Fluid and Electrolytes Flashcards
What does ADH do?
Hypothalomus monitors osmolality of body fluid to secrete ADH from the pituitary to regulate kidneys to excrete or retain water.
What does Renin-angiotensin-aldosterone-system (RAAS) do?
With decreased blood pressure the kidneys release Renin which secretes Angiotensin 1 then 2 which causes the secretion of Aldosterone from the adrenal cortex. Sodium reabsorption occurs to increase water.
What does atrial natriuretic peptide do?
Cardiac atria monitor atrial pressures for an increase thereby causing nephrons to increase sodium excretion. Sodium excretion occurs to decrease water.
What regulates fluid intake?
Thirst, located in hypothalamus, based on plasma osmolality
Serum levels of Na
135-145
What does sodium do?
Regulating ECF volume and distribution
Maintaining blood volume
Transmitting nerve impulses and contracting muscles
Potassium levels?
3.5-5.3
What does potassium do?
Maintaining ICF osmolality
Transmitting nerve and electrical impulses
Regulating cardiac impule transmisson and muscle contraction
Skeletal and smooth muscle function
Regulating acid-base balance
Calcium levels?
8.2-10.2
What does calcium do?
Forming bones and teeth Transmitting nerve impulses Regulating muscle contractions Maintaining cardiac pacemaker Blood clotting Activating enzymes
Magnesium levels?
1.6-2.6
What does magnesium do?
Metabolism Sodium-potassium pump Relaxing muscle contractions Transmitting nerve impulses Regulating cardiac function
What is clinical dehydration?
ECV deficit and hypernatremia combined
What is FVD?
Equal loss of sodium, chloride, bicarbonate, and water in interstitial or vascular volume
What causes FVD?
vomiting, diarrhea, fever, diuretics
S/S of FVD?
Weight loss and thirst
Vascular deficit: orthostatic blood pressure changes; weak, rapid pulse; decreased urine output; slow filling peripheral veins, increased BUN and hematocrit
Interstitial deficit: dry mucous membranes; poor skin turgor
How do we treat FVD?
oral or IV replacement (isotonic)
What is FVE?
Equal increase of sodium, chloride, bicarbonate, and water in interstitial or vascular volume
What causes FVE?
What causes FVE?
excess intake (Na IV fluids or salty foods with water) OR impaired fluid balance regulation (CHF, RF)
S/S of FVE?
Weight gain, increased blood pressure, bounding pulse, fullness of neck veins, possible increased urine output, pulmonary edema (dyspnea, orthopnea, crackles), decreased BUN and hematocrit
Management of FVE?
restriction of sodium, restriction of water, administration of diuretics
What is hypernatremia?
Unequal loss of water relative to solutes or unequal gain of solutes relative to water
Decrease in water intake (NPO) OR water loss (diuresis) OR excess intake of solute (IV fluids)
(Water Deficit or Hyperosmolarity)
S/S of hypernatremia?
Increased serum Na+ level and Confusion, agitation, convulsions, coma, decreased urine output, increased urine concentration, thirst, dry mucous membranes, death
Management of hypernatremia?
water orally or IV (D5W)
Excessive rate of correction may lead to seizures, brain damage, death
What is hyponatremia?
Unequal gain of water relative to solutes or unequal loss of solutes relative to water
Unequal gain of water relative to solutes or unequal loss of solutes relative to water
(Water Excess or Hypoosmolarity)
S/S of hyponatremia?
Decreased serum sodium and lethargy, irritability, confusion, personality changes, anorexia, nausea, vomiting, weakness, cramps, seizures, coma and death
Management of hyponatremia?
treat cause, hypertonic 3% saline and diuretics
Excessive correction has been associated with seizures, brain damage, death
Levels of hypernatremia? Why?
Greater than 145
Decreased water, increased diarrhea, excess intake of sodium
What do you find in physical exam with hypernatremia?
Confusion
Agitation
Convulsions
Coma
Levels of hyponatremia?
Less than 135
What do we find in physical exam with hyponatremia?
Decreased LOC (confusion, lethargy, coma)
Seizures
Muscle cramping
Decreased vomiting, excess water, sweating
What are some isotonic solutions?
Normal Saline 0.9% NaCl (NSS /PSS)
Lactated Ringer’s (LR)
What are some hypotonic solutions? What does it do?
0.45 % NaCl (½ NSS or ½ PSS)
Promotes fluid shifts into cells = Cells Swell
Primarily used to expand intracellular volume.
What are some hypertonic solutions? What do they do?
3% NaCl or 5% NaCl (NSS or PSS)
Dextrose solution greater than 5% (10% or 50% Dextrose solutions)
Promotes fluid shifts out of cells = Cells Shrink
Primarily used to decrease intracellular volume and expand the intravascular space.
What are some IV therapy complications?
