NSG101 FLUID & ELECTROLYTES

fluid and electrolytes!!!!!!!!!!!!!!!

Intracellular Fluid

Fluid found within cells

Constitutes 2/3 of the total body fluids in adults

Extracellular Fluid

Fluid found surrounding the cells

Composed of intravascular (plasma), interstitial, lymph, and transcellular (cerebrospinal, pericardial, etc) fluids

Hypovolemia

AKA isotonic dehydration, fluid volume deficit (FVD)

Lack of both WATER and ELECTROLYTES, causing a decrease in circulating blood volume

Dehydration

Lack of FLUID in the body, from insufficient intake or excessive loss

Causes of Isotonic FVD

Excessive GI loss: vomiting, nasogastric suctioning, diarrhea

Excessive skin loss: diaphoresis without water/sodium replacement

Excessive renal loss: diuretic therapy, kidney disease, adrenal insufficiency

Third spacing: burns

Hemorrhage or plasma loss

Altered intake: anorexia, nausea, dysphagia, confusion, NPO

Causes of Dehydration

Hyperventilation or excessive perspiration without water replacement

Prolonged fever

Diabetic ketoacidosis

Insufficient water intake

Arginine vasopressin disorder (Diabetes insipidus)

Osmotic diuresis

Excessive intake of salt or hypertonic IV fluids

Expected Findings of Hypovolemia/Dehydration

Vital Signs: Hypothermia (hypovolemia), hyperthermia (dehydration), tachycardia, thready pulse, hypotension, tachypnea, hypoxia

Neuromusculoskeletal: Dizziness, syncope, confusion, weakness, fatigue, seizures

GI: Thirst, dry mucous membranes, vomiting, anorexia, weight loss

Renal: Oliguria

Other: Diminished capillary refill, clammy skin, diaphoresis, decreased skin turgor

Hypervolemia

AKA fluid volume excess (FVE)

Excess of WATER and ELECTROLYTE

Overhydration

Excess of fluid or water

Causes of Hypervolemia

Chronic stimulus to the kidney to conserve sodium and water: heart failure, cirrhosis, increased glucocoritcosteroids

Altered kidney function with reduced excretion of sodium and water: kidney failure

Interstitial to plasma fluid shifts: hypertonic fluids, burns

Age related changes in cardiovascular and kidney function

Excessive sodium intake: IV fluids, diet, medications

Causes of Overhydration

Water replacement without electrolyte replacement

Excessive water intake

Syndome of inappropriate antidiuretic hormone (SIADH)

Excessive administration of IV D5W

Expected Findings of Hypervolemia/Overhydration

Vital Signs: Tachycardia, bounding pulse, hypertension, tachypnea

Neuromusculoskeletal: Confusion, muscle weakness, altered LOC, seizures

GI: Increased motility, ascites

Respiratory: Dyspnea, orthopnea, crackles

Other: Pitting edema, distended neck veins, weight gain, skin pallor/coolness

Hyponatremia

Blood sodium level less than 136 mEq/L

Delays and slows the depolarization of membranes

Causes cells in the nervous system and brain to swell

Causes of Hyponatremia

Deficient ECF volume

Increased ECF volume: Excessive water intake, symptom of inappropriate antidiuretic hormone (SIADH)

Excessive GI losses: Vomiting, diarrhea, NG suctioning, tap water enemas

Renal losses: Diuretics, kidney disease, adrenal insufficiency

Skin losses: Burns, wound drainage excessive sweating

Edematous states: Heart failure, cirrhosis, nephrotic syndrome, peripheral edema, ascites

Excessive IV administration of dextrose 5% in water

Inadequate sodium intake: NPO status

Hyperglycemia: Osmotic shift in sodium (PSEUDO-)

Expected Findings of Hyponatremia

Vital Signs: Tachycardia, rapid thready pulse, hypotension, orthostatic hypotension

Neuromusculoskeletal: Headache, confusion, fatigue, lethargy, twitching, irritability, seizures, coma

GI: Anorexia, nausea, vomiting

Hypernatremia

Blood sodium level greater than 145 mEq/L

Causes of Hypernatremia

Water deprivation: NPO

Heat stroke

Excessive sodium intake

Fluid losses: Fever, diaphoresis, burns, respiratory infection, diabetes insipidus, hyperglycemia, watery diarrhea

