Electrolytes Flashcards
How fast should you replace sodium?
0.5 mEq/hr (slowly) to prevent cerebral edema and increased ICP
Neurological s/s of hypernatremia
- restlessness
- agitated
- lethargic
- drowsy
- stupor
- Coma
Musculoskeletal s/s of hypernatremia include
- twitching
- cramping
- weakness
Cardiovascular s/s of hypervolemic hypernatremia
- Edema
- hypertension
- bounding pulses
cardiovascular s/s of hypovolemic hypernatremia
- hypotension
- weak pulses
Other s/s of hypernatremia
- flushed skin
- decreased urine output
- dry mouth
How do we treat hypernatremia if due to fluid loss?
Get them some more water
1. PO intake if mild
2. IV isotonic fluid admin if more severe
3. NS is relatively hypotonic to the body in hypernatremia
Two main causes of hypernatremia are
fluid loss
1. hyperventilation
2. excessive sweating
fever
Gaining/retaining sodium
1. Hypertonic IVF (GAIN)
2. Sodium bicarb (GAIN)
3. Increased sodium intake (GAIN)
4. Hyperaldosteronism (RETAIN)
5. Corticosteriods (RETAIN)
6. Cushings disease (RETAIN)
How do we treat hypernatremia if due to gaining/retaining sodium?
- Stop giving them sodium and iv fluids
- find the causative agent and DC
- Loop diuretics
What is our number one thing to monitor when it comes to sodium imbalances
neruo status
What are the 2 causes of hyponatremia?
Water in the body is increased and diluting sodium or loss of sodium in the body
What are some disease processes that can cause hyponatremia?
- SIDAH
- Adrenal insufficiency/ADDISONS
- Polydipsia (Thirst)
- Excessive hypotonic IVF
- low dietary intake of sodium
- chf
- Kidney failure
- Nephrotic syndrome
- Liver failure
- Water intoxication
What are some ways our body looses sodium?
- v/d
- NG suction
- excessive sweating
- Diuretic
- Burns
What are some neurological s/s of hyponatremia?
- Seizures
- Confusion
- Lethargy
- Stupor
- Cerebral edema
- Increased ICP
What are some cardiovascular s/s of hypovolemia hyponatremia?
- Weak pulse
- Tachycardia
- Hypotension
What are some cardiovascular s/s of hypervolemic hyponatremia
- bounding pulse
- hypertension
What are some gi/gu s/s of hyponatremia
- loss of appetite
- Hyperactive bowel sounds
What are some musculoskeletal s/s of hyponatremia
- abdominal cramps
- weakness
- shallow respirations
- decreased DTR
- Muscle spasms
- orthostatic hypotension
7
If chloride is high bicarb is
low
what is chlorides relationship with sodium and potassium
direct
what are causes of hyperchloremia?
Fluid loss
1. dehydration
2. vomiting
3. Sweating
Steroids
1. Cushings syndrome
2. Excess corticosteriod admin
Excess chloride admin
1. normal saline
What are the s/s of hyperchloremia
Same as hypernatremia
- restless, agitated, lethargic, drowsy, stupor, coma
- edema, hypertension, bounding pulse (hypervolemia)
- Hypotension, weak pulse (hypovolemic)
- twitching, cramps, weakness
- dry mouth, flushed, decreased urine output.
How do we treat hyperchloremia?
- Treat underlying cause
- Correct the imbalance
- Bicarb admin
- discontinue any sodium containing meds
- no NS for IVF- consider LR
- Monitor all electrolytes- its usually not the only imbalance
What causes hypocholremia?
- Volume overload
- CHF
- Water intoxication
- Salt losses
- Burns
- Sweating
- Vomiting
- Diarrhea
- Cystic fibrosis
- Addison’s disease
