fluid and electrolytes archer Flashcards
normal sodium levels
135-145
causes of euvolemic hypernatremia
increased insensible water loss
diabetes insipidus
treatment of euvolemic hypernatremia
give po water
causes of hypovolemic hypernatremia
dehydration
diarrhea
burns
NPO
vomiting
diuretics
treatment of hypovolemic hypernatremia
give isotonic fluids “NS”
causes of hypervolemic hypernatremia
hypertonic IV
increased sodium intake
cushings
sodium bicarb
corticosteroids
hyperaldosteronism
treatment of hypervolemic hypernatremia
stop sodium and water
find cause
loop diuretics
free water administration
Neuro changes in hypernatremia
restless
agitated
lethargic
drowsy
stupor
coma
musculoskeletal signs of hypernatremia
twitching
cramps
weakness
cardiovascular signs of hypernatremia
fever
HYPERVOLEMIC-
edema
hypertension
bounding pulse
HYPOVOLEMIC
hypotension
weak pulse
misc signs of hypernatremia
flushed skin
decreased top
dry mouth
causes of euvolemic hyponatremia
SIADH
adrenal insufficiency
addisons
polydipsia
excessive hypotonic IVF
low dietary sodium
causes of hypervolemic hyponatremia
CHF
kidney failure
liver failure
water intoxication
treatment for euvolemic/hypervolemic hyponatremia
restrict free water
osmotic diuretics
sodium tablets
increased sodium in diet
causes of hypovolemic hyponatremia
vomiting
diarrhea
ng suction
diuretics
burns
excessive sweating
treatment for hypovolemic hyponatremia
mild 0.9 NS
severe 3 NS
near signs of hyponatremia
seizures
confusion
lethargy
stupor
cerebral edema
increased ICP
musculoskeletal signs of hyponatremia
abdominal cramps
weakness
shallow respirations
decreased deep tendon reflexes
muscle spasm
orthostatic hypotension
cardiovascular signs of hyponatremia
HYPOVOLEMIC
weak pulse
tachycardia
dizziness
HYPERVOLEMIC
bounding pulses
hypertension
what rate should you replace sodium
0.5%meq/hr too fast causes cerebral edema and increased icp
characteristics of chloride
inversely related to bicarb
directly related to sodium and potassium
chloride lab values
96-108
causes of hypochloremia
FLUID LOSS
sweating
dehydration
vomit
STEROIDS
cushings
excess corticosteroids
excessive normal saline
treatment of hyperchloremia
treat underlying cause
correct imbalance
give bicarb
discontinue sodium products
use LR instead of NS
monitor all electrolytes
causes of hypochloremia
CHF
water intoxication
SALT LOSS
sweating
burns
vomiting
diarrhea
cystic fibrosis
addisons
treatment of hypochloremia
treat underlying cause
correct imbalance (0.9% ns)
monitor all electrolytes
normal potassium levels
3.5-5
characteristics of potassium
responsible for nerve impulse conduction
acidotic has increased potassium
causes of hyperkalemia
too much potassium from intercellular to extracellular
-burns
-tissue damage
-dka
too much total potassium
-renal failure
excessive potassium intake
medications
-ace inhibitors
potassium sparing diuretics
signs hyperkalemia
muscle weakness
numbness
increased bowel sounds
impaired contractility
EKG CHANGES
shallow respirations
cramping
diarrhea
decreased CO
treatment for hyperkalemia
DRIVE POTASSIUM INTO CELLS
d5w + regular insulin
albuterol
bicarb
REDUCE TOTAL BODY K
kayexalate
diuretics
dialysis if other treatment doesn’t work
MONITOR CARDIAC RHYTHM
IV calcium gluconate or chloride
causes of hypokalemia
POTASSIUM WASTING DRUGS
laxatives
diuretics
corticosteroids
cushings
INADEQUATE PO INTAKE
NPO, poor diet
anorexia, bulimia, alcoholism
DILUTING K IN BLOOD-TOO MUCH WATER
FLUID LOSS
NG suction
vomiting
wound drainage
signs of hypokalemia
weak muscles
cramps
decreased deep tendon reflexes
facility
shallow respirations
decreased bowelsounds
constipation
increased uop
orthostatic hypotension
weak thready pulse
cardiac arrhythmia
treatment of hypokalemia
prevent arrhythmia/ hold digoxin
give potassium
orally with food to prevent GI upset
