Fluid And Electrolytes Flashcards
What are the primary ECF ions?
There are two
Sodium and Chloride
What are the primary ICF ions?
There are two. P&P
Potassium and Phosphate?
What are the ways of movement for facilitation?
There are four; eight advanced
Diffusion (Passive and Facilitated), Active Transport, Osmotic, Pressure (Hydrostatic and Oncotic)
(T/F) The cell swells during hypotonic ECF
True
Think opposite; hypotonic causes swelling, hyper causes shrinking
(T/F) The cell swells for hypertonic ECF?
False, the cell shrinks
Think opposite, hypertonic causes shrinking and hypo causes swelling
What is Hydrostatic Pressure? What is an example
PUSHES force of fluid against cell wall. Ex: Blood pressure
What is oncotic pressure?
PULL force of proteins, attracting water from one space to another
(T/F) The first spacing is normal ICF and ECF
True
What and where is second spacing? Give an example of what second spacing would look like.
Abnormal increase located in INTERSTITIAL FLUID. Example: edema
What and where is third spacing? Give an example.
Excess fluid in NON-FUNCTION spaces around CELLS. Example is ascites and edema from burns.
(T/F) It is easy to move third spacing fluid back to ICF or plasma
False, fluid is trapped and difficult to move back to ICF or plasma.
What are the three processes that help keep water and electrolyte balance?
There are four
Intake and Absorption
Distribution
Output
(T/F) The antidiuretic hormone (ADH) regulates water excretion only
True, the ADH encourages kidneys to hold onto water
(T/F) The RAAS system (Renin-Angiotensin-ALDOSTERONE-System) regulates water and sodium.
True, Aldosterone encourages kidneys to hold onto water and sodium
What is the difference between dehydration and hypovolemia?
Hint: What cation moves with water?
Dehydration is loss of water alone while hypovolemia is loss of water and sodium
What causes hypovolemia?
There are four causes
Abnormal loss, Inadequate intake, Shift from plasma to interstitial fluid, Third Spacing
What are interventions for hypovolemia?
There are two
Replace water and electrolytes with options like isotonic fluids and blood transfusions.
(T/F) 1kg of weight equals 1 liter of fluid retention
True, this is why it’s important to do daily weights for patients with fluid imbalances.
What is the lab value for Hct?
Equals ten by adding and then multiplying
37-52%
What is the lab value for BUN?
This is not Urine Specific Gravity; it is a whole number
10-20mg/dL
What is the lab value for Urine Specific Gravity:
1.010-1.025
What is the normal range for sodium?
136-145 mEq/L
(T/F) Water follows sodium
True, this is why sodium imbalances are closely related to water imbalances
What are the causes for hypernatremia?
There are two
Low water intake, excess water loss
What are some symptoms associated with hypernatremia?
FRIED and SALTED acronyms
Fever (low grade)
Restlessness and agitation
Increased fluid retention
Edema (peripheral and pitting)
Dry mouth
Skin flushed
Altered LOC and confusion
Low urinary output
Thirst
Elevated Blood pressure
Decreased energy
What is the management for hypernatremia?
There are five things to manage it
Think what you want to do to manage excess sodium
Water deficit (replace isotonic fluids)
Sodium excess: replace with sodium free fluids
Sodium restrictions
Monitor lab levels
Safety (seizure precautions)
What causes hyponatremia?
There are two causes
Loss of sodium-rich fluids (ex: wounds, diarrhea, vomiting), and water excess
What are symptoms of hypocalcemia?
Acronyms: SALT LOSS
Stupor/coma
Anorexia
Lethargy
Tendon reflexes go down
Limp muscles
Orthostatic Hypotension
Seizures
Stomach Cramping
What is management for hyponatremia?
There are five
Isotonic or sodium containing fluids
PO intake
Water excess: restrict fluids
Monitor labs
Monitor I&Os
What is the range for hyponatremia?
Less than (<) 136
What is the range for hypernatremia?
More than (>) 145
What is the normal range for potassium?
3.5-5.0 mEq/L
What is the function for potassium?
There are two
Neuromusclar and cardiac
(T/F) Potassium is inversely related to sodium regulation
True; When sodium goes up, potassium goes down and vice-versa.
What is the range for hyperkalemia?
More than (>) 5.0
If the range is 3.5-5.0, then anything above it is hyper.
What are the causes for hyperkalemia?
There are four
Impaired ouput (ex: kidney failure)
Increased intake
Shift from ICF to ECF
Certain medications (ex: Digoxin, Propranolol, Hydrocholride)
What are the clinical manifestations for hyperkalemia?
There are eight
Cell excitability
Electrocardiac changes
Dysrhythmia
Muscle cramps; tetany numbness/tingling
Diarrhea, cramping, vomiting
What are managements for hyperkalemia?
There are five
Stop potassium intake
Increase potassium excretion (ex: diuretics)
Calcium gluconate–reverses effects on cardiac
Cardiac monitoring
Labs: CMP
Bold is what might be on a case-study like question (my suspcions alone)
What is the range for hypokalemia?
Less than(<) 3.6
Range for potassium is 3.6-5.0
What are causes for hypokalemia?
There are three
Potassium loss (GI, Renal, low Magnesium)
Decreased intake
Shift from ECF to ICF
What are clinical manifestations for hypokalemia?
There are five
Impaired muscle contractions
Electrocardiac changes
Dysrhythmias
Weakness
Parethesias (numbness/tingling)
What are managements for hypokalemia?
There are four
PO/IV potassium chloride (KC1)
Potassium rich foods
Cardiac monitoring
Monitor labs (CMP)
Safety: Never crush or give KCL pills and IV push respectively. If given IV, slow push with monitoring
What does diuretics do to sodium and water?
