Fluid and Electrolytes

Minimum output

30ml of Urine per hour

Average urine output

60 ml/hr

Isotonic solution

D5W, 0.9 NS, Lactated Ringers - expand body fluid volume without causing fluid shifts in cells.

Hypotonic solution

0.45 NS, 0.25 NS - move into cells causing them to expand

Hypertonic solution

D10W, D5/0.45NS, D50, Albumin - Good for hyponatremia, IICP/cerbral edema

Fluid Volume Excess S/S

Dyspnea, Edema, Lung Crackles/Cough, Bounding pulse, Increased Blood pressure, Decreased Hgb/Hct weight gain

Fluid Volume Excess Interventions

Fowler’s position for breating, Supplemental Oxygen pursed lip breathing exercises, Diurectics, Elevate extremities, antihypertensives

Fluid Volume Deficit

Rapid breathing/Pulse, Hypotension, Poor,sluggish turgor, Dry oral mucosa/Furrows on tongue, Low grade temp, Low or No urine output, Abnormally high labs (electrolytes, Hgb/Hct)

Sodium Range

135 to 145 mEq

Hyponatremia S/S

(Low Sodium) - Weakness, Anorexia, Cramps, Confusion, Fatigue, Headache, Edema, Seizures,

Hyponatremia Causes

Vomiting, Diarrhea, Excessive intake of water, Diurectics

Hypernatremia S/S

Dry mucous, decreased urine output, flushed skins, confusion

Hypernatremia Causes

Increased intake of Na+ and rapid infusion of IV saline

Potassium Range

3.5-5.0 mEq

Hypokalemia causes

Polyuria, Potassium depleting diuretics (Loop diuretics and Thiazides), GI losses from vomiting/diarrhea/suctioning, Ileostomy, increased aldosterone activity, lose from cells, decreased K+ intake

Hypokalemia S/S

Muscle weakness, cramps, paresthesia (numbness), hyorefelxia, Dysrhythmias (Weak, irregular pulses), orthostatic hypotension, decreased bowel sounds, lethargy

(Prolonged deficency can cause kidney damage, paralytic ileus, and cardiac or respiratory arrest)

Hypokalemia Interventions

Increase potassium intake, monitor EKG/telemtry, monito VS and labs

Hyperkalemia causes

renal failure (Monitor BUN, Crt, and glomerular filtration rates), K+ supplements, Excessive use of salt substitutes, Excessive intake of food high in K+

Medications - Ace inhibitors, beta blockers, NSAIDS, potassium sparing diuretics

Hyperkalemia S/S

Dysrhythmias (Cardiac arrest), vomiting, Colic, irritability, muscle weakness

Hyperkalemia interventions

Reduce K+ intake, Kayexalate (PO or enema), sodium zirconium silicate (Lokelma), potassium depleting diuretics, give insulin with D5W, Monitor VS, telemetry, I&O, K+ level, Hemodialysis

Calcium Range

8.5 - 10.5

Hypocalcemia Causes

CKD or ESRF, parathyroid hormone deficiency, decreased intake of calcium or Vit D, Malabsorption, some anticonvulsants, some diurectics, excess alcohol intake, large amount of citrated blood

Hypocalcemia S/S

Neuromuscular irritability and increased excitability, Dysrhythmias, Tetany (Tingling around mouth, nose, ears fingers, and toes + Carpopedal spasms+ Nervousness, irritability, and apprehension), Chvostek’s and Trousseau’s, Laryngeal spasms, Abdominal cramping and diarrhea, paresthesia

Chvostek’s sign

Hyperflexia of the check muscles (C = Cheek)

Trousseau’s

Hyperflexia of the arm muscles tested with a pressure cuff (T = Trunk)

Hypocalcemia Interventions

Monitor labs, I&O, VS, resp status, telemetry, administer calcium gluconate, encourage calcium intake

Hypercalcemia causes

immobilized patients, increased calcium or vitamin D, parathormone, some cancers, antacids

