Fluids and Electrolytes Flashcards by Elizabeth McGee

Normal Range: Sodium (Na)

135-145 mEq/L

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Uses of Sodium

Regulates water (water follows salt)
Important for brain, nerves, muscle cells
*Must be replaced/shifted slowly

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Normal Range: Chloride (Cl)

90-108 mEq/L

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Uses of Chloride

Works with Na to maintain fluid balance
Binds with H to form stomach acid (HCl)
Inversely related to bicarbonate
Directly related to Na and K

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Normal Range: Potassium (K)

3.5-5.0

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Uses of Potassium

Responsible for nerve conduction
Important in heart and skeletal muscle contraction
Important in acid-base balance (acidic indicates increased K)

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Hypernatremia S/Sx

FRIED & SALTED

Fever (low grade)
Restlessness and Agitation
Increased fluid retention
Edema (peripheral and pitting)
Dry Mouth

Skin flushed
Altered LOC and Confusion
Thirst
Elevated blood pressure
Decreased energy

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Hypernatremia Management

FLAG

Free water administration
Loop diuretics
Agent causing (remove)
Give fluids IV

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Hyponatremia Causes

MOBS Fail

Meds (diuretics)
Oral gastric tube suctioning
Burns
SIADH

Failure (heart, kidney, liver)

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Hyponatremia S/Sx

LOW SODIUM

LOC altered
Orthostatic hypotension
Weak muscles

Seizures
Osmolarity low (serum)
Diarrhea
Increased ICP
Urine osmolarity high
More bowel sounds

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Euvolemic Hyponatremia Management
(Water in body increases, Na stay the same)

Restrict free water
Sodium tablets
Osmotic diuretics
Encourage high salt diet

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Hypervolemic Hyponatremia Management
(Water increases and dilutes amount of Na in body)

Restrict free water
Sodiu tablets
Osmotic diuretics
Encourage high salt diet

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Hpovolemic Hyponatremia Management
(Water and Na both lost)

Restore volume and sodium
-Mild: 0.9% NS
-Severe: 3% NS

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High Salt Foods

Anything processed
Bacon
Butter
Canned food
Cheese
Hot dogs
Lunch meat
Processed food
Table salt

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Causes of Hyperkalemia

MACHINE

Medication (ACE inhibitors, K-sparring diuretics)
Acidosis
Cellular destruction
Hypoaldosteronism
Intake
Nephrons-renal failure
Excretion impaired

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Hyperkalemia S/Sx

Muscle cramps
Urine abnormalities
Respiratory distress
Decreased cardiac contractility
EKG changes
Reflexes (depressed/absent DTRs)

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Hyperkalemia Management

CRIED

Calcium IV
Remove sources of K
Increase K excretion (diuretics, Kayexalate)
Enhance K uptake into cells (D5W + regular insulin, albuterol, sodium bicarb)
Dialysis

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High Potassium Foods

Milk/Dairy
Oranges
Avocados
Dried beans
Salmon
Bananas

Causes of Hypokalemia

DITCH

Drugs (Laxatives, diuretics, Corticosteroids)
Inadequate K intake
Too much water
Cushing’s Disease
Heavy fluid loss

Hypokalemia S/Sx

6 L’s

Lethargy
Low/Shallow respirations
Limp mucles
Lethal dysrhythmias
Leg cramps
Lots of urine output

Hypokalemia Management

POD

Potassium IV (NEVER push!)
Oral potassium
Diet rich in potassium

Hyperkalemia ECG changes

Wide, flat P waves
Prolonged PR interval
Widened QRS complexes
Depressed ST segment
Tall, peaked T waves

Can lead to heart block or V fib, eventually to cardiac arrest

Hypokalemia ECG changes

Slightly peaked P wave
Slightly prolonged PR interval
ST depression
Flat/shallow/inverted T waves
Prominent U wave

Normal Range: Calcium (Ca)

9.0-10.5

Uses of Calcium

Stored in bones, absorbed by GI system, excreted by kidneys Important for bones, teeth, nerves, and muscles Important for coagulation Controlled by PTH and Vitamin D Inverse relationship with Phosphorus

Normal Value: Phosphorus

3.0-4.5 mg/dL

Uses of Phosphorus

Major role in cellular metabolism and energy production Makes up phospholipid layer of cell membranes Large component of bones and teeth Inverse relationship with Ca

Normal value: Magnesium (Mg)

1.6-2.6 mg/dL

Uses of Magnesium

Stored in bones and cartilage Major role in skeletal muscle contraction Important for ATP formation Activates vitamins Necessary for cellular growth Directly related to Ca

Causes of Hypercalcemia (also Hypophosphatemia and Hypermagnesmia)

MD SPIED Malignancy Diuretics Steroids Parathyroid (hyperparathyroid) Immobilization Endocrine (Addison's) Deficient Vitamin D

Hypercalcemia Management

Reduce dietary calcium intake Cadiac monitoring IV fluids (NS preferred) Loop diuretics Encourage oral hydration Dialysis Calcium binders

Causes of Hypocalcemia (also Hyperphosphatemia and Hypomagnesmia)

CHAMP Celiac, Crohn's disease Hypoparathyroid/Hyperphosphatemia Alcoholism Malnutrition/Malabsorption Pancreatitis

Hypocalcemia S/Sx

CATS Convulsions Arryhythmias Tetany Spasms

High Calcium and Vitamin D foods

Calcium: Dairy Soy/Tofu Green vegetables Almonds Vitamin D: Tuna Cod liver oil Egg yolk Oily fish Both: Milk Sardines Salmon Cereal

Foods high in Phosphorus

Dairy Ceans Meat Nuts Seeds Grains Chocolate Colas

S/Sx of Fluid Volume Excess

Bounding pulses Hypertension Jugular vein distention Edema Good urine output Pale, dilute urine Wt gain (daily weights--> watch for gain of 2-3 lbs/day)

S/Sx of Fluid Volume Deficit

Weak pulses Hypotension Poor skin turgor Poor urine output Dark, concentrated urine Wt loss

Isotonic Fluids?

Do not cause fluid shift Normal saline, Lactated Ringers, D5 in Water

Hypotonic Fluids?

Less tonicity than blood Move fluid out of blood vessels and into cells

Hypertonic Fluids?

More tonicity than blood Move fluid from cells into blood vessels

Uses for Isotonic fluids?

Increase intravascular volume Blood loss Surgery Isotonic dehydration Fluid loss Maintenance fluid NPO status

Uses for Hypotonic fluids?

DKA HHNS Hypernatremia

Uses for Hypertonic fluids?

Hyponatremia Cerebral edema