Fluid and Electrolytes Flashcards
Dehydration
Loss of water alone with increased serum sodium levels
Hypovolemia
Fluid volume deficit related to active fluid volume loss
Characterized by change in mental state, decreased BP, decreased turgor, decreased urine output, dry skin, elevated hematocrit, etc.
Normal BUN
8-23 mg/dL
Normal Creatinine
0.7-1.6 mg/dL
Elevated levels indicate diminished kidney function
Hypokalemia
Decreased potassium
GI losses and renal losses
Hyperkalemia
Increased potassium
Adrenal insufficiency
Hyponatremia
Decreased sodium
Increased thirst and ADH release
Hypernatremia
Increased sodium
Increased insensible losses and diabetes insipidus
Elevated Hematocrit
Indicates decreased plasma volume
Normal Urine Specific Gravity
1.010-1.025
Solutions for Fluid Volume Deficit
IV isotonic electrolyte solutions (Lactated Ringer’s 0.9% NaCl when BP is low, 0.45% NaCl when BP is normal)
Rate of fluid administration depends on severity of initial fluid loss and hemodynamic abilities of the patient
Assessment of Fluid Status
Intake and output, vital signs, central venous pressure, level of consciousness, breath sounds, skin color
Fluid Challenge for those with Decreased Urine Output
Caused by pre-renal azotemia or acute tubular necrosis
Give 100-200 mL of normal saline over 15 minutes
Glomerular Filtration Rate
Nephrons filter blood at a rate of 125 mL per minute
Leads to 1-2 L of urine per day
Simple and Accurate Method of Determining Water Balance
WEIGH THE PATIENT
Intake and Output
Record in milliliters
Daily should be around 2500 mL
Intake includes IV fluids, tube feedings, anything that goes into the body for any reason
Minimum Output should be 30 mL/hour
Hypervolemia
Increased isotonic fluid retention
Caused by simple fluid overload (too much sodium and water), diminished function of homeostatic regulation of fluid (heart failure, renal failure, cirrhosis)
Diagnostic Test Results of Hypervolemia
BUN: decreased due to dilution caused by plasma
Hematocrit: decreased due to dilution caused by plasma
Chest X-Ray: pulmonary vascular congestion
Assessment Findings of Hypervolemia
Crackles in the lungs, edema, distended neck veins, elevated central venous pressure, shortness of breath, elevated blood pressure, bounding pulses, increased respiratory rate, increased urine output
Treatment of Hypervolemia
Diuretics, fluid restriction, sodium restriction, dialysis