Exam 5 (Fluid & Electrolytes)

Dr. Goodner lecture

crystalloid 

• fluids with soluble mineral ions in water

• saline, lactated ringer, D5W 

colloid 

• fluids with non- soluble particles evenly distributed

• albumin

hydrostatic pressure

pressure exerted by fluid aginst vessel walls; drives filtration

osmosis

fluid shipfts across semipermeable membrane from low » high solute concentration

osmolality 

• osmotic pressure per kg of solvent 

• 275-290 

diffusion

movement of particles from high to low concentration (oxygen to carbondioxide exchange)

intracellular

• 2/3 of body fluid

• potassium/ magnesium/ phosphate 

extracellular 

• 1/3 of body fluid 

• sodium/ chloride/ bicarbonate 

intravascular

• plasma 3L + blood cells 3L

• fluid within blood vessels

interstital fluid compartment

• 11-12 L surrounding

• fluid that surrounds cells (lymph is an interstitial fluid) 

transcellular fluid compartment

• 1 L

• CSF, pericardial fluid, synovial fluid, intraocular fluid, pleural fluid, sweat, digestive secretions

Respirtory Acidosis

• pH: 7.35

• CO2: >45

• HCO3: N

what are the causes of respirtory acidosis 

COPD exacerbations 

what are the signs and symptoms of respirtory acidosis

• tachycardia

• HTN

• confusion

• hyperkalemia

what are some treatment options for someone with respirtory acidosis

• improve ventilation

• oxygen, bronchodilators

• reverse opioids if needed

• mechanical ventilation

respirtory alkalosis

• pH: >7.45

• CO2: <35

• HCO3: N

what is the cause of respirtory alkalosis 

• hyperventilation 

• anxiety

• pain

• fever

what are the signs and symptoms of respirtory alkalosis

• lightheadedness

• tingling

• arrhythmias

what are some treatment options for someone with respirtory alkalosis

• slow breathing

• rebreather mask 

• sedation for anxiety 

• treat pain 

metablic acidosis

• pH: <7.34

• CO2: N

• HCO3: <22

metabolic acidosis causes  

• DKA ( diabetic keto acidosis) 

• diarrhea 

• renal failure 

• lactic acidosis 

signs and symptoms of metabolic acidosis 

• HA

• kussmaul respirations 

• confusion

• tachypnea

• hypotension

what are some treatment options for someone with metablic acidosis 

• treat uderlying cuase 

• IV sodium bicarb 

• insulin for DKA

• dialysis for renal failure

metabloic alkalosis

• pH: >7.45

• CO2: N

• HCO3: >26

what are causes of metabolic alkalosis

• vommiting

• gastric suction

• diuretics

signs and symptoms of metabolic alkalosis 

• tingling

• muscle cramps 

• hypokalemia 

• hypoventilation

• dizziness

• tetany

what are some treatment options for someone with metabolic alkalosis 

• replace electrolytes Cl and K

• stop vommiting

• stop diuretics

normal pH values:

7.35-7.45

normal CO2 values

35-45

normal HCO3 values 

22-26 mEq/L 

hyponatremia s/s

• neuro changes

• seizures

• coma

• headache

• confusion

• tachycardia

• respirtory arrest

causes of hyponatremia

• SIADH

• excessive water intake

• GI loses

• diuretics

what is the pathology of hyponatremia 

low sodium causes water to shift into cells which causes the cells to swell 

what are managment tactics for hyponatremia

• restric water

• slow Na replacement (IV NS or LR)

• monitor I and O, as well as daily weight

what foods should one eat if they have hyponatremia

• kale

• processed foods

• soups

• cheese

hypernatremia causes 

• water loss (diabetes insipidus) 

• excessive Na intake 

• hypertonic IV fluids 

what is the pathology of hypernatremia

high sodium causes water to shift out of cells which leads to cell shrinkage

s/s of hypernatremia

“FRIED SALT”

• flushed skin

• restlessness

• increased BP

• edema

• decreased urine

• dry mouth

• thrist

management strategies for hypernatremia

• gradual lowering with hypotonic 0.45 NS or isotonic D5W

• restrict sodium intake

• offer fluids gradually

causes of hypokalemia 

• diuretics 

• laxatives 

• GI loses 

• Inadequate intake 

• cushings syndrome 

pathology of hypokalemia

low potassium leads to imapried muscle/nerve conduction

s/s of hypokalemia

“7 L’s”

• lethargy

• low respirations

• lethal arrhythmias

• lots of urine

• leg crmaps

• limp muscles

• low BP

management strategies for hypokalemia 

• PO (K) diluted in juice 

• IV K* (slow, cardiac monitor, painful infusion) 

