Fluid and Electroltyes

What body fluid is inside the cell and accounts for 2/3 of body fluid?

intracellular fluid

What body fluid is outside the cell and accounts for 1/3 of body fluid?

extracellular fluid

What type of fluid is in the blood vessel?

intravascular fluid (plasma)

What type of fluid is between cells, tissues, organs and blood vessels?

interstitial fluid

What symptoms does extra fluid in the interstitial space cause?

pitting edemaH

What type of body fluid is in the cerebrospinal, pericardial, synovial, intraocular, and pleural spaces?

trancellular

What are some causes of volume deficits?

vomiting, diarrhea, overuse of diuretics, inadequate fluid intake, burns, surgery, medication induced

What are some causes of fluid excess?

heart failure, renal failure excess fluid intake, medication induced

What are s/s of hypovolemia?

restlessness, lethargy, thirst, dry mucus membranes, decreased skin turgor, weight loss

What are s/s of hypervolemia?

edema, JVD, dyspnea/crackles, weight gain, HTN

What are ways to manage fluid and electrolyte imbalances?

identify and correct the underlying cause, daily weights, strict Is and Os, medication therapy

What type of fluids remain in the intravascular space, creating no fluid shift?

isotonic fluid

What type of fluid draws water out of the cell and into the intravascular space, causing the cells to shrink?

hypertonic fluid

What type of fluid moves water from the intravascular space and into the cells, causing it to swell?

hypotonic fluid

What fluids are isotonic?

0.9% NS, LR and D5W

What fluids are hypertonic?

3% and 5% NS

What fluids are hypotonic?

0.45% NS

What type of fluids contain only Na and Cl; the only fluid given with blood; is given for dehydration; and is used cautiously in pts with excess fluid?

0.9% Sodium Chloride (NS)

What type of fluid contains Na, K, Cl, Ca, and lactate; is used to treat burns, trauma surgery, and GI losses; and is avoided in pts with renal failure, liver failure, or lactic acidosis?

LR

What fluid has no electrolytes and is used in the treatment of fluid loss, hypernatremia, and dehydration, and is contraindicated in head injury → cerebral edema and fluid resuscitation → hyperglycemia?

D5W

What type of fluid contains Na, Cl, and free water, is used to treat hypernatremia, uncontrolled hyperglycemia, and gastric fluid loss, and is avoided in 3rd-spacing shifts or increased ICP?

0.45% NS

What specialty IV solution is used when the GU tract cannot be used, requires a central line, need close glucose monitoring, and has a high infection risk?

TPN

What specialty fluid is known as a “volume expander”, pulls fluids into the bloodstream, and has a risk for fluid overload?

colloid solutions

What are examples of colloid solutions?

albumin, FFP, blood products

What electrolyte fx is to manage BP and blood volume?

Na

Na is the most dominant electrolyte in what?

extracellular fluid

What causes hyponatremia?

sodium loss (hypovolemia) and excess water gain (hypervolemia)

What causes sodium loss?

GI losses, diuretics, adrenal insufficiency, and burns

What causes excess water gain?

renal and heart failure, cirrhosis, SIADH

What are the clinical manifestations of hyponatremia?

HA, confusion, altered LOC, lethargy, seizures

What is the treatment for hyponatremia?

Oral Na replacement, 0.9% NS, LR or 3% NS

What causes hypernatremia?

inadequate water intake, excess water loss, excess Na intake, DI, Cushing Syndrome

What are the clinical manifestations of hypernatremia?

restlessness, confusion, hyperreflexia, seizures/coma

What is treatment for hypernatremia?

restore fluid with isotonic fluid then hypotonic solutions

What electrolytes fx is to manage heart and muscle function, maintain fluid balance and BP, regulated by the kidneys?

K

Where is K most dominant in?

intracellular fluid

What causes hypokalemia?

increased output or decreased intake

What causes increased output?

d/v, ng suction, diuretics, HF

What causes decreased intake?

NPO, malnutrition, alcohol use disorder, fasting diets

What a the clinical manifestations of hypokalemia?

CARDIAC DYSRHYTHMIAS, lethargy, irritability, AMS, coma, weakness, decreased DTR, shallow respirations, respiratory muscle weakness, decreased bowel mobility, constipation, abdominal distention

What is the treatment for hypokalemia?

increase intake, oral/IV K

What causes hyperkalemia?

renal failure, oliguria, salt substitutes, K supplements, trauma, burns, tumor lysis, severe infections, decreased aldosterone, ACE inhibitors, K-sparing diuretics, NSAIDs and ARBs

What are the clinical manifestations of hyperkalemia?

cardiac dysrhythmias, fatigue, irritability, confusion, muscle weakness/paralysis, low HR, low BP, ECG changes, ventricular dysrhythmias, increased motility, diarrhea, hyperactive bowel sounds

What are the treatments for hyperkalemia?

IV Ca gluconate, insulin and dextrose, sodium bicarb, kayexalate, furosemide, hemodialysis, restrict K

What electrolyte fx is to stabilize neuron excitability and control bones, blood and heartbeats?

calcium

What causes hypocalcemia?

low intake, low parathyroid hormone, Ca loss/binding

What are the clinical manifestations of hypocalcemia?

seizures, tetany, Chvostek and Trousseau, ECG changes, bleeding risk, hyperactive bowels, abdominal cramping, decreased bone density, height loss, spinal curvature

How to treat hypocalcemia?

IV calcium gluconate, IV CaCl, Ca-rich diet, monitor P

What causes hypercalcemia?

hyperparathyroidism, malignant cancer cells, excess Ca or vitamin D intake, osteoporosis, prolonged immobilization, thiazide diuretics

What are the clinical manifestations of hypercalcemia?

fatigue, muscle weakness, decreased DTRs, confusion, decreased HR, HTN, ECG changes, n/v, constipation, distention, anorexia

How to treat hypercalcemia?

increased fluids, furosemide, calcitonin, bisphosphonates, dialysis

What electrolyte fx is neuromuscular relaxation?

Mg

Where is MG the second most abundant at?

intracellular

What causes hypomagnesemia?

poor intake, GI losses, and renal losses

What are the clinical manifestations of hypomagnesemia?

seizure, hyperactive DTRs, tremors, paresthesias, confusion/irritability, ECG changes, torsades

What is the treatment for hypomagnesemia?

IV Mg sulfate, PO Mg oxide

What causes hypermagnesemia?

too much Mg in or not enough Mg out

What can cause too much Mg buildup?

Mg containing antacids/laxatives, DKA

What can cause not enough Mg to be excreted?

renal failure, adrenal insufficiency

What are the clinical manifestations of hypermagnesemia?

lethargy/drowsiness, decreased DTR, muscle weakness, respiratory depression, urinary retention, hypotension, vasodilation/flushing, ECG changes

What is the treatment of hypermagnesemia?

IV gluconate, Mg restriction, hemodialysis