Chapter 8 - Disorders of Fluid and Electrolyte Balance Flashcards
Water is lost through what organs?
- Kidneys
- GI
- Skin
- Lungs (breathing)
Water intake from food and liquid is absorbed in the ________?
GI tract
_______ increases with fever?
Metabolic rate
Osmotic/Osmolarity refers to what?
Water!
Compulsive Water drinking is called what?
Psychogenic Polydipsia
Drink large amounts of water and excrete large amounts of urine
Inadequate amounts of antidiuretic hormone in the body or failure of the kidneys to respond to the antidiuretic hormone is called what?
Diabetes insipidous (DI)
All the body is doing is constantly getting rid of urine and they are retaining nothing, leading to dehydration
What is the MOST IMPORTANT thing to do in someone with Diabetes Insipidus?
Weigh patient daily!!
NOT subjective data
What is SIADH?
Syndrome of Inappropriate Antidiuretic Hormone
Signs and Symptoms of SIADH?
- Water retention (w/o edema)
- Decreased urine output
- Decreased serum osmolarity
- Hyponatremia
- Increased urine osmolarity
- Increased urine specific gravity >1.030
Which electrolyte abnormality will you be sure to monitor in someone with SIADH?
Hyponatremia
Fluid Deficit - Hypovolemia signs and symptoms?
- Thirst
- Decreased skin turgor
- Dry mucous membranes
- Sunken eyeballs
- Depressed fontanel
- Hypotension
- Weak, rapid pulse
(EARLY: tachycardia, tachypenia)
(LATE: low BP)
Fluid Volume Excess - Hypervolemia signs & symptoms?
- Edema
- Full, bounding pulse
- Hypertension
- Jugular Venous Distention (JVD)
- Pulmonary edema (severe)
- Decreased Hematocrit
- Decreased BUN
________ controls excitability of nerve and muscle cells?
potassium
Hyponatremia?
Low sodium
_______ regulates the ECF volume?
Sodium
Fluid is primarily lost how?
- Urine
- GI
- Sweat glands
_________ controls contractility of skeletal, cardiac, and smooth muscle
Potassium
Hyponatremia is considered sodium levels less than what?
<135mEg/L
90-95% of Sodium is located in the ____?
ECF
What is the most common type of Hyponatremia?
Hypotonic (dilutional) hyponatremia
Hypotonic hyponatremia is caused by what?
Water retention (this dilutes the sodium level)
What type of Hyponatremia causes both water and sodium to be lost; but water exceeds the associated sodium lost?
Hypovolemic hypotonic hyponatremia
Causes of Hypovolemic hypotonic hyponatremia?
- Excessive sweating
- Heavy exercise
What are two different types of Hyponatremia?
- Hypervolemic hypotonic hyponatremia
- Hypertonic hyponatremia
Signs and Symptoms of Hyponatremia?
EARLY signs - edema - muscle cramps - weakness - fatigue LATE signs (ALL Neurological) - apathy - lethargy - headache - disorientation - gross motor dysfunction
Hypernatremia is considered a sodium level of what?
Sodium level >145mEq/L
Hypernatremia can also be considered __________?
Dehydration
What is Hypernatremia?
To much sodium, NOT enough water
Signs and Symptoms of Hypernatremia?
EARLY - thirst - decrease urine output and urine osmolarity - tachycardia LATE - hypotension - decreased reflexes - agitation - headache - restlessness
_________ is found abundantly in the body?
Chloride
Chloride is found where in the body?
extracellular fluid
Chloride helps to maintain what?
- water balance
- acid-base balance
Normal Potassium levels?
3.5 - 5.0 mEq/L
Potassium is normally derived from where?
dietary sources
Plasma potassium is regulated through what two mechanisms?
- Renal mechanisms that conserve or eliminate potassium
- A transcellular shift between the ICF and ECF compartments
Hypokalemia typically results from what?`
Inadequate intake (diet deficient in K+)
Hypokalemia is a potassium level of what?
