Fluid, Electrolyte, and Acid-base disorders

Question 1

Hx in volume overload

Answer 1

-Volume overload: weight gain, edema, ascites, symptoms of heart failure, dietary sodium intake, changes in medications, noncompliance and IV fluid regimens

Question 2

Hx in volume depletion

Answer 2

• Weight loss
• Thirst
• GI losses
• Urinary losses
• Oral intake
• Insensible losses
• IV fluid regimens

Question 3

Hx in electrolyte problems

Answer 3

• Diuretics
• Other medications
• GI losses
• Relevant medical conditions (heart failure, liver disease, renal disease, pulmonary disease, CNS disease, malignancy)

Question 4

PE in fluid and electrolyte disorders

Answer 4

• Orthostatic vitals
• Signs of fluid overload (peripheral edema, pulmonary edema, ascites, edema)
• Signs of volume depletion (tachycardia, orthostatic hypotension, dry mucous membranes, poor skin turgor)
• Signs of sodium disorder (lethargy, weakness, encephalopathy, delirium, seizures)
• Signs of potassium disorder (weakness, fatigue, constipation, ileus, cramping, tetany, hypo/hyperreflexia)
• Signs of calcium disorders (cramping, tetany, Chvostek’s and Trousseau’s sign, seizures, anorexia, constipation, polyuria, hypo/hyperreflexia, stupor, coma)

Question 5

Potential labs in electrolytes and fluid disorders

Answer 5

• Serum electrolytes, BUN/Cr
• Anion gap
• ABG
• Serum and urine osmolality
• Urinary sodium
• FeNa
• ECG findings in hyper/hypokalemia

Question 6

Counseling in fluid and electrolyte disorder

Answer 6

• Explain why IV fluids are needed
• Dx, Tx, f/u
• Elicit questions and input