IV
diet with potassium
normal calcium levels
9.0-10.5
characteristics of calcium
important for bones, teeth, nerves and muscles
important for coagulation
controlled by PTH and vitamin D
inverse relationship with phosphorus
cause of hypercalcermia
excessive intake of calcium
excessive vitamin D
vitamin D toxicity
bone cancer
immobility
glucocorticoids
neuromuscular sinus of hypercalcemia
weakness
flaccidity
decreased deep tendon reflexes
cardiovascular signs of hypercalcemia
bradycardia
cyanosis
dVT
gastrointestinal signs of hypercalcemia
decreased peristalsis
decreased bowel sounds
abdominal pain
nausea
vomiting
constipation
kidney stones
treatment of hypercalcemia
reduce dietary calcium
cardiac monitoring
IVF (NS)
loof diuretics
encourage oral hydration
dialysis
calcium binders
causes of hypocalcemia
renal failure
acute pancreatits
malnutrition
alcoholism
bulemia
vitamin d deficiency
hypoparathyroid
hyperphophatemia
neuromuscular signs of hypocalcemia
irritability
hallucinations
paresthesia
tetany
seizures
muscle spasm
CHVOSTEKS SIGNS
TROUSSEAUS SIGNS
gastrointestinal signs of hypocalcemia
increased bowel sounds
cramping
diarrhea
misc signs of hypocalcemia
weak bones
weak brittle nails
arrhythmias-V-TACh
treatment of hypocalcemia
PO supplements with vitamin d to increase absorption
IV calcium supplement
calcium rich diet
normal phosphorus levels
3.0-4.5
characteristics of phosphorus
inverse relationship with calcium
component of bones and teeth
makes phospholipid bilayer
causes of hyperphophatemia
excesive dietary intake
tumor lysis sundrome
renal failure
hypoparathyroid
treatment of hyperphophatemia
phosphate binders (give with food)
manage hypocalcemia
causes of hypophosphatemia
malnutrition
alcoholism
TPN
hyperparathyroidism
treatment of hypophosphatemia
phosphorus replacement
PO
IV- give slowly
phosphorus rich diet
diet low in calcium
magnesium lab values
1.6-2.6
characteristics of magnesium
stored in bone and cartilage
role in muscle contraction
activates vitamins
directly related to calcium
causes of hypermagnesemia
excessive dietary intake
too many magnesium containing meds- antacids
overcorrection hypomagnesemia
renal failure (time not friends with calcium)
neuromuscular signs of hypermagnesemia
weakness
shallow breathing
cardiovascular signs of hypermagnesimia
bardycardia
hypotension
vasodilation
near signs of hypermagnesemia
drowsy
lethargic
coma
treatment of hypermagnesmia
hold fluids and meds containing magnesium
loop diuretics
calcium gluconate
dialysis
causes of hypomagnesemia
ALCOHOLISM
malnutrition
malabsormed
hypoparathyroid
hypocalcemia
diarrhea
neuromuscular signs of hypomagnesemia
numbness
tingling
cramping
tetany
seizures
increased deep tendon reflexes
neuro signs of hypomagnesemia
psychosis
confusion
cardiovascular symptoms
torsades de pointes
Gi signs of hypomagnesemia
nausea
vomiting
abdominal cramps
anorexia
treatment of hypomagnesemia
monitor cardiac rhythm
give IV magnesium very slowly
PO magnesium
characteristics of isotonic IV fluids
osmolarity similar to blood
does not cause fluid shift
uses of isotonic IVF
increase volume
blood loss
surgery
isotonic dehydration
fluid loss
maintenance fluid
NPO client
types of isotonic fluid
0.9% NS
lactated ringers
D5W
What is special about D5W
it is isotonic on its own but hypotonic in the body
Characteristics of hypotonic IV fluid
osmolarity lower than blood
molders fluid out of blood and into cells
uses for hypotonic IVF
DKA
HHSN
hypernatremia
types of hypotonic fluids
0.45% sodium chloride (1/2 NS)
0.33% or 0.2% sodium chloride
D5W
D2.5W
characteristics of hypertonic IV fluid
osmolarity higher than blood
moves fluid out cells and into vascular/interstitial space
uses of hypertonic IVF
hyponatremia
cerebral edema
types of hypertonic IVF
1.5%, 3%, 5% sodium chloride
D5NS
D5LR
D10W
