Fluid and Electrolyte

what causes extracellular fluid deficit?

hemorrhage, GI losses

what are the signs and symptoms for extracellular fluid deficit?

hypotension
tachycardia
poor skin turgor
urinary output

what is the treatment for extracellular fluid deficit?

replace fluids (ex: IV normal saline)

what is the cause of extracellular fluid volume excess?

renal or cardiac failure, increased aldosterone, too much water or sodium

what are the signs and symptoms of extracellular fluid volume excess?

weight gain
edema
JVD
crackles in lungs

what is the treatment for extracellular fluid volume excess?

diuretics, sodium or fluid restriction

what is the normal lab value for sodium

135-145

what is the sodium level in hypernatremia

>145

what is the serum osmolality in hypernatremia

>295

what is the urine specific gravity in hypernatremia

>1.015

what are the causes of hypernatremia

deficient water intake, excessive sodium intake

what are the signs and symptoms of hypernatremia

thirst
tachycardia
dry mucous membranes
seizures
hyperactive deep tendon reflexes
hallucinations
confusion
lethargy or coma

what does the nurse need to assess for a patient with hypernatremia

I&O
daily weights
changes in LOC
cerebral edema (headache, N/V, increased BP)

what is the treatment for hypernatremia

IV hypotonic Na+
diuretics

what is the sodium level in hyponatremia

what is the serum osmolality in hyponatremia

what is the urine specific gravity in hyponatremia

what is the cause of hyponatremia

hypervolemia, prolonged diuretic use, insufficient Na+ intake

what are the signs and symptoms for hyponatremia

HA
confusion
muscle cramps and twitching
convulsion
coma

what assessments should the nurse do for a patient with hyponatremia

I&O
daily weights
LOC

what is the treatment for hyponatremia

3-5% NaCl IV, increase sodium in diet, restrict fluids

what is the normal lab value for potassium

3.5-5.5

what is the potassium level in hyperkalemia

>5.5

what is the pH level in hyperkalemia

decreased arterial pH

what are the causes of hyperkalemia

impaired K+ secretion, excessive K+ intake, cellular damage

what are the signs and symptoms of hyperkalemia

cardiac arrest
skeletal muscle weakness/flaccid muscle paralysis
apathy/confusion
paresthesia/numbness

what does an EKG look like for a patient with hyperkalemia

tall tented T waves
wide QRS complex
asystole

what assessments should a nurse do for a patient with hyperkalemia

palce pt on cardiac monitor
I&O

what is the treatment for hyperkalemia

treat acidosis
IV glucose, insulin, and sodium bicarb
kayexalate, sorbital, lokelma
diuretics

what is the potassium level in hypokalemia

what is the urine specific gravity in hypokalemia

what is the pH and bicarb level in hypokalemia

elevated pH and bicarb

what is the cause of hypokalemia

prolonged diuretics, inadequate K+ intake, GI losses, steroid therapy

what are the signs and symptoms of hypokalemia

anorexia, N/V
drowsiness, lethargy, coma
hyporeflexia
weakness
ileus
increased urinary output
hypotension
digitalis toxicity

what does an EKG look like for a patient with hypokalemia

ST depression
flattened T waves
U waves
arrhythmias

what is the treatment for hypokalemia

treat alkalosis
give KCl- IV (DONT PUSH)
encourage foods high in K+

what is the normal lab value for magnesium

1.6-2.2

what is the magnesium level in hypermagnesium

>2.2

what other electrolyte imbalances are associated with hypermagnesium

hyperkalemia and hypercalcemia

what are the causes of hypermagnesium

renal failure, excessive use of Mg (antacids, laxatives)

what are the signs and symptoms of hypermagnesium

drowsiness
flaccid paralysis
absent deep tendon reflexes
decreased RR and HR
hypotension

what does an EKG look like on a patient with hypermagnesium

prolonged PRI, QRS, and QT interval
heart block
asystole

what is the treatment for hypermagnesium

dialysis, diuretics

what is the magnesium level in hypomagnesium

what other electrolyte imbalances are seen with hypomagnesium

hypokalemia and hypocalcemia

what are the causes of hypomagnesium

decreased intake or absorption, chemotherapy, steroids, hemodilution

what are the signs and symptoms of hypomagensium

CNS agitation, twitching
seizures
confusion
hyperactive deep tendon reflexes
hypotension
tachycardia and arrhythmias

