Fluid and Electrolytes

What type of person has a body with 50% water

An elderly person

What type of person has a body with 70% water

An adult

What type of person has a body with 80% water

A newborn at birth

What has a body with 100% water

a fetus

Two thirds of the body’s fluids are where

In the intracellular space

One third of the body’s fluids is where

In the extracellular space

What major electrolytes are in the intracellular fluid

K, Mg, Phosphorus

What major electrolytes are in the extracellular fluid

NaCL, chloride, calcium, bicarb

types of fluid that are extracellular

plasma, limb fluid, css

Who needs to be on strict fluid watch because they have more fluid to lose and can lose it very quickly

Infants

Muscle holds water, true or false?

True

who is at risk for fluid imbalance due to having less total body water

The older adult

decreased thirst, renal changes, and polypharmacy are fluid imbalance risk factors for who?

The older adult

fever, diarrhea, vomiting, surgery, medications, chronic diseases are risk factors for

fluid imbalance

What regulates the thirst sensation

Hypothalamus

Questions to ask patients regarding their fluid intake and output

Are you drinking with meals

How much do you drink a day

What color is your urine

Have you experienced any vomiting, diarrhea, or excessive sweating

Have you felt unusually weak, fatigued, or experienced muscle cramps

Questions to ask patients regarding possible risk factors

Have you felt confused, sluggish, or had trouble concentrating

Have you recently gained or lost weight rapidly

Do you have a history of heart failure, kidney disease, liver problems, or diabetes

What medications are you taking

Osmosis

Movement of water across a semi permeable membrane from low to high concentration

Semipermeable

Some things can pass, others can’t. water can pass freely

Diffusion

The movement of particles from an area of high to low concentration until it is equal in both areas

Going through a crowd back to your stadium seats

Active Transport

Active Transport

Needs ATP and moves fluids across a concentration gradient (against the grain) of low to high

Which type of fluid movement feels like a group of people leaving an over crowded concert pushing you out so hard you don’t have to walk

Filtration

Filtration

Pressure pushing fluid through a membrane, fluid moving from high to low

Hydrostatic Pressure

Pushes fluid out

Oncotic Pressure

pulls fluid in

Osmolality (serum osmolality lab)

Particles per kg of water which measures body fluids

Osmolarity (IV fluid concentration)

Particles per liter of solution meaning concentration of a solution

Tonicity (hypotonic, hypertonic, isotonic)

How fluid is effecting the cells. Whether they shrink, swell, or stay the same

Things to look out for when suspecting fluid and electrolyte imbalance

kidney function, mental status, breathing sounds

Which hormone promotes water reabsorption by the kidneys

Antidiuretic hormone

Renin angiotensin aldosterone system (RAAS)

kidneys sense something abnormal like low bp, blood volume, or low electrolyte levels, sends a message to the liver to help regulate by releasing renin or does the regulation by themselves through retention

what is released when body has too much fluid volume

NATRIURETIC PEPTIDES

Labs to check kidney function

BUN, creatinine, urine output, eGFR, electrolytes

Questions to ask if you suspect sodium imbalances

Have you unexpectedly gained or lost any weight recently

What is your salt intake like

Have you had any problems with confusion or headaches

Any muscle cramps or twitching

Has your heart been beating really fast

Questions to ask if you suspect calcium imbalances

diet and supplements, medication use, surgical history (thyroid or parathyroid surgery, or a history of neck radiation)

Questions to ask if you suspect chloride imbalances

Have you been experiencing persistent vomiting, diarrhea, or heavy sweating?"
Are you taking any diuretic medications (like water pills)?"

Do you have a history of heart failure, cystic fibrosis, or adrenal insufficiency (

Are you feeling unusually fatigued, weak, or dizzy?

Questions to ask if you suspect magnesium imbalances

Diuretics, alcohol, Gi history, muscle cramps, tremors, racing fluttering heart beat

Questions to ask if you suspect potassium imbalances

Do you take potassium-sparing diuretics (such as spironolactone) or ACE inhibitors?

Do you regularly use salt substitutes (which often contain potassium chloride) or over-the-counter laxatives/enemas?

Have you recently started any new prescription medications, steroids, or insulin

Questions to ask if you suspect phosphorus imbalances

Do you have a history of chronic kidney disease, alcohol use, Have you been diagnosed with a parathyroid disorder, or have you had any thyroid or parathyroid surgery

What is third spacing

Fluid leaving the blood vessels and collects in a body compartment where it cannot perform any useful function

Two examples of third spacing

Ascites and pleural effusion

Hypovolemia

loss of water and solutes

How does the body compensate with hypovolemia? What does this look like?

Tries to pull fluid from other spaces to keep up blood volume. Decreased urine, tachycardia, tachypnea, anxiety, cool clammy skin, polydipsia, muscle cramps, tenting

Around how much urine should a healthy adult be producing per hour

30 mL

Specific gravity vs urinalysis

specific gravity is how concentrated your urine is. Urinalysis tells you all about your urine color, ph, metabolic contents, etc

Range for specific gravity

1.005 to 1.030

The more concentrated a serum osmol is the more…

dehydrated your body is

Range for serum osmolality

275 to 290

An example of a hypotonic solution

0.45%

An example of a hypertonic solution

3% NaCL

what has a greater osmolality than plasma and moves water out of cells into the intravascular space causing them to shrink

Hypertonic solution

What causes water to move out of plasma into the tissues and cells in the intracellular space

Hypotonic solution

What is the fluid space between cells and tissues called?

