Fluid balance, Acid Base balance, Electrolytes

Hypernatremia

Excessive sodium in the body, caused by increased sodium intake or deficient water.

Causes of Hypernatremia

Excessive sodium intake, Cushing's, hyperaldosteronism, water loss, loss of thirst.

Manifestations of Hypernatremia

Neuromuscular symptoms like headache, confusion, muscle cramps, seizures; hypovolemia symptoms like thirst, dry mucous membranes, decreased urine output, hypotension, tachycardia.

Hyponatremia

Deficient sodium in the body, often due to sodium loss or excessive water.

Causes of Hyponatremia

Loss of sodium, hypoaldosteronism, dietary sodium restrictions, excessive water intake, hyperglycemia.

Manifestations of Hyponatremia

Neuromuscular symptoms like headache, confusion, muscle weakness, seizures; GI symptoms like nausea, vomiting, diarrhea; hypovolemia and hypervolemia symptoms.

Hyperkalemia

Excessive potassium in the body, often due to deficient potassium excretion or excessive intake.

Causes of Hyperkalemia

Renal failure, ACE inhibitors, potassium-sparing diuretics, excessive potassium intake, trauma, DKA, acidosis.

Manifestations of Hyperkalemia

Cardiac symptoms like tall peaked T waves, bradycardia; GI symptoms like increased motility; neuromuscular symptoms like paresthesia, flaccid paralysis, muscle weakness.

Hypokalemia

Deficient potassium in the body, often due to excessive loss or deficient intake.

Causes of Hypokalemia

Excessive GI loss, kidney loss, deficient potassium intake, shifts of potassium into cells.

Manifestations of Hypokalemia

Cardiac symptoms like flattened T waves, weak and irregular pulse; GI symptoms like decreased motility; neuromuscular symptoms like paresthesia, muscle weakness.

Hypercalcemia

Excessive calcium in the body, often due to excessive intake or release from bone.

Causes of Hypercalcemia

Excessive calcium intake, immobility, vitamin D deficiency, renal failure, hyperparathyroidism.

Manifestations of Hypercalcemia

Muscle weakness, nausea, vomiting, constipation, polyuria, renal calculi, decreased deep tendon reflexes.

Hypocalcemia

Deficient calcium in the body, often due to deficient intake or excessive losses.

Causes of Hypocalcemia

Deficient calcium intake, renal failure, alcoholism, absorption disorders, excessive losses.

Manifestations of Hypocalcemia

Trousseau's sign, Chvostek's sign, diarrhea, decreased bone density, increased deep tendon reflexes.

Hypermagnesemia

Excessive magnesium in the body, often due to excessive intake ( excessive use of antacids) or deficient excretion (renal failure or excessive laxative use)

Hypomagnesemia

Deficient magnesium in the body, often due to deficient intake (alcoholism, malnutrition, preeclampsia) or excessive losses (diuretics or diarrhea)

Hypophosphatemia

Deficient phosphate in the body, often related to causes of hypercalcemia.

Hyperphosphatemia

Excessive phosphate in the body, often related to causes of hypocalcemia.

Hypomagnesemia manifestations

same as hypocalcemia

hypermagnesemia manifestations

same as hypercalcemia

Causes of FVE

increased Ns or H2O intake (high Na diet, psychogenic polydipsia, hypertonic IV fluid, free water/enteral feeds)

decreased Na or H2o elimination (syndrome of inappropriate antidiuretic hormone, hyperaldosteronism, Cushing's syndrome, organ failure (kidney, heart, liver))

Causes of FVD

inadequate fluid intake

(poor oral fluid intake, insufficient IV replacement, decreased thirst mechanism)

excessive fluid loss (diabetes insipidus (low antidiuretic hormone), hemorrhage, vomiting, diarrhea, burns, excessive diuretic use)

FVE manifestations

weight gain, increased BP pulse, respirations, labored breathing with coughing or crackles, JVD, edema, increased urine output, urine specific gravity <1.005

FVD manifestations

weight loss, decrease BP, increase pulse (weal and thready), increase respiration, Increase capillary refill, thirst, dry mucous membrane, tenting in skin, decreased urine output, urine specific gravity >1.030

Metabolic Alkalosis Lung componesation

decrease respirations, retain CO2

Metabolic Acidosis lung compensation

increase respirations, expel CO2

Respiratory Alkalosis Kidney Compensation

Retain hydrogen ions/excrete bicarbonate

Respiratory Acidosis kidney compensation

Excrete hydrogen ions/ retain bicarbonate

Metabolic Alkalosis causes

vomiting, NG suctioning, diuretic therapy, hypokalemia

Metabolic Acidosis causes

diarrhea, DKA, lactic acidosis, renal failure, shock, starvation

Metabolic alkalosis manifestations

decreased respirations, dizziness, hypertonic muscles, tetany (salt bae cramp), paresthesia, dysrhythmia

Metabolic Acidosis manifestations

bradycardia, weak pulses, hypotension, tachypnea, Kussmaul's respirations (fast labored breathing), Hyperkalemia, Warm flushed skin

Respiratory Alkalosis causes

hyperventilation, pain, anxiety, fever, liver failure

Respiratory Alkalosis manifestations

tachypnea, palpitations, chest pain, paresthesia, syncope

Respiratory Acidosis manifestations

muscle twitching, dizziness, palpitations

Normal pH range

7.35-7.45

Normal PaCO2

35-45

Normal HCO3

22-26

metabolic acidosis

low pH, normal PCO2, low HCO3

metabolic alkalosis

high pH, normal PCO2, high HCO3

respiratory acidosis

low pH, high PCO2, normal HCO3

respiratory alkalosis

high pH, low PCO2, normal HCO3

4 ways the body maintains fluid balance control

thirst mechanism, antidiuretic hormone, aldosterone, natriuretic peptides

most accurate reflection of fluid status

daily weight

potassium

primary intracellular cation, role in electrical conduction and acid-base balance

sodium

primary extracellular cation, controls water balance

phosphorus

mostly found in bones, role in acid-balance, bone and tooth mineralization, needs vitamin D to absorb

calcium

regulated by vitamin K, parathyroid hormone and calcitonin, mostly found in bone/teeth

magnesium

intracellular cation, stored in muscle and bone, role in cardiac rhythm, BP, bone strength

causes of: dilution of blood, loss of sodium

hyponatremia

Causes of: immobility, vitamin D deficiency

hypercalcemia

causes of: malnutrition, preeclampsia

hypomagnesemia

Causes of: alkalosis, diarrhea, NGT suctioning

Hypokalemia

causes of: excessive antacid or laxative use

hypermagnesemia

causes of: loss of thirst, increased sodium intake

hypernatremia

causes of: alcoholism, hypoparathyroidism

hypocalcemia

causes of: acidosis, renal failure, PO or IV potassium

Hyperkalemia