fluid and electrolytes exam one!

isotonic solutions

0.9% sodium chloride, lactated ringers; given to patients with hypotension and hypovolemia

hypertonic solutions

3% sodium chloride, D5NS, D5LR, given to patients with ICP

hypotonic solutions

0.45% NS, D5W, 0.25 NS, given to patients with dehydration and hypernatremia

hyponatremia [135-145]

caused by: fluid excess, diarrhea/vomiting, sweating, diuretics

clinical manifestations: decreased LOC, lethargy, seizures, weight gain/loss, orthostatic hypotension

interventions: IV hypertonic solution, monitor LOC, vitals, seizure precautions

hypernatremia [135-145]

caused by: water loss, excessive Na intake, decreased water intake

clinical manifestations: thirst, irritability, confusion, dehydration,

interventions: seizure precautions, low sodium diet

hyperkalemia [3.5-5]

caused by: k-sparing[spironolactone], diuretics, potassium supplements

clinical manifestations: mental confusion, neuromuscular hyperexcitability, weakness, paresthesia, ECG changes

treatments: lokelma, regular insulin[IV], kayexalate, dextrose 50% injection

hypokalemia [3.5-5]

caused by: diuretics, furosemide, hydrochlorothiazide, bumetanide, laxatives, diabetic ketoacidosis, NG suctioning, diarrhea, malnutrition, metabolic alkalosis

clinical manifestations: leg cramps, muscle breakdown and paralysis, apnea, weakness, fatigue, ECG changes

treatments: K-dur, K supplement IV/PO, NEVER give K via IV push!

hypermagnesemia [1.3-2.1]

caused by: burns, sepsis, trauma, renal insufficiency, overuse of magnesium products

clinical manifestations: hypotension, bradycardia, drowsiness, lethargy, flaccid muscle tones, dysrhythmia

treatments: IV hydration to correct hypotension, diuretics to promote renal excretion of magnesium, calcium gluconate for very high magnesium levels and hemodialysis

hypomagnesemia [1.3-2.1]

caused by: poor dietary intake, side effects of meds, chronic alcohol use

clinical manifestations: muscle weakness/cramping, tremors, tachycardia, twitching, N/V, disorientation, combativeness, irritability

treatments: magnesium 2G/100mL NaCl or D5W over 1 hour, put patient on cardiac monitor with infusion, magnesium supplements, dietary replacement

hypercalemia

neuromuscular transmissions, control of muscle contraction, blood clotting, bone and teeth formation

levels controlled by vitamin D

manifestations: renal calculi, anorexia, fatigue, weakness, cardiac dysrhythmias

treatment: D/C thiazide diuretics, vitamins and minerals

hypocalemia

troussecu’s sign: induction of carpopedal spasms by inflation of a bp cuff

chvostek’s sign: contraction of ipsilateral facial muscles by tapping the facial nerve near the ear

fluid volume deficit

cues: hypovolemia, dehydration, hemorrhage, GI suctioning, third spacing, intestinal fistulas, diuretics

clinical manifestations: decreased BP, increased RR and HR, thready weak pulse, dyspnea, orthostatic hypotension, decreased amber urine output, dry skin

treatments: 0.9 NS most commonly

fluid volume overload

cues: increased sodium content, rapid IV infusions, heart and renal failure, liver cirrhosis

clinical manifestations: increased BP, HR, RR, bounding pulse, jugular vein distension, dyspnea, crackles, orthopnea, altered LOC, fatigue, ascities, anascara, edema, weight gain, increased dilute urine output, moist skin

treatments: furosemide most commonly