Interstitial space

What is the fluid space inside blood vessels called?

Intervascular space

What is it called when fluid leaks into the tissues?

Edema

Sodium range

135 to 145

which electrolyte Regulates osmolality, transmits nerve impulses to muscles and tissues, and maintains acid base balance

sodium

Which electrolyte maintains cellular chemical reactions and BP

sodium

signs and symptoms of hyponatremia

nausea, muscle cramps/twitching. Neuro changes; confusion, delirium, headache, coma. Hypotension, edema, seizures

urine specific gravity of less than 1.010 is indicative of what type of electrolyte imbalance

hyponatremia

How can you treat hyponatremia

sodium rich foods, 0.9% NS, LR

What can cause hyponatremia

Too much hypotonic IVF, diuretics, diarrhea, dehydration, drains, vomiting

What can cause hypernatremia

too much water loss or sodium loss, not drinking enough fluids, diarrhea, burns, hyperventilating, too much sodium IVF, diabetes insipid, osmotic diuretics.

what is diabetes insipidus

a rare disorder that causes the body to lose fluid balance. It happens when the body lacks the hormone arginine vasopressin (AVP, or antidiuretic hormone) or the kidneys cannot respond to it. This leads to extreme thirst and passing large amounts of dilute urine

Hypernatremia manifestations

pyrexia, flushed skin, restlessness, increased fluid retention, edema, decreased urine output, dry mouth,

Hypernatremia signs and symptoms

weakness, disorientation, irritable, restlessness, seizures, thirst. dry swollen tongue, tachycardia, sticky mucous membranes

how to treat hypernatremia

decrease sodium, IVF 0.45& NaCl or D5W

serum osmol over 300 and a specific gravity over 1.030 is…

hypernatremia

normal range for potassium

3.5 to 5

Which electrolyte maintains intracellular fluid balance, nerve impulse transmission, and heart rhythms

potassium

Which electrolyte maintains cell enzyme activity, muscle contractions/functions, and acid base balance (not sodium)

potassium

what causes hypokalemia

vomiting, gastric suction, diarrhea, diuretics

Signs and symptoms of hypokalemia

nausea, anorexia, muscle weakness, leg cramps, paresthesia, fatigue, dysrhythmias

Treatments for hypokalemia

20 to 40 Meq/L of potassium on IV pump and potassium rich foods

Treatments for hyperkalemia

iv insulin, dextrose, sodium polystyrene sulfonate and diuretics. In serious emergencies sodium bicarbonate, calcium gluconate, and dialysis

signs and symptoms of hyperkalemia

skeletal muscle weakness, parasthethia, paralysis, cardiac dysrhythmias and arrest, EKG changes

what causes hyperkalemia

renal failure, potassium supplements, ACE inhibs, NSAIDs, Heparin, K+ sparing diuretics, hypoaldosteronism

Normal range for magnesium

1.3 to 2.3

which electrolyte is lost through the urine and helps with vasodilation

magnesium

Magnesium

helps with metabolism of carbs and proteins, helps nerves and muscles work properly, second most abundant electrolyte, and helps with vasodilation

which hyper imbalance of an electrolyte is caused by renal failure and excessive use of antacids and laxatives

magnesium

signs and symptoms of hypermagnesemia hint (hypoactive DTR)

weakness, flushing, lethargy, respiratory depression, coma, cardiac arrest

The nurse treats hyperkalemia by administering sodium polystyrene sulfonate. What can be done to prevent diarrhea

not administer oral medication within 3 hours of SPS admin

treatments for hypermagnesemia

IV calcium gluconate, ventilation

treatments for hypomagnesemia

telemetry IV magnesium or tablets

before giving PO tablets to treat for hypomagnesemia the nurse checks for

dysphagia

What can cause hypomagnesemia

NG suction, diarrhea, alcohol use, tube feeding

Things that cause hypomagnesemia

parental nutrition, sepsis, burns, and diuretics

signs and symptoms of hypomagnesemia

muscle weakness, tremors, tetany(involuntary muscle contractions), cardiac arrhythmias, change in mental status

a patient is experiencing hyperactive deep tendon reflexes, respiratory paralysis, dysphagia, and cardiac dysrhythmias. What hypo imbalance of an electrolyte are they experiencing?

magnesium

Normal range for calcium

8.6 to 10.5

what electrolyte helps with bone strength, blood clotting, nerve impulse transmission, and muscle contraction and relaxation

calcium

causes of hypocalcemia

vitamin d deficiency and hypothyroidism

signs and symptoms of hypocalcemia

paresthesia of fingers mouth or feet, tetany, muscle cramps, confusion, irritability

Trossaeau’s sign and Chvostek’s sign are indicative of

hypocalcemia

IV calcium gluconate or calcium chloride can treat…

hypocalcemia

What is Trosseau’s sign

carpal spasm activated by inflating bf cuff

what is Chvostek’s sign

face contracting after tapping facial nerve

causes of hypercalcemia

cancer, hyperparathyroidism, thiazide diuretics, prolonged immobility