Fluid and Electrolytes & Acid Base Balance Flashcards
Intracellular makes up _____ of totatl body water
2/3
Extracellular is made up of ______, _______, and __________ and makes up _________ of the bodys total water
- Intravascular
- Transcellular (CSF, Pleural, Peritoneal, Synovial)
- Interstitial
1/3
Dehydratyion leads to ______
Hemoconcentration
- Increased hematocrit
- Increased BUN
Increased serium sodium
- Increased blood osmolality
- Increased urine specific gravity
Fluid overload leads to
- Decreased H&H
- Decreased blood osmolality (Water fluid excess only)
- Decreased urine sodium, specific gravity
- Decreased BUN
Hyponatremia causes
Losing Na+
- GI losses
- Wound/burn losses
- Medications (diuretics)
Gaining fluid
- Excess H2O intake
- Dilutional overload
- Renal failure
- Medications (ADH, SSRIs)
Hypernatremia Causes
Gaining Na+
- Excess Na+ intake
- Hypertonic fluids
- Hypertonic feeds
Losing Fluid
- Decrease H2O Intake
- GI, Wound/Burn losses
- Sweating/Heat stroke
- Medications (steroids)
Hyponatremia presentation
Neuro
- Cerebral edema
- Confusion, lethargy. irritability -> Coma
- Muscle cramps, decreased DTR
- Siezures
- NV
Hypernatremia presentation
- Thirst, Dry mucus membranes
Neuro
- Confusion, lethargy, irritability -> Coma
- Muscle Twitching, Altered DTR
- Resp compromise
- Seizures
Hyponatreamia treatment
Too little Na+
- PO intake
- Hypertonic saline solutions
Too much H2O
- Fluid restriction
- Drugs blocking ADH
Hypernatremia Treatments
Too much Na+
- Diuretics
Too little H2O
- PO intake
- Isotonic IV fluids
Hypokalemia Causes
Losing K+
- Decreased intake
- GI losses
- Metabolic alkalosis
- Diabetic ketoacidosis
- Renal disease
- Medications (diuretics)
Gaining fluid
- Diultional overload
Hyperkalemia causes
Gaining K+
- Increased intake (salt subs)
- Diuretics, ACE-I
- Acidosis
- Renal failure
Losing fluid
- Hemoconcentration
Hypokalemia presentation
GI - constipation, paralytic ileus
Cardiac - hypotension, arrhythmias, EKG: flat T-wave, U-wave
Neuro/MSK - fatigue, muscle weakness, resp compromise
Hyperkalemia Presentation
GI - diarrhea
Cardiac - hypotension, arrhythmias, EKG: peak T-wave, wide QRS, PVC/VF
Neuro/MSK - restlessness, irritability, muscle weakness, paresthesias
Potassium Exception to the Rule
HAM
- Hypotension
- Arrhythmias
- Muscle weakness
It occurs in both Hypo and Hyperkalemia
Hypokalemia treatment
Too little K+? → add K+
PO or IV intake
NEVER BOLUS
Too much fluid? → decrease fluid
Potassium-sparing diuretic
Respiratory Acidosis causes
Hypoventilation/Shallow breathing
Airway constriction
Damage to respiratory center in medulla
Hyperkalemia Treatment
Too much K+? → decrease K+
Dialysis/Diuretics (wasting)
Insulin + glucose, albuterol
Calcium gluconate
Kayexalate
Too little fluid? → Increase fluid
Respiratory Alkalosis causes
Hyperventilation (asthma, anxiety, high altitude)
Metabolic Acidosis causes
Severe diarrhea
Kidney failure
Diabetes mellitus
Excess alcohol ingestion
Metabolic Alkalosis causes
Constipation for prolonged periods
Ingestion of excess sodium bicarbonate
Diuretics which cause potassium depletion
Severe vomiting
Acidosis signs and symptoms
Headache
Confusion, drowsiness
Increased RR
Hypotension, decreased cardiac output, dysrhythmias, palpitations
Shock
Alkalosis signs and symptoms
Lightheadedness
Inability to concentrate
Numbness, tingling
Tinnitis
Management of pediatric fluids
Assessment: same as adults other than:
- Fontanels
- Weight loss or gain = big sign of fluid status changes
Fluid Therapy:
- Maintenance fluids: calculated based on weight
- Dextrose in maintenance fluids
- Rehydration bolus: 20mL/kg unless cardiac patients