what is the treatment for hypomagnesium

mag sulfate 50% IM or IV

what is the normal lab value for calcium

8.5-10.5

what is the calcium level in hypercalcemia

>10.5

what are the causes of hypercalcemia

excessive Ca+ intake
increased mobilization from bones
hyperparathyroidism
alkalosis
decreased phosphate

what are the signs and symptoms of hypercalcemia

CNS depressant, weakness, flaccidity
renal calculi
pathologic fractures
polyuria
N/V, anorexia, constipation, thirst

what does an EKG look like on a patient with hypercalcemia

shortened QT interval and ST segment

what is the treatment for hypercalcemia

ROM exercise and ambulation
phosphate binder
hydration and loop diuretics
increase fiber

what is the calcium level in hypocalcemia

what is the ionized calcium level in hypocalcemia

how are PT and PTT effected in hypocalcemia

both are prolonged

what are the causes of hypocalcemia

hypoparathyroidism
renal failure
hyperphosphatemia
malabsorption syndrome
lack of vitamin D

what are the signs and symptoms of hypocalcemia

neuromuscular irritability
tetany (chvostek and trousseaus sign)
bronchospasms, stridor, respiratory arrest
seizures
ileus

what is chvosteks sign

facial spasm when cranial nerve 7 is stimulated

what is trousseaus sign

carpal spasm

what does an EKG look like on a patient with hypocalcemia

prolonged QT interval and ST segment

what is the treatment for hypocalcemia

Ca+ gluconate and CaCl IV, vitamin D, seizure precautions

what is the normal lab value for phosphate

3.0-4.5

what is the phosphate level in hyperphosphatemia

>4.5

what electrolyte imbalance is associated with hyperphosphatemia

hypocalcemia

what are the causes of hyperphosphatemia

renal failure, cathartic abuse, increased phosphate intake

what are the signs and symptoms of hyperphosphatemia

seizures, Ca+ and phosphate precipitate in the body

what is the treatment of hyperphosphatemia

eliminate use of phosphorus based laxatives
add albumin hydroxide antacids
vitamin D supplements
Ca+ supplements
dialysis
reduce phosphate in diet

what is the phosphate level in hypophosphatemia

what electrolyte imbalance is associated with hypophosphatemia

hypercalcemia

what is the cause of hypophosphatemia

long term total parental nutrition, malabsorption syndrome, hypercalcemia

what are the signs and symptoms of hypophosphatemia

muscle weakness and tremors
confusion and lethargy

what is the treatment for hypophosphatemia

increase phosphorus rich foods (eggs, buts, whole grains, meat, fish, poultry, milk)

what is the tonicity of 5% dextrose in water

isotonic but physiologically hypotonic

what is the composition of 5% dextrose in water

50g/L dextrose
contains free water only (no electrolytes)

when is 5% dextrose in water use indicated

replace water losses and treat hypernatremia

what is the tonicity of 10% dextrose in water

hypertonic

what is the composition of 10% dextrose in water

100 g/L dextrose
free water only (no electrolytes)

what is the tonicity of 0.45% saline

hypotonic

what is the composition of 0.45% saline

Na+
Cl-
free water

when is 0.45% saline use indicated

treat hypernatremia and hyperglycemia

when is 10% dextrose in water use indicated

parenteral nutrition

what is the tonicity of 0.9% saline

isotonic

what is the composition of 0.9% saline

Na+ and Cl- in excess of plasma levels

when is 0.9% saline use indicated

expand intravascular volume and replace extracellular fluid loss, only solution thats able to be given with blood products

what is the tonicity of 3% saline

hypertonic

what is the composition of 3% saline

Na+ and Cl- in excess of plasma levels

when is 3% saline use indicated

treat hyponatremia, patients with head injuries and trauma

what is the tonicity of lactated ringers

isotonic

what is the composition of lactated ringers

Na+, Cl, K+, Ca+, lactate

when is lactated ringer use indicated

treat hypovolemia, GI fluid losses

what does hypotonic mean

lower osmolality compared to plasma

how to hypotonic solutions effect the body

move fluid from extracellular fluid (blood) to interstitial space

what are hypotonic solutions used for

treating hypernatremia and lowering BP

what does isotonic mean

osmolality similar to plasma

how do isotonic solutions effect the body

expands only extracellular fluid (fluid does not move into cells)

what are isotonic solutions used for

fluid replacements in volume deficits

what does hypertonic mean

higher osmolality than plasma

how do hypertonic solutions effects the body

draws water out of cells and into extracellular fluid (blood)