Fluid and Electrolyte Imbalances

Question 1

Diagnostic tests used to evaluate fluid and electrolyte imbalances

Answer 1

Serum electrolytes, serum osmolarity, urine osmolarity, urine specific gravity - SG (measure his kidneys ability to concentrate urine)

Question 2

Describe Edema and its etiology

Answer 2

Definition: too much fluid in interstitial space, usually worse independent areas, severe Edema inhibits blood flow and cell function
Etiology: increased capillary hydrostatic pressure, loss of plasma fluid which allows fluid to leave capillary, obstruction in lymphatic vessels, increased capillary permeability due to infection or inflammation

Question 3

Signs and symptoms of Edema

Answer 3

Local area swelling, pitting edema, increased weight, functional impairment, pain due to pressure, impaired arterial circulation

Question 4

Define dehydration

Answer 4

Insufficient fluids due to inadequate intake or excessive loss of fluid or both, affect extracellular compartments first

Question 5

Hypervolaemia and it’s etiology

Answer 5

Excess fluid in the extracellular compartment

Etiology: renal failure, congestive heart failure, increased salt intake, steroid use, overhydration

Question 6

Hypovolaemia and it’s etiology

Answer 6

Excessive fluid loss from extracellular space
Etiology: abdominal surgery, diabetes mellitus, excessive use of diuretics, laxative, fear, sweating, hemorrhage, nasal gastric drainage, vomiting and diarrhoea

Question 7

Signs and symptoms of hypervolaemia

Answer 7

Tachypnea, dyspnea, crackles in lungs, puffy eyes, rapid bounding pulses, hypertension, distended neck and hand veins, acute weight gain, edema, as three heart sound

Question 8

Signs and symptoms of hypovolemia

Answer 8

Orthostatic hypertension, urinary output initially more than 30 mg/h then lower, cool pale skin on arms and legs, weight loss, dry mucous membranes, mental status deterioration, thirst, tachycardia with weak thready pulse, delayed capillary refill, concentrated urine

Question 9

Medical treatment for hypovolaemia

Answer 9

Replace lost fluids with fluids of the same concentration, may need of normal saline, meds that assist with vasoconstriction, oxygen therapy

Question 10

Medical treatment for hypervolaemia

Answer 10

Restrict sodium and fluid intake, medication to treat CHF and diuretics, morphine or nitro can be given to relieve air hunger and dilute blood vessels which will reduce pulmonary congestion

Question 11

Etiology of hypokalaemia

Answer 11

Poor dietary intake, diarrhea, excessive urine output, medications, glucocorticoid treatment or excess in the body, treatment of diabetic ketoacidosis

Question 12

Signs and symptoms of hypokalaemia

Answer 12

Skeltal muscle weakness progressing to paresthesia, fatigue, anorexia nausea constipation, deep tendon reflexes decreased or absent, muscle twitch/leg cramps, shallow respirations, orthostatic hypotension, cardiac dysrhythmias leading to cardiac arrest

Question 13

Medical treatment of hypokalaemia

Answer 13

High potassium diet, oral or IV potassium supplements

Question 14

Causes of hyperkalaemia

Answer 14

Decreased kidney function, potassium sparing diuretics, tissue damage, severe acidosis, aldosterone deficiency

Question 15

Signs and symptoms of hyperkalaemia

Answer 15

Weakness spreads from legs to trunk and may involve respiratory muscles, smooth muscle hyperactivity-nausea vomiting diarrhea, decreased heart rate irregular pulse hypotension cardiac dysrhythmias cardiac arrest

Question 16

Medical treatment for hyperkalaemia

Answer 16

Loop diuretics, reduce potassium intake in diet, IV/inhale/PO meds, kayexalate

Question 17

Causes of hypernatraemia

Answer 17

Large amounts of sodium without proportionate water intake through ingestion, loss of water from the body that is faster than the loss of sodium, diarrhea, rapid respirations, large volumes of dilute urine due to lack of ADH, loss of thirst mechanism

Question 18

Signs and symptoms of hypernatraemia

Answer 18

Agitation weakness lethargy confusion stupor seizures and coma, increased thirst with rough dry mucous membranes, edema, elevated blood pressure

Question 19

Medical treatment for hyper natraemia

Answer 19

Dependent on cause, IV fluid replacement, restriction of sodium intake

Question 20

Causes of hypo natraemia

Answer 20

Losses from excessive perspiration, vomiting and diarrhea, diuretics combined with low salt diet, excess ADH secretions, insufficient aldosterone, adrenal insufficiency, excessive water intake, early chronic renal failure

Question 21

Signs and symptoms of hypo natraemia

Answer 21

Abdominal cramps, fatigue, muscle cramps, nausea vomiting, hypovolemia, hypotension, confusion, headaches, weakness, seizures

Question 22

Medical treatment of hyponatraemia

Answer 22

Identify underlying causes and correct, monitor serum electrolytes, restrict fluid intake, administer sodium chloride

Question 23

Causes of hypercalcaemia

Answer 23

Neoplasms of the bone, hyperparathyroidism, immobility, increase intake of calcium, increase milk and antacid intake

Question 24

Signs and symptoms of hypercalcemia

Answer 24

General malaise fatigue weakness loss of muscle tone, if severe blood pressure drops, constipation or diarrhea, anorexia nausea vomiting, drowsiness, pathologic fracture’s, bone pain, cardiac arrhythmias/arrest

Question 25

Medical treatment for hypercalcaemia

Answer 25

Treat underlying causes, IV solution to dilute extracellular calcium levels, diuretics, sodium bicarb, steroids, haemodialysis

Question 26

Causes of hypocalcaemia

Answer 26

Poor absorption (diarrhea, laxatives, chronic malabsorption syndrome), excessive loss of calcium(thyroid or parathyroid surgery), hypoparathyroidism, deficient serum albumin, increased serum pH

Question 27

Signs and symptoms of hypocalcemia

Answer 27

Paraesthesia of toes fingers or face, twitching, muscle cramps or tremors, and spasms, chvostecs sign, Trousseau’s signs, laryngeal spasm’s, fractures, abdominal cramps, arrhythmias, weak heart contractions

Question 28

Medical treatment of hypocalcaemia

Answer 28

Acute-calcium gluconate or carbonate per IV

Chronic-dietary supplements, vitamin D

Question 29

Causes of hypomagnesemia

Answer 29

Diuretics, diabetic ketoacidosis, hyperparathyroidism, hyperaldosteronism

Question 30

Signs and symptoms of hypomagnesemia

Answer 30

Neuromuscular hyperirritability, tremors, involuntary repetitive movements, insomnia, personality changes, increased heart rate with arrhythmias

Question 31

Causes of hypermagnesaemia

Answer 31

Renal failure

Question 32

Signs and symptoms of hypermagnesemia

Answer 32

Depressed neuromuscular function, depressed reflexes, lethargic, cardiac arrhythmias