Fluid and Electrolytes and Hyper/Hypovolemia

Sodium (Na)

135 - 145mEq/L

Potassium (K)

3.5 - 5.0 mEq/L

Magnesium (Mg)

1.5 - 2.5 mEq/L

Chloride (Cl)

98 - 108 mg/dL

Calcium (Ca)

8.5 - 10.5 mmol/L

Phosphorous

2.5-4.5mmol/L

Functions of Electrolytes

Acid/base balance

Osmotic Pressure and Fluid regulation

Muscle contractions

Sodium

Found in the extracellular fluid.

Important for osmotic regulation

Causes swelling

Elevated Sodium Levels and causes(Hypernatremia)

Causes Medication, meals (too much salt), Osmotic diuretics, Diabetic insipidus, Elevated water loss, Low water intake

Manifestations: Fatigue, restlessness, increased thirst, dry mouth and skin.

Treatment: rehydrate with D5W

Decreased Sodium Levels (Hyponatremia)

Cause: Too much water intake, loop diuretics

Manifestations: headache, confusion, coma,

Treatment: 3% normal saline and fluid restriction

Potassium

Most abundant intracellular cation in the cell. Has a lot to do with the arrhythmic regulation. It

High potassium level (Hyperkalemia)

Causes: Excessive potassium intake, renal dysfunction, (90% of potassium is excreted through the kidneys), ACE inhibitors

manifestions: muscle tightness, cardiac arrthymias, peaked T waves, cramping, diarrhea, irritability.

Treatment: Limit potassium intake, Kayexalate is a medication used to decrease high K levels, dialysis, insulin (will help to move K back into the cells, where they belong).

Lowered Potassium Levels (Hypokalemia)

Cause: Loop diuretics, administration of insulin,

Symptoms: Weakness, Arrythmia (U-waves), Lethargy and Thready pulse.

Treatment: Give IV potassium med infused over 4 hours (K-rider) because it is irritating to the vessel wall phlebitis inflammation of the vessel. NEVER GIVE IV PUSH POTASSIUM.

Magnesium Excessive intake (Hypermagnesia)

Cause: excessive Mg intake(laxatives and anatcids), renal dysfunction.

Manifestations: muscle weakness, bradycardia, asystole, tremors ad slow reflexes

Calcium (8.5 to 10.5mg/dL)

Calcium is necessary for bone development, Bones, Grones and Stones. Calcium can leech out of the bones and enter the blood serum. Calcium is generally stored in the bones and teeth. High Ca levels can lead to kidney stones, renal calculi

Excessive Calcium (Hypercalcemia)

Overactive thyroid glands (due to the hormone calcitonin), cancer

Manifestation: vomitting, nausea, constipation, thirst.

Treatment: reduce Ca in the diet, increase phosphorus and mobility.

Decreased Calcium (Hypocalcemia)

Cause: removal of the parathyroid glands, diuretic use

manifestations: numbling and tingling, chivoks signs(facial nerve twitching, trousseu sign(tetany when a cuff is put in the arm)

Treatment: Increase Ca in the diet.

Low magnesium (Hypomagnesia)

Cause: diuretics, undernutrition, long term alcohol, NGT suction, diarrhea, or parenteral nutrition.

Manifestations: nausea, vomitting, tremors, tetany, cramps, seizures, respiratory paralysis.

Treatment: increase Mg in the diet.

Elevated Chlorine (Hyperchloremia)

cause: often seen in metabolic acidosis, hypernatremia, increased chloride retention,

symptoms, tachypnea, weakness, lethargy, decrease cognition

Treatment: IV fluid and diuretics

Decreased Chlorine (Hypochloremia)

Cause: metabolic alkalosis, excessive use of loop diuretics, NGT suction,

Symptoms: fatigue, weakness, respiratory distress, muscle cramps, confusion.

Excessive Phosphorous (Hyperphosphemia)

cause: impaired kidney function, hypoparathyrodism, excess Vit D, excess phosphate in diet, DKA. Low calcium

symptoms: hyperreflexia, anorexia, muscle weakness, decreased mental status. chivok sign and trusseau sign can be seen as well.

Treatment: with normal kidney, vlume repletion with saline and diuresis with a loop diuretic

Hypophosphotemia

Cause: admin of calories to malmourished patients, hyperventilation, diuretic use, GI absorption problems

symptoms, weakness of muscle, slurred speech, dysphagia, irritability, seizures,

Treatment: Oral Phoshate supplementation.

Hypervolemia

Increase in Intracellular fluid due to increased sodium, decreased albumin, increased aldosterone, disruption of homeostatic mechanisms eg heart failure, renal failure, cirrhosis of liver.

Manifestations

Jugular vein distention, edema, weight gain (over 10 lbs a week), ascites, crackles in lungs. high pulse and blood pressure

Hematocrit

The ratio between RBC and fluid. In hypervolemia, the ratio would be lower because theres more fluid than there are red blood cells.

Serum Osmolality (275-295)

Fliud volume excess will make it Lower. Less than 275.

Serum Sodium (!35 - 145mEq/L)

In fliud volume excess, it would be lower than 135.

Blood Urea Nitrogen (BUN)Test

DEtermines how well the kidneys are eliminating the Nitrogen.

Hypovolemia (fluid Volume Deficit)

Isotonic Dehydration

Equal loss of water and electrolyte

Hyponatremic dehydration

Salt is <130 mEq/L. ou lose more water than salt. More sodium loss than water

Hypernatremic

Salt content is > 150mEq/L. You lose salt than do water. For example in cystic fibrosis

Causes of Hypovolemia Diaphoresis

Diaphoresis, excessive GI losses, such as vomiting, Excessive sweating (diahoresis), renal system loss, diuretic therapy, diabetes, kidney diseases, third spacing, ascites, excessive loss from a wound, hemorrhage.

Manifestations of Dehydration

Decreasd LOC, prolonged capillary refill time, dry mucus membraines, change in vital sisgn, decreased or absent tears, depresed fontanelle

Tilt test

Test for dehydration. Looking for drop in BP. Considered positive if bp drops below 20mmHg with position changes.

How does the body compensate for low fluid volume

ADH aka vasopressin is released to stimulate the kidneys to hold or reabsorb water.

Diagnositics

Examine physical characterisitcs of urine, stool, emesis, sweat, and then nutrition.

Lab diagnostics

Check for serum concentrations of electrolytes, bicarbonate blood urea nitrogen, creatinine, specific gravity.

Treatment

Rehydration, Oral, Intravenous, Correction of electrolyte imbalalnces.

Isotonic solutions

They dont cross the ICF,