<3.5 mEq/L
Signs and Symptoms of Hypokalemia?
- postural hypotension (most common)
- weak, thready, irregular pulse
- polyuria
- nausea/vomiting
- abdominal distention
- weakness
- muscle cramps
- thirst
- paresthesias
- confusion
- depression
- metabolic alkalosis
- ECG changes
What are types of ECG changes seen in Hypokalemia?
- Depressed ST segment
- Low T wave
- Prominent U wave
- Ventricular tachycardia
- Ventricular fibrillation
- Cardiac arrest
IV potassium causes patient to feel what when if is infused?
BURNING!
* Usually give lidocaine or fluids with it
Hyperkalemia is defined as what?
(Lab value)
Potassium >5.0 mEq/L
Most common cause of Hyperkalemia?
Decreased renal elimination
Signs and Symptoms of Hyperkalemia?
- Nausea, Vomiting, Diarrhea (N/V/D)
- Abdominal cramps
- Weakness
- Dizziness
- Muscle Cramps
- Neuromuscular excitability
(with K+ > 6.0 mEq/L)
ECG changes
ECG changes seen with Hyperkalemia?
- peaked and narrow T waves
- wide QRS segment
- ventricular tachycardia
- ventricular fibrillation
- cardiac arrest
In regards to Hyperkalemia; What decreases the excitability of the heart?
- Calcium chloride or gluconate
what are the major cations (+) in the body?
- calcium
- phosphorus
- magnesium
What is Hypocalcemia?
Low calcium levels
Hypocalcemia is calcium levels of ______?
< 8.5 mEq/L
Causes of Hypocalcemia?
- Liver and Kidney disease
- Malabsorption
- Hypothyroidism
- Renal failure
- Hypoparathyroidism
- Acute pancreatitis
Signs and Symptoms of Hypocalcemia?
- ALL NEUROMUSCULAR*
- paresthesias
- muscle cramps
- abdominal cramps/spasms
- hyperactive reflexes
- tetany
- hypotension
- cardiac insufficiency
- EKG changes
- bone pain
- Chvostek sign (facial spasms)
- Trousseau sign (BP cuff and spasm)
Lab values that indicate Hypercalcemia?
Calcium levels >10.5 mg/dL
Signs and symptoms of Hypercalcemia?
- polyuria
- thirst
- muscle weakness
- Ataxia
- lethargy
- hypertension
- nausea/vomiting
- EKG changes
Phosphorus and Calcium do what ?
Go in opposite directions!
Ex: Increase Ca+/ decrease K+
Causes of Hypophosphatemia?
- Antacids
- Severe diarrhea
- lack of vitamin D
- Diabetic ketoacidosis
- Alcoholism
- Hyperparathyroidism
Hypophosphatemia Manifestations?
- tremor
- ataxia
- paresthesias
- confusion
- muscle weakness
- bone pain
- platelet dysfunction
- impaired white count
what lab values indicate Hyperphosphatemia?
Serum phosphorus levels > 4.5 mg/dL
Hyperphosphatemia Manifestations?
- paresthesia
- tetany
- hypotension
- cardiac arrhythmias
__________ is essential for cellular energy metabolism?
Magnesium
What is the range for normal Magnesium levels
1.6 mg/dL to 2.4 mg/dL
Magnesium is absorbed from the ________?
intestines
Hypomagnesemia is indicated by what?
(Lab value wise)
Magnesium level <1.6 mg/dL
Hypomagnesemia Manifestations?
- Personality changes
- Choreiform movements
- nystagmus
- tetany
- positive Babinski
- Chvostek
- Trousseau signs
- Tachycardia
- Hypertension
- Ventricular disrhythmias
Lab value that indicates Hypermagnesemia?
Serum magnesium levels > 2.4 mg/dL
Hypermagnesemia Manifestations?
- Lethargy
- Hyporeflexia
- Confusion
- Hypotension
- Cardiac Dysrhythmias
- Cardiac arrest
