonged QT

ECG Changes: Hypocalcemia

ShorT and Wide T, Calcium on a spree

• Short ST

• Wide T wave

  • (siya lang wide T, the rest ay QRS)

ECG Changes: Hypercalcemia

Tall T & STD, magnesium on the D

• Tall T wave

• ST Depression

ECG Changes: Hypomagnesemia

PRolonged and Wide, Mg on overdrive

• Prolonged PR interval

• Wide QRS

ECG Changes: Hypermagnesemia

1. 7.35 - [7.40] - 7.45 (Magic 35-45)

2. 35 - 45 mmHg (Magic 35-45)

3. 22 - 26 mEq/L

4. 80 - 100 mmHg

5. 95 - 100%

ABG Analysis: What are the normal values of the following?

1. Blood pH

2. PaCO2

3. HCO3

4. PaO2

5. O2 Saturation

1. Arrows and Normal

   1. AciDOWNsis and UPkalosis for pH

2. ROME/ROMS

3. Compensation

What are the steps for the technique in analyzing ABG?