Fluid and Electrolytes Flashcards
what is osmolality defined as?
is determined by the number of dissolved particles (sodium, urea, & glucose) per kilogram of water or solvent (sodium being the largest contributor).
what is osmolarity defined as?l
is the number of osmoles of solute in a liter of solution.
what is normal serum osmolality?
270-300 mOsm/L
what does aldosterone release promote?
-sodium reabsorption and potassium excretion
-(water follows Na) decreased water loss
what does ADH promote?
water reabsorption
what is an example of hypotonic fluids?
-1/2 NS or 0.45NS, 0.45% Na Cl
-D5W
when should hypotonic fluids be cautioned? why in these patients?
Beware of administration of Hypotonic fluids to patients with Intra Cellular Fluid Volume Excess (ICFVE).
-Cerebral edema may result.
what is an example of isotonic fluids?
-NS, 0.9% Na Cl
-LR
what are some examples of hypertonic fluids?
-D51/2NS
-D5NS
-D5LR
-3% NS
-D10
-D50
what are some s/s of dehydration?
-thirst
-dry membranes
-lethargy, confusion
-hypotension
-tachycardia
-low-grade temp
-weight loss
-decreased UO
-metabolic acidosis
-hypoxia (viscous RBC)
what are some causes of dehydration?
-vomiting/diarrhea
-low Na or no Na intake
-diabetes insipidus
-no H2O intake or fluid loss
-diuretics
-constipation medication
what are the lab values expected for those with dehydration?
-concentrated
-increased solutes
what are some interventions for dehydration?
-encourage fluids
-IV fluids: LR, D5NS, 0.9% NS
-supplemental O2 (hypoxia)
-monitor I & O
-monitor daily weights
-monitor BP
what are some s/s of hypervolemia?
-edema
-Pulmonary edema: crackles
-JVD
-lethargy, confusion
-alterations in NA
-hypertension
-tachycardia
-hypoxia, low Hgb
-weight gain
-decreased UO
what are the causes of hypervolemia?
-CHF
-too much fluid (PO or IV)
-renal injury or disease
what are the expected lab values of hypervolemia?
-diluted
-decreased solutes, increased fluids
what are some interventions for hypervolemia?
-diuretics
-Na and H2O restrictions
-monitor daily weights
-monitor I & O
-assess IV fluids (rate? stop?)
-monitor BP
what is the power of 3 CBC?
- RBC= 5
- Hgb= 15
- Hct= 45
what is the normal range for Mg? what is the memory key?
-1.8-2.6
-M for muscle
what is the normal range for Phos?
2.5-4.5
what is the normal range for K? what is the memory key?
-3.5-5
-K for Kardiac
what is the normal range for Ca? what is the memory key?
-9-10.5
-Ca for calm
what is the normal range for CL?
95-108
what is the normal range for Na? what is the memory key?
-135-145
-N for neuro
what is addisons disease? how is it treated?
an adrenal gland disorder where the patient lacks appropriate cortisol and aldosterone to maintain body function. (this can be treated/activated with corticosteroids)
what are some causes of hyponatremia?
-diarrhea
-vomiting
-burns
-sweating
-GI suctioning
s/s of hyponatremia
-neuro! lethargy, headache, confusion, seizures, coma
-N/V, muscular weakness, diminished reflexes
how do we treat hyponatremia?
-assessments (neuro)
-IV NS or D5NS
-increase Na in diet
-daily weights
-admin steroids
what are some causes of hypernatremia?
-severe N/V
-steroids or Cushing syndrome
-stress (cortisol release)
what is Cushing syndrome?
promotes Na retention and K excretion because of additional release of aldosterone and cortisol)
what are the s/s of hypernatremia?
-thirst
-s/s of dehydration
-orthostatic hypotention
-N/V & anorexia
how do we treat hypernatremia?
-Na free IV fluids
-daily weight
-Na restrictions
causes of hyperkalemia?
-Oral K supplements: too much intake
-K sparing diuretics (spironolactone), ACE inhibitors, NSAIDS
-↓ renal function
-Metabolic acidosis
-Addison’s disease
what are some s/s of hyperkalemia?
-abd cramping
-EKG changes (peaked T-wave)
-bradycardia
-muscle weakness
-oliguria
how do we treat hyperkalemia?
meds:
-ca gluconate
-furosemide
-Polystyrene sulfonate (Kayexalate)
-insulin + D50
-hold K-containing meds
monitor EKG
Dialysis
what are some causes of hypokalemia?
-Malnutrition,
-Vomiting, diarrhea,
-K-wasting diuretic: furosemide
-Metabolic Alkalosis
-Steroid use/Cushing syndrome - increased secretion of cortisol and aldosterone
what are some s/s of hypokalemia?
-early: weakness, leg cramping
-dysrhythmias
-irregular HR
how do we treat hypokalemia?
-IV KCL
-monitor EKG
-monitor for dig toxicity (low K enhances the action of dig)
-oral K replacement in rich foods
when Ca levels are high _____ levels are low.
Phos
what are some causes of hypercalcemia?
-hyperparathyroidism
-↓ serum phosphorus
-some cancers
-steroid therapy-Steroids promote Ca loss from the bone
-medications
hypercalcemia s/s?
*↓ neuromuscular excitability →
↓ GI motility (constipation & diminished bowel sounds), lethargy, depression – progressing to stupor and coma
*Calcium containing kidney stones (#1 cause of kidney stones)
*Pathologic fractures
*AV heart blocks
how do we treat hypercalcemia?
-calcitonin
-biophosphonates
-loop diuretics
-fluids
-safety: weakness, neuro checks
what are some causes of hypocalcemia?
*Parathyroid or thyroid surgery; Hypoparathyroidism
*↓ Ca consumption & Vitamin D deficiency
*Abuse of antacids & laxatives
*Diarrhea & diuretics
*CKD, ESRD
*↓ albumin (liver disease, alcoholism)
*Prolonged NG suction leads to Metabolic Alkalosis. Alkalosis ↑ Ca binding to albumin, which ↓ Ca
*Magnesium imbalances
s/s of hypocalcemia?
CNS excitability leads to the following:
*Irritability; numbness and tingling around the mouth, hands, and feet;
*Tetany of the face and extremities
oChvostek’s sign: facial tap causes cheek tetany.
*Hyperactive deep tendon reflexes
*Abd distention/cramps
how do we treat hypocalcemia?
*Medications: V Calcium Gluconate or Calcium chloride
oCorrection of magnesium deficiency; Vit D therapy
*Monitor Ca level following thyroid and parathyroid surgery
what is the major cause of hypophosphatemia?
- increased renal excretion (kidney injury or renal disease)
what is one major cause of hypermagnesemia?
-Rare, but usually caused by renal injury/renal disease or excessive intake of magnesium containing antacids/laxatives
