Nutrition and Electrolytes

Sodium (Na+) Normal value

135-145 mEq/L

Chloride (Cl-) Normal Value

95-105 mEq/L

Bicarbonate (HCO3-)

22-30 mEq/L

Calcium (Ca 2+) (Total)

4.5-5.5 mEq/L (9-11 mg/dl)

Potassium (K+)

3.5-5.3 mEq/L

Phosphorus (PO4³-) 

1.7-2.6 mEq/L (2.5-4.5 mg/dl)

Magnesium (Mg²+)

1.5-2.5 mEq/L (1.8-3.0 mg/dl)

Intracellular Fluid

inside the cell. 60-70% water lies here, composed of water, proteins, and electrolytes. 

Extracellular fluid

Outside the cell, 30-37% of body weight (1/3 of bodies water) surrounds cells in tissues.

Osmosis

H20 higher concentration to lower concentration. This is a passive-semi-permeable membrane. 

Diffusion

Molecules move from higher to lower concentration areas. 

Edema

Accumulation of interstitial fluid volume. Causes: increased capillary pressure, obstruction in the lymphatic system, excess body water, and sodium. 

Isotonic

Osmalilty the same as body fluids. (i.e. 0.9% normal saline)

Hypertonic (hyponatremia/hypovolemic shock)

Osmolality is higher than body fluids. cause fluids to move out of the cells and into the ECF to normalize the concentration of particles between the two compartments. (i.e., 3 or 5% sodium chloride (NaCl).

Hypotonic (dehydration/hypernatremia)

provide free water for excretion of body wastes, treat cellular dehydration, and replace the cellular fluid. (lower than blood plasma) (i.e 2.5% dextrose in water.)

Macronutrients (Essential)

Carbs, fats and protein

Micronutrients (Essential)

Vitamins and minerals

Nonessential (body can produce them)

Cholesterol, Non-essential amino acids, Vitamins D and K, Fiber- not a nutrient but important for diet/health

Basal metabolism

-Increases with growth, infection, fever, emotional tension, extreme temp, and elevation of certain hormones i.e., thyroid. 

-Decreases with aging, prolonged fasting, and sleep. 

Carbs

Sugars and starches (carbon, hydrogen, oxygen) plant based except for dairy.

Liver

Stores glucose as glycogen and regulates entry into the blood. 

Brain

Can only use glucose for energy!

Insulin

Responsible for keeping levels of glucose relatively constant. Extra glucose can be converted to glycogen. 

Cortisol (stress hormone)

keeps blood glucose high

Protein

Made up of amino acids, some are required in diet and some made by the body. Maintains body tissues, support growth of new tissues. 

protein amount in diet

should be 10-20% of caloric intake.

Saturate and Trans Fat

raise cholesterol

Unsaturated Fat

Lower cholesterol

Fats in diet

20-35% of caloric intake

Cholesterol

A fat-like substance found only in animal products. not essential that the body makes cholesterol in sufficient amounts. High serum levels risk of atherosclerosis. 

Folic Acid

Important in hemoglobin formation, cellular division DNA synthesis (think pregnancy)!

Vitamin C

Important for Immune function, collagen synthesis, and iron absorption. 

Vitamin D

Important in regulating calcium levels, promotes calcium absorption

Source of calcium and phosphorus in food

Milk and dairy products, canned fish with bones, greens 

Source of magnesium in food

Green leafy veg, nuts, beans and grains

Source of potassium in food

Citrus fruits, whole grains, fruits, leafy vegetables, potatoes

Source of Iron in food (Taken W/ Vit C)

Liver, lean meats, enriched and whole grain breads, and cereal. 

Water soluble Vitamins

Folic acids, vitamin C

Fat soluble vitamins

Vitamin D, Vitamin K (For clotting) in green leafy veg

Calcium source/function 

Bone/teeth formation. source: dairy, green leafy veg, whole grains. 

Potassium source/function

Intracellular fluid control, source: fruit, veg, potatoes and avocado 

Sodium source/function

Water balance, nerve transmissions (seizures), source: salt, milk, meat, eggs, baking soda. 

