Fluid & Electrolytes

Sodium: Functions (4)

1. Serum Osmolality

2. Controls & Regulates ECF

3. Muscle contraction & transmission of nerve impulses

4. Acid-base balance

Sodium: Sources

Dietary intake → GI tract

Sodium: Loss (3)

1. GI Tract - vomiting, diarrhea, suction

2. Kidneys - diuretics

3. Skin - sweating, burns

GI Tract: Regulation (3)

1. Sodium-Potassium Pump - sodium out, potassium in

2. RAAS

3. Kidneys - elimination & reabsorption

Hyponatremia (6 causes?)

Causes

1. Diuretic use

2. Adrenal Insufficiency

3. Loss through GI tract

4. Water intoxication

5. Excessive D5W

6. SIADH

Hyponatremia: Manifestations (8)

S - tupor

A - norexia

L - ethargy

T - endon Refelxes (decreased)

L - imp Muscles

O - rthostatic Hypotension

S - eizures

S - tomach Cramps

Hyponatremia: Interventions (6)

1. Monitor I/O

2. Assess GI & Neuro

3. Encourage oral intake

4. Seizure Precautions

5. AVOID FREE WATER

6. Isotonic Sodium Solutions - IV

Hypernatremia: Causes (4)

1. Excess Oral Intake

2. Inadequate Water Intake

3. Excess Water Loss

4. Excess Sodium Containing Parenteral Fluids

Hypernatremia: Manifestations (9)

FRIED SALT

1. Flushed Skin

2. Restless

3. Increased BP

4. Edema

5. Decreased U/O

6. Skin Dry

7. Agitation

8. Low Grade Fever

9. Thirst

Hypernatremia: Interventions (5)

1. Monitor I/O

2. Asses Neuro Status

3. Restrict Dietary Sodium

4. Administer sufficient water

5. IV Fluids - without sodium

Potassium: Functions (4)

1. Controls INTRAcellular Osmolality

2. Cellular Enzyme Activity

3. Transmission of electrical impulses

4. Acid-Base Balance

Potassium: Sources

Diet (fruits,veggies)

Potassium: Loss (4)

1. Kidneys

2. Stool

3. Sweat

4. GI Secretions

Potassium: Regulation (2)

1. Aldosterone (high aldosterone tells kidneys to excrete K+ & reabsorb Na+)

2. Shifts between ECF & ICF

Potassium: Elimination (1)

Kidneys

Hypokalemia: Causes (4)

1. GI Loss (Emesis, NG suction, Diarrhea)

2. Potassium Wasting Diuretics

3. Poor Nutritional Intake

4. ETOH → increased U/O

5. Polyuria

Hypokalemia: Manifestations

A SIC WALT

1. Alkalosis - potassium shifts INTO cells when H+ shifts out

2. Shallow Respirations

3. Irritability

4. Confusion

5. Weakness

6. Arrhythmia

7. Lethargy

8. Thready Pulse

Hypokalemia: Interventions (3)

1. Prevention

2. Correction

3. IV Administration

Hyperkalemia: Causes (5)

1. Decreased K+ Secretion d/t Renal Failure

2. Potassium-sparing diuretics

3. Hypoaldosteronism

4. High K+ Intake

5. Shift out of cells (acidosis → H+ in and K+ out, tissue trauma, malignant cell lysis)

Hyperkalemia: Manifestations (6)

MURDER

1. Muscle Weakness

2. Urine (oliguria/Anuria)

3. Respiratory Distress

4. Decreased heart contractility

5. ECG Changes (tall T waves)

6. Reflexes (decreased or absent)

Hyperkalemia: Interventions (5)

1. Decrease K+ Intake (PO & IV)

2. Increase K+ Excretion (Kayexalate)

3. Prevention

4. Cocktail (Insulin IV Push → drives K+ into cells + D50W IV Push → prevents hypoglycemia + Calcium Chloride IV Push)

Insulin - stimulates sodium potassium pump (K+ in & Na+ out)

Calcium Gluconate (IV salt) - stabilizes cardiac cell membranes

Calcium