Reduces sodium and water reabsorption; water and sodium loss.
What is the normal range for calcium?
9.0-10.5 mg/dL
What does calcium contribute to?
BONES, muscle contraction (including the heart)
What controls calcium regulation?
There are two
The parathyroid horomone (PTH) and Calcitonin
So if you lose your thyroid your calcium can go out of wack.
(T/F) The Thyroid gland will relase calcintonin to cause a fall in blood calcium levels
True
(T/F) The thyroid will relase the parathyroid hormone (PTH) to cause a rise in blood calcium levels
True
What are the causes for calcium imbalances?
There are four
Hyperparathyroidism
Cancer
Tumors
Bone breakdown
Remember, PTH causes a rise in calcium, so if you’re getting an excess of the hormone your calcium will rise
What is the range for hypercalcemia?
More than (>) 10.5
Range is 9.0-10.5
What are clincial manifestations for hypercalcemia?
There are two important ones, two kinda important ones
Sedative symptoms
Fatigue, weakness, confusion, seizures, coma
Bone pain
Dysrhythmias
Kidney stones
Nausea, vomiting, anorexia
Increased BP
Bold is what I think can turn up, italics are possibiltiies (50/50)
What are the symptoms of hypercalcemia based on rhyme “bones, stones, groans, and psychiatric overtones”
Bones–abnormal bone remodeling and fracture risk
Stones–kidney stones!
Groans–abdominal cramping, nausea, ileus, constipation
Psychiatric overtones–Lethargy, depressed mood, psychosis, cognitive dsyfunction
What are managements for hypercalcemia?
There are five, one important
Weight-bearing activity
Hydration (3-4L)
Biphosphonates
Calcitonin (injection)
Dialysis
Hydration to dilute water. Calcitonin brings your calcium levels down.
What is the range for hypocalcemia?
Less than (<) 9.0
Range is 9.0-10.5
What are the causes for hypocalcemia?
There are three
Low PTH (Parathyroid removal, radiation)
Chronic alcohol use
Diarrhea
What are clinial manifestations for hypocalcemia?
There are six, three important
Nerve excitability
Tetany
Chvostek sign
Trousseau sign
Numbness/tingling (extremities and circumoral)
Cardiac changes
What is the difference between tetany and Trousseau sign?
Tetany is muscle contractions, Trousseau sign is a carpopedal spasm that can be a sign of latent tetany
What is management for hypocalcemia?
There are five, two important
Diet (Vitamin D)
Supplements
Calcium Gluconate (IV)
Post-surgical management
Monitor labs (CMP)
Vitamin D helps with absorption of calcium
What is the normal range for phosphorous?
3.0-4.5
(T/F) Phosphorous has a inverse relationship with calcium
True
Balanced with PTH and kidneys
What is the range for hyperphosphatemia?
Greater than (>) 4.5
What are causes for hyperphosphatemia?
There are four
Kidney injury/disease
Laxatives/enemas
Shift from ICF to ECF
Hypoparathyroidism
Inverse relationship with calcium, if the PCT is down then phosphorus goes up.
What are clinical manifestations of hyperphosphatemia?
There are four
Same as symptoms of hypocalcemia (nerve excitability, tetany, paresthesias)
Soft tissue calcium deposits
What are the managements for hyperphosphatemia?
One important one, four total
Treat underlying cause
Dietary restrictions
Calcium carbonate (Tums)
Hemodialysis
What is the range for hypophosphatemia?
Less than (<) 3.0
Range is 3.0-4.6
What are the causes for hypophosphatemia?
There are three, eight advanced
Decreased absorption (malnourishment, high use of certain antacids, diarrhea, chronic alcohol use
Increased excretion (diarrhea)
ECF to ICF shift (respiratory alkalosis)
What are the clinical manifestations of hypophosphatemia?
Central Nervous System (CNS) depression
Weakness
Pain
Respiratory or heart failure
Rickets/osteomalacia
What is the management for hypophosphatemia?
Diet or supplements
IV phosphate
Monitor labs (CMP)
What is the normal range for magnesium imbalance?
1.3-2.1 mEq/L
What does magnesium contribute to?
Muscle contractions/relaxations
Neuro function
(T/F) Magnesium has a close parallel relationship with calcium
True, when calcium rises so does magnesium and vice versa
What is magnesium regulated by?
There are two
GI and Kidneys
What is the range for hypermagnesium?
Greater than (>) 2.1
What are the causes of hypermagnesium?
There are three
Increased intake
Renal problems
Magnesium-containing medications
What are the clincial manifestations of hypermagnesium?
There are ten
Decreased BP and HR
Facial flushing
Nausea/vomiting
Lethargy
Muscle paralysis, weakness, decreased deep tendon reflexes (DTR)
Coma
Cardiac or respiratory arrest
What are the managements for hypermagensium?
There are five
Dietary limitations
Increase fluids
Diuretics
Dialysis
Calcium Gluconate (for cardiac muscle)
What are the range for hypomagnesium?
Less than (<) 1.3
What are the causes for hypomagnesium?
There’s five
Diet
GI or renal loss
Chronic alcohol use
Meds: diuretics, proton pump inhibitors (PPIs), some antibiotics
Pancreatitis
What are the clinial manifestations for hypomagnesium?
There are 10
Same as hypocalcemia
Cramps, tremors, tetany, increased DTR
Chvostek, Trousseau
Confusion, vertigo, seizures
Dsyrhytmias
What are the managements for hypomagnesium?
Treat cause
Diet/supplements
IV magnesium
What are the two fluid imbalances that have symptoms of tetany, Chovestsk, and Trosseau?
Hypocalcemia
Hypomagnesium