Iron source/function

Hemoglobin synthesis, metabolic function. Sources: meat, eggs, spinach, broccoli, seafood. 

LDL (Low density lipoproteins)

Transport cholesterol to the body cells- found in saturated/trans fats

HDL (High density liproteins)

“Healthy” helps remove cholesterol from the body cells. unsaturated fats, GOOD fats. found in olive oil, nuts, avocado, fish

Clinical manifestations of excess fluid

Weight gain, distended neck veins, increased BP, and edema. Treat w/ restriction of fluid and correct underlying cause

Clinical manifestation of fluid deficit

Decreased urine output, weight loss, increased hematocrit, tachycardia, decreased skin turgor, decreased BP. Treat w/ IV rehydration or increase oral fluid intake.

Hypernatremia

Na greater than 145 mEq/L. Causes increased output or decreased water intake (dehydration). increased Na consumption. 

Hypernatremia (Clinical manifestations)

Dry membranes, hypotension, pulmonary edema, tachycardia, CNS symptoms.

Treatment for Hypernatremia

Hypotonic fluids, assess and correct underlying etiology. 

Hyponatremia

Sodium concentration below 135 mEq/L

Hyponatremia (causes)

vomitting and diarrhea, diuretic use.

Hyponatremia (clinical manifestations)

Neurologic effects, hypotension, tachycardia, decreased urine output. 

Hyponatremia

Oral or IV Na replacement, severe hypertonic fluid replacement.

High sodium foods

Canned foods, processed foods, packaged foods, frozen foods, cured pickled foods. 

Hyperkalemia

Abnormally high plasma concentration of potassium ions. 

Hyperkalemia causes

Over supplementation, renal failure, endocrine abnormalities, and potassium-sparing diuretics. 

Hyperkalemia Clinical manifestations

Muscle weakness or paralysis, dysrhythmias, CNS effects

Hyperkalemia Treatment

sodium sulfonate, change diuretic med, IV calcium gluconate, hemodialysis, inuslin/D5

Hypokalemia

Abnormally low plasma concentration of potassium ions 

Hypokalemia causes

Decreased potassium intake, GI loss, fluid overload, diuretics, hyperaldoand steronism.

Hypokalemia clinical manifestations

Elevated blood sugar and serum cortisol in Cushing's disease.

Hypokalemia treatment

Oral or IV K+ replacement. 

Hypermagnesemia

Abnormally high plasma concentration of magnesium ions.

Hypermagnesemia causes

Renal failure 

Hypermagnesemia clinical manifestations

Increased BUN and creatinine levels, other electrolyte disturbances, cardiac abnormalities

Treatment for Hypermagnesemia

Cease all magnesium containing meds

Hypomagnesemia

Abnormally low plasma concentration of magnesium ions

Hypomagnesemia causes

Hypocalcemia, hypokalemia, decreased dietary intake/absorption in GI tract.

Clinical manifestations of hypomagnesemia

similar to hypermagnesemia

Treatment of Hypomagnesemia

Dietary management and magnesium supplements.

Hypercalcemia

Abnormally high plasma concentration of calcium ions.

Causes of Hypercalcemia

Malignancy, hyperparathyroidism, immobilization, thiazide diuretics, excessive ingestion of calcium and/or vitamin D. 

Clinical manifestions of Hypercalcemia

Decreased excitability of muscles and nerves. fatigue, weakness and lethargy. 

Treatment of hypercalcemia

Intramuscular calcitonin, IV fluids to dilute serum calcium and enhance renal excretion.

Hypocalcemia

Abnormally low plasma concentration of calcium ions.

Hypocalcemia causes

Hypoparathyroidism, hypomagnesemia, hyperphosphatemia, and vitamin D deficiency. 

Hypocalcemia Clinical manifestations

CNS and neuromuscular excitability. Chvostek sign, Trousseau sign, ECG abnormalities.

Hypocalcemia treatment

IV calcium salts, Vitamin D supplementation, and dietary management.