• assess renal function 

foods to eat if hypokalemic

• bananas

• oranges

• avocados

• salmon

• milk

causes of hyperkalemia 

• renal failure 

• metablic acidosis 

• meds (spironolactone/beta blockers) 

• insuliln deficiency 

pathology of hyperkalemia

high potassium causes an increase in excitability which leads to arrhythmias

s/s of hyperkalemia

MURDER

• muscle cramps

• urine changes

• respirtory distress

• decreased contractility

• ECG changes (peaked T)

• reflex changes

managment strategies for hyperkalemia

• restrict potassium intake 

• stabilize membrane: IV calcium gluconate 

• shift potassium with insulin + dextrose, albuterol

• excrete potassium with diuretics, sodium bicarb, kayexalate, dialysis 

hypocalcemia causes

• hypoparathyroidism

• low vitamin D

• acute kideny injury (Aki)

• hyperphosphatemia

pathology of hypocalcemia

low calcium leads to increased neuromuscular excitatbility

s/s of hypocalcemia 

CATS 

• convulsions ( uncontrolled shaking)

• arrhythimas 

• tetany 

• spasms/stridor 

• Trousseaus/Chvosteks signs 

management strategies for hypocalemia

• calcium replacement

• monitor ECG

• seizure precuations

what foods should you eat when you are hypercalemic

• dairy

• leafy greens

• fortified cereals

hypercalcemia causes 

• hyperparathyroidism 

• malignancy 

• excess calcium intake 

what is the pathology for hypercalcemia

high calcium causes decreased excitability

s/s of hypercalcemia

“moans, bones, stones, groans”

• constipation

• bone pain

• kidney stones

• lethargy

management strategies for hypercalcemia 

• IV NS

• encourage fluids 

• loop diuretics 

• calcitonin 

• mobilize the pt 

• restrict dietary calcium intake 

hypomagnesemia causes

• GI losis

• chronic alcohol use

• DKA

• meds

pathology of hypomagnesemia

low magnesium leading to an incrased excitability

s/s of hypomagnesemia

• torsades de pointes

• V- fib

• tachycardia

• hyperfreflexia

• nystagmus diarrhea

management strategies for hypomagnesemia

• diet (nuts, seeds, leafy greens) 

• PO mg salts (but watch for diarrhea) 

• IV Mg (monitor cardiac rhythm/ urine output) 

hypermagnesemia causes

• kideny injury

• addiosns disease

• Mg containing meds

• tissue necrosis

pathology of hypermagnesemia

high magnesium leads to depressed neuromusclular activity

signs and symptoms of hypermagnesemia 

• heart block 

• brady cardia 

• hypotension 

• hyporefelxia 

• shallow resps 

• hypoactive bowel sounds 

managment strategies for hypermagnesemia

• loop diuretics with isotonic fluids

• IV calcium

• Monitor VS, cardiac rhythm and LOC

what specific foods would you recomend to someone that is low in phosphorus  

• diary products 

• organ meats, fish, poultry 

• beans and legumes 

• nuts and seeds 

• whole grains 

what are normal sodium levels

135 to 145

what are normal potassium levels

3.5 to 5.0

what are normal magnesium levels 

1.8 to 2.6 

what are causes of fluid volume deficit

• vommiting

• diarrhea

• burns

• hemorrahe

• diuretics

what are s/s of fluid volume deficit

• weight loss

• hypotension

• tachycardia

• dry mucous membranes

• low urine output

• increase Hct

what are some managment strategies for fluid volume deficit 

• isotonic fluids (NS or LR) 

• treat cause 

• daily weight 

• I&O 

Fluid volue excess causes

• heart failure

• kidney failure

• excess IV fluids

• SIADH

what are signs and symptoms of fluid volume excess

• edema

• crackles

• hypertension

• weight gain

• JDV

• low hct

what are some management strategies for fluid volume excess 

• diuretics 

• fluid restriction 

• sodium restriction 

• daily weight 

• monitor lungs 

Isotonic fluids

smae osmolality as plasma

• NS (0.9%)

• LR

• D5W

what are isotonic fluids used for 

• shock 

• fluid loss 

• burns 

• dehydration 

hypotonic fluids 

shift fluid into the cell (hydrate it) 

• 0.45% NS 

• D5W ( after metabolism becomes hypotonic) 

what are hypotonic fluids used for 

• cellular dehydration 

• DKA 

• hypernatremia 

hypertonic fluids

pull fluid out of cells into bloodstream

• 3% NaCl

• IV mannitol

• D5NS

• D5LR

• D50W

(central vein/PICC)