Fluid and Electrolytes

Respiratory acidosis

CO2 >45 Ph < 7.35

Causes: Hypoventilation, COPD, anesthesia, drug OD, cardiac arrest, airway obstruction

S/S: rapid shallow resp, dyspnea, HA, Hyperkalemia, dysrhythmias, drowsiness, mm weakness, neuro changes

TX: improve ventilation, increase RR, reposition, maintain airway, O2

Respiratory Alkalosis

CO2 < 35 pH > 7.45

Causes: hyperventilation, anxiety, PE, mech ventilation

S/S: tachypnea, anxiety, tetany, numbness/tingling, lightheaded, dizziness

TX: decrease RR, rebreather mask, calm pt

Metabolic Acidosis

PH < 7.35 HCO3 <22

Causes: gained acid (shock, ketoacidosis, renal failure) lost bicarb (diarrhea)

S/S: kussmaul respirations, Hyperkalemia, hypotension, confusion, drowsiness, mm twitch

TX: tx cause, fluids electrolytes

Metabolic Alkalosis

PH>7.45 HCO3 > 26

Causes: lost acid (vomiting, NG suction, Potassium loss), antacids

S/S: restless, dysrhythmias from hypokalemia, compensatory Hypoventilation, confusion,tetany, mm cramp N/V/D

TX: treat cause, fluids and electrolytes

Acid base ranges

CO2: 35-45

HCO3: 22-26

PH: 7.35-7.45

Hypernatremia

Norm: 135-145 Na is extra cellular

Causes: dehydration, excess Na intake

S/S: lethargy, agitation, sz, coma, mm cramps

Tx: sodium free fluids, diuretics, restrict Na intake

Nursing: monitor sodium/osmolality, recent rapid correction, sz precautions

Hyponatremia

Norm:135-145

Cause: Gi loss, diuretics, excess water

S/S: HA, confusion, sz, coma

Tx: Isotonic fluids, fluid restriction, hypertonic saline for severe, vasopressin antagonists

Nursing: monitor NA level, avoid rapid correction

Hyperkalemia

Norm: 3.5-5 K is intracellular

Cause: potassium sparing diuretics, renal failure, tissue damage

S/S: tall T waves, abd cramping, Dysrhythmias, paresthesia

TX: stop K intake, diuretics, dialysis , insulin dextrose, calcium gluconate

Nursing: EKG, tx underlying renal failure or acidosis

Hypokalemia

Norm: 3.5-5

Causes: diuretics, GI loss, inadequate intake

S/S: fatigue, mm weakness, leg cramps, paralytic ileus, decreased reflexes, flattened Twave, prolonged QRS

TX: potassium chloride supplement, increase dietary intake(bananas, potatoes, oranges)

Always dilute IV KCL and admin slowly NOT A PUSH

Nursing: monitor K levels, EKG, urine output

Hypercalcemia

Norm: 8.5-10.5

Causes: hyperparathyroidism, malignancy

S/S: lethargy, confusion, sz, heart block, weakness

TX: hydration, biophosphates, calcitonin, dialysis

Nursing: prevent kidney stones with hydration

Hypocalcemia

Norm: 8.5-10.5

Causes: hypoparathyroidism, Vit D deficiency, renal failure

S/S: tetany, chvostek and trousseau signs, laryngeal stridor, sz, prolonged QT

TX: calcium/vitamin D supplements, IV calcium gluconate for severe

Nursing: watch symptoms post thyroid surgery and blood transfusions. Tx pain and anxiety to avoid alkalosis

Hyperphosphatemia

Norm: 2.4-4.5

Causes: kidney disease, excess intake, tumor lysis syndrome

Symptoms: tetany, sz, calcified deposits in soft tissue

TX: limit phosphate intake, phosphate binders, dialysis

Hypophosphatemia

Norm: 2.5-4.5

Causes: malnourishment, alcohol disorder, DKA recovery, respiratory alkalosis

S/S: CNS depression:coma, confusion, mm weakness, sz, rhabdomyolysis, dysrhythmias

TX: increase oral intake, IV phosphate

Nursing: monitor hypocalcemia, gradual correction

Hyermagnesemia

Norm: 1.3-2.1

Causes: renal failure, excess Mg intake from antacids or laxatives

S/S flushing, hypotension, loss of reflexes, respiratory/cardiac arrest

TX: IV calcium, fluids, diuretics, dialysis

Hypomagnesemia

Norm:1.3-2.1

Causes: alcoholism, GI loss, diuretics

S/S: mm cramps tremors, hyperreflexia, sz, dysrhythmias

TX: oral or IV mag

ABG

Identifies acid base imbalances

Osmosis

Water moves from low solute concentration to high solute concentration

Diffusion

Movement of molecules from high to low concentration

-goal to be equal in both areas

Facilitated diffusion

Molecules from high concentration to low concentration with help of proteins but still no energy

Active transport

Molecules move against gradient

EX: sodium potassium pump

Isotonic fluids

Same osmolality as the cell interior

Expands only ECF

replacement for ECF vol deficit

Ex NS, LR

Hypotonic fluids

Solutions in which the solutes are less concentrated than in the cells.

Cell surrounded by hypotonic then water moves into cell, can burst

Lower osmolality compared to plasma, dilutes ECF

WATER MOVES FROM ECF TO ICF

Tx of hypernatremia

Hypertonic fluids

Solutes are more concentrated than in the cells

High osmolality compared to plasma

Hypertonic fluid around cell, water leaves cell, can shrivel up cell

Draws water out of cell

Monitor BP, Lungs, sodium

Crystalloid

Eater based solution of small water soluble molecules and mineral salts

NS, Dextrose in water, dextrose in NS, ringers, LR

Colloid

Contain large molecules that increase oncotic pressure and pull fluid into blood vessels

Plasma products, blood product, albumin