Hypercalcemia S+S

• Dysrhythmias

• Decreased LOC

• N/V/Anorexia

• Behavioral changes, including confusion and lethargy

• Thirst

• Polyuria

• Decreased DTRs

• Decreased muscle tone

• Constipation

• Paralytic ileus

• HTN

• Decreased GI motility

• Bone pain

• Pathological fractures

• Renal calculi (Urolithiasis)

  • Flank pain

  • CT scan

HyperCalcemia interventions

adminster diuretics as ordered, decreased intake, encourage fluids, monitor I&O, VS, telemetry

Phosphorus PO4

3.0 - 4.5 mg

Hypophosphatemia causes

Rare because found in most foods, Dietary insufficiency, impaired kidney function, maldistribution of phosphate

(When phosphate low, Calcium high)

Hypophosphatemia S/S

muscle weakness, especially respiratory

Hypophosphate Treatment

Balanced diet, IV phosphate administration

Hyperphosphatemia causes

Most common renal problems, increased intake of vitamin D and phosphates

Hyperphosphatemia S+S

Tetany, itching

Hyperphosphatemia treatment

decrease phosphate intake, phosphate binder - Sevelamer, Calcium acetate

Magnesium

1.5-2.5 mEq

Hypomagnesemia causes

Increased excretion, impaired absorption from the GI tract, Diarrhea, Decreased intake (Prolonged malnutrition, Starvation), conditions causing polyuria, prolonged tube feedings (TPN without magnesium replacement

Hypomagnesemia S+S

Agitation, confusion, Depression, Hyperreflexia, Tachycardia, paresthesia, Tetany and neuromuscular irritation (LOW and FAST)

Hypomagnesemia interventions

I&Os, VS, Respiratory status, Telemetry, Assess Neuro Status, increase intake of magnesium rich foods, administer supplements

Hypermagnesemia Causes

Rarely occurs when kidney function is normal

Three most common causes - Impaired renal function, Excess magnesium administration, Excess fluid loss from diabetic ketoacidosis

Hypermagnesemia S/S

Excess magnesium severely restricts nerve and muscle activity

Decreased deep tendon reflexes (hyporeflexia), Decreased urine output, Decreased LOC - lethargic, Bradypnea, Bradycardia, Hypotension

Hypermagnesemia Interventions

Promote urine excretion, administer diuretics, Decrease foods high in magnesium, stop magnesium, supplements, monitor I&O

Bicarbonate

22 to 26 mEq

Carbonic acid / Carbon dioxide

35 - 45 mm Hg

Blood pH

7.35 to 7.45

Respiratory Acidosis

ph will be low CO2 - caused by conditions that restrict breathing and gas exchange

Respiration Alkalosis

pH will be high; CO2 will be low - Caused by hyperventilation, anxiety and inappropriate ventilator settings

Metabolic Acidosis

Too many acids, produced by ketones (Diabetic ketoacidosis and starvation diets), renal failure, Not enough bases - diarrhea

metabolic Acidosis S/S

Decreased Level of consciousness, Lethargy, Headache,Kussmaul’s resprations, Cardiac arrhythmias, Anorexia, N/V + Diarrhea, Weakness

Treatment for Metabolic Acidosis

DKA - lower blood sugar, Improve diet, Stop ASA, treat diarrhea, administration of sodium bicarbonate

Metabolic Alkalosis

Not enough acid, Hydrochloric (stomach, digestion), vomiting, GI suctioning, Too many bases, excessive ingestion of bicarbonate, antacids

Metabolic Alkalosis S/S

Headache, irritability, lethargy, Decrease LOC, Atrial tachycardia, Slow, shallow respirations with periods of apnea, Bradycardia, N/V, Numbness and tingling of extremities, Hypertonicity of muscles, Tetany

Treatment of metabolic Alkalosis

Stop antacids and sodium bicarb, Stop vomiting (Antiemetics), decrease suctioning