Fluid and Electrolyte Flashcards
3 parts that make up extracellular fluid
interstitial fluid
intravascular fluid
transcellular space
where is interstitial fluid located?
surrounds cell
found in lymph
intravascular fluid
found in blood vessels
transcellular fluid
found in sweat, cerebral, pleural and digestive juices
which type of fluid will show physical signs of dehydration
extracellular fluid
which type of fluid will show neurological symptoms of dehyrdation
Intracellular fluid
why do infants/children get dehydrated faster?
increased BSA, higher metabolic rate
immature kidney function
under normal circumstances the amount of water consumed closely approximates
the amount of urine excreted in a 24 hour period
water in food and from oxidation closely approximates
the amount of water lost in feces or through evaporation
meeting fluid requirements involves doing what 3 things?
maintenance (normal losses of fluids and electrolytes)
deficit (total amount of fluids and electrolytes lost from an illness
on-going loss- requirement of fluids and electrolytes to replace ongoing losses ( from third spacing, blood loss, diarrhea)
what is the holliday-segar method for calculating maintenance fluid?
based on wt in kilo’s
first 10 kilo’s multiply by 100
next 10 kilo’s multiply by 50
>20 kilo’s multiply by 20
ex: 24 kilo child 10x100= 1000ml 10x50= 500 ml 4x20= 80ml total volume= 1580ml for all day
how does fever increase maintenance fluid requirements
for each 1 degree over 99% fluid requirements increase by 7ml/kg/day
factors that increase the need of maintenance fluid requirements
fever tachypnea increased environment temp. burns ongoing loss diabetic ketoacidosis, DI shock radiant warmer/ phototherapy post op bowel surgery
factors that decrease maintenance fluid requirements
mist tents, incubator, swamp bed humidified ventilator oliguria, anuria hypothyroidism CHF increased ICP SIADH
causes of fluid excess
excessive oral intake hypotonic overload plain water enemas renal failure CHF malnutrition
symptoms of fluid excess
edema slow bounding pulse crackles in lungs lethargy hepatomegaly weight gain seizures, coma
management/nursing care for fluid excess
limit intake diuretics VS neurologic status seizure precautions
causes of fluid depletion
lack of oral intake abnormal losses ( diarrhea, vomiting, hyperventilation, burns, hemorrhage) * these causes deplete children/ infants faster than adults
what are the three types of dehyration
isotonic
hypertonic
hypotonic
isotonic dehydration
electrolytes and water are lost in same concentration
most common type
sodium is within normal limits
hypertonic dehydration
more water loss than electrolytes
sodium is greater than 145
hypotonic dehydration
more electrolyte than water.
common cause: water toxicity ( adding to much water to formula)
sodium is less than 135
clinical assessment of mild dehydration
3-5% wt loss active and alert normal VS skin springs back normal fontanel
Clinical assessment of moderate dehydration
6-9% wt loss irritable, alert, thirsty > 3 sec cap refill slight increased pulse slight tachypnea normal or slight orthostatic hypotension dry mucous membranes skin tents briefly normal or slightly sunken slightly
clinical assessment of severe dehydration
greater than 10% wt loss lethargic, looks sick delayed cap refill >4 seconds very fast thready pulse fast deep respirations orthostatic to shock BP parched skin absent tears significantly sunken fontanels sunken eyes
management of dehydration
correct imbalance and treat underlying cause
when can you use oral rehydration therapy
when child is alert, awake, not in shock
when do you provide rapid replacement of fluid loss?
over 4-6 hours
used for on-going losses
providing maintenance fluids
causes of hyponatreimia
fever increased water intake decreased sodium intake diabetic ketoacidosis burns, wounds SIADH malnutrition CF renal disease vomiting, diarrhea, NG suction
clinical manifestations of hyponatremia
sodium less than 135
neurological (less than 125) behavior change, irritability, lethargy, headache, dizziness, apprehension
cardio- increased HR, decreased BP, cold, clammy skin
muscle cramps (esp. abdomen)
nausea
causes of hypernatremia
water loss/ deprivation high sodium intake DI diarrhea fever hyperglycemia renal disease increased insensible loss
clinical manifestations of hypernatremia
serum sodium higher than 147 intense thirst oliguria agitation flushed skin peripheral and pulmonary edema dry, sticky mucous membranes n/v severe CNS for Na >150 (disorientation, seizure, hyperirritability when resting)
causes of hypokalemia
stress starvation malabsorption excess loss of fluid through vomiting, diarrhea, sweat, NG tube diuretics (furosemide, ethacrynic acid, thiazide) IV without potassium corticosteroids DKA
clinical manifestations of hypokalemia
muscle cramps (legs), weakness
CVS: weak, or irregular pulse, tachycardia, bradycardia, cardiac dysrhythmias, hypotension
GIL Ileus or decrease in bowel movements
CNS: irritability, fatigue, paralysis, weakness
how to treat hypokalemia
determine and treat cause
monitor VS, EKG
administer supplemental K+ ( assess renal function before beginning)
how to treat hyperkalemia
determine and treat cause
monitor VS, EKG
administer IV fluids
may give IV insulin or cation exchange resin
causes of hyperkalemia
increased K+ intake decreased urine excretion kidney failure metabolic acidosis hyperglycemia potassium sparing diuretics severe dehydration rapid IVF potassium burns
clinical manifestations of hyperkalemia
irritability, anxiety twitching hyperreflexia weakness flaccid paralysis nausea, diarrhea bradycardia cardiac arrest for k+ greater than 8.5 apnea, respiratory arrest
how to treat hypocalcemia
serum less than 8.8
determine and treat cause
administer calcium supplements
if IV monitor site as it can cause irritation
causes of hypocalcemia
inadequate calcium intake vit D deficiency renal insufficiency calcium loss (infection, burns, loop diuretics) alkalosis hypoparathyroidism
clinical manifestations of hypocalcemia
numbness, tingling of fingers, toes, nose, ears, and circumoral area hyperactive reflexes, seizures muscle cramps/tetany laryngospasm lethargy poor feeding in neonate positive trousseau's and Chvostek's sign hypotension, cardiac arrest
how to treat hypercalcemia
serum calcium greater than 10.8
determine and treat cause
monitor serum calcium levels
monitor EKG
causes of hypercalcemia
milk alkali syndrome (chronic intake of tums or milk) excessive IV or oral calcium acidosis prolonged immobilization hypoproteinemia renal disease hyperparathyroidism hyperthyroidism
clinical manifestations of hypercalcemia
lethargy, weakness anorexia, thirst itching behavior changes confusion, stupor n/v/ constipation bradycardia, cardiac arrest
what is the ORS of choice in the peds world?
pedialyte
can you keep a kid at home in mild dehydration?
yes, ORS
can you keep a kid at home in moderate dehydration?
get a clinic appt, ORS
Mod to severe dehydration what do you tell parents?
bring to ER, get IV started before you loose access, ORS
what is the expected urine output her hour for a child
1-2ml per KG per Hour