Expected Findings of Hypernatremia

Vital signs: Hyperthermia, tachycardia, orthostatic hypotension

Neuromusculoskeletal: Restlessness, lethargy, confusion, irritability, muscle twitching/weakness, seizures, decreased LOC, coma, brisk DTR

GI: Thirst, dry/sticky mucous membrane, nausea, vomiting

Other: Warm flushed skin, oliguria

Hypokalemia

Blood potassium level less than 3.5 mEq/L

Result of increased loss of potassium from the body, decreased intake and absorption of potassium, or movement of potassium into the cells

Causes of Hypokalemia

Hyperaldosteronism

Cushing Syndrome

Inadequate dietary intake (rare), eating disorders

Increased intracellular uptake: insulin

Prolonged administration of non-electrolyte-containing IV solutions (5% dextrose in water)

Metabolic alkalosis

Renal losses: Excessive use of potassium-excreting diuretics (Furosemide) and corticosteroids, renal disorders

Skin losses: Diaphoresis, wound losses

Expected Findings for Hypokalemia

Vital signs: Weak pulse, irregular pulse, hypotension, respiratory distress

Neuromusculoskeletal: Fatigue, muscle weakness, muscle twitches, cramping, decreased muscle tone, hypoactive reflexes, mental confusion, seizures

GI: Abdominal distention, constipation, ileus, nausea, vomiting

Hyperkalemia

Blood potassium level greater than 5 mEq/L

Result of increased intake of potassium, movement of potassium out of cells, and inadequate renal excretion

Causes of Hyperkalemia

Increased total body potassium: Salt substitutes

ICF to ECF shift: Insufficient insulin, diabetic ketoacidosis, tissue catabolism

Hypertonic states: Diabetes mellitus

Decreased excretion of potassium: Kidney failure, severe dehydration, potassium-sparing diuretics, ACE inhibitors, adrenal insufficiency

Expected Findings for Hyperkalemia

Vital signs: Irregular pulse, hypotension

Hypocalcemia

Total blood calcium level less than 9 mg/dl

Causes of Hypocalcemia

Increased calcium output: Diarrhea, steatorrhea

Inadequate calcium intake or absorption: Chron’s disease, bariatric surgery, vitamin D deficiency (ALCOHOLISM), inadequate dietary intake, magnesium deficiency (impairs parathyroid)

Calcium shift from ECF into bone: Rapid infusion of citrated blood transfusion, post-thyroidectomy, hypoparathyroidism alkalosis, PANCREATITIS, renal disease, hypophosphatemia, sepsis

Expected Findings for Hypocalcemia

Musculoskeletal: Numbness/tingling, muscle spasms, positive Chvostek’s sign, positive trousseau’s sign, laryngospasms

Cardiovascular: weak/thready pulse, tachycardia or bradycardia

GI: Hyperactive bowel sounds, diarrhea, abdominal cramping

CNS: Anxiety, depression, confusion, lethargy, seizures

Hypercalcemia

Total blood calcium level greater than 10.5 mg/dl

Causes of Hypercalcemia

Thiazide diuretic or lithium carbonate

Paget’s disease

Hyperthyroidism and hyperparathyroidism

Bone cancer

Expected Findings for Hypercalcemia

Neuromuscular: Decreased reflexes, muscle pain, bone pain

Cardiovascular: Dysrhythmias, increased risk for blood clots, hypertension

Hypomagnesemia

Blood magnesium level less than 1.3 mEq/L

Causes of Hypomagnesemia

Increased magnesium output: Diarrhea, renal losses, Thiazide or loos diuretics, HYPOCALCEMIA

Expected Findings for Hypomagnesemia

Neuromuscular: Increased nerve impulse transmission, positive Chvostek’s and Trousseau’s signs, tetany, delirium, agitation, psychosis, seizures, insomnia, coma

GI: Nausea, vomiting, decreased appetite

Cardiovascular: Dysrhythmias, tachycardia, hypertension

Hypermagnesemia

Blood magnesium level greater than 2.1 mEq/L

Causes of Hypermagnesemia

Kidney/adrenal impairment, hypothyroidism, increased intake of medications containing magnesium (laxatives, antacids)

Expected Findings for Hypermagnesemia

Neuromuscular: Diminished DTR, muscle paralysis, shallow respirations

Cardiovascular: Bradycardia, hypotension, cardiac arrest, dysrhythmias

CNS: Confusion, sleepiness, dizziness, blurred vision headache, seizures, coma

GI/GU: Constipation, bladder paralysis