Fluids and Electrolytes Flashcards
Functions of water in the body?
Transporting nutrients to cells and wastes from cells
Transporting hormones, enzymes, blood platelets, and blood
Facilitating cellular metabolism and proper cellular chemical functioning
Acting as a solvent for electrolytes and non-electrolytes
Helping maintain normal body temperature
Facilitating digestion and promoting elimination
Acting as a tissue lubricant
What is the total body fluid?
50-60% of body weight
How much of our body weight comes from cell fluid or intracellular fluid?
35-40% of body weight
How much of our body weight comes from extra cellular fluid?
15 to 20% if body weight
5% from plasma (intravascular)
10-15% from interstitial fluid
Define osmosis
Water passes from an area of lesser solute concentration to greater concentration until equilibrium is established
Define diffusion
Tendency of solutes to move freely throughout a solvent (downhill)
Define active transport
Requires energy for movement of substances through the cell membrane from the lesser solute concentration to the higher solute concentration
Define capillary filtration
Passage of fluid through a permeable membrane from the area of higher to lower pressure
Define isotonic
Fluid has the same osmolarity as plasma
Cells neither shrink nor swell with fluid movement.
Define hypotonic
Fluid has fewer solutes than plasma
Osmotic pressure draws water into the cells from the ECF and the cell swells
What is hypertonic?
Fluid has more solutes than plasma
Draws water out of the cells, and into the more highly concentrated ECF and the cell shrinks
What are some examples of isotonic IV fluids?
0.9% normal saline
Ringers lactate
What are some examples of hypotonic IV fluids?
0.45% NS
D5W (because dextrose is used up by the body leaving behind only water)
What are some examples of hypertonic IV fluids?
3% saline
D5NS (normal saline)
D10W
D5LR
D50
Chief function of sodium?
Controls and regulates volume of body fluids
Brain!
Chief function of potassium
Chief regulator of cellular enzyme activity and water content
Heart
Chief function of calcium
Nerve impulses, blood clotting, muscle contraction, B12 absorption
Chief function of magnesium
Metabolism of carbohydrates and proteins, vital actions involving enzymes
Chief function of chloride
Maintains osmotic pressure in blood, produces hydrochloric acid
Chief function of bicarbonate
Bodies primary buffer system
Chief function of phosphate
Involved in important chemical reactions in the body, cell division, and hereditary traits
Reference values for sodium?
Adult: 135-145 mmol/L
Panic values for sodium
<125 or > 150 mmol/L
What are some important functions of sodium?
Major cation in the extracellular fluid
Helps to maintain body fluid, is responsible for conduction of neuromuscular impulses, is involved in enzyme activity
Important in acid base balance
What is hyponatremia and how could you get it?
Less than 135 mmol/L
Results from excessive loss of sodium or an excessive gain of water, diuretic therapy, excessive drinking of water, endocrine disorders
What are symptoms of hyponatremia and what are the treatments?
Symptoms: headache, N&V, confusion, muscle twitching, tremors, weakness, irritability
Treatment: receive oral sodium, supplementation, restrict fluid intake
What is hypernatremia and how can you get it?
Sodium higher than 145 mmol/L
Too much sodium in diet, severe insensible water losses that are not replaced, severe vomiting
Symptoms and treatment of hypernatremia
Symptoms: extreme thirst, restlessness, or agitation, anorexia, N&V, dry sticky tongue and oral mucosa, disorientation, hyperactive reflexes, oliguria and anuria, lethargy
Treatment: prescribed oral/IV therapy and sodium restricted diet
Reference values for potassium
Adult: 3.5- 5.3 mmol/L
Panic values for potassium
< 2.5 and > 7.0 mmol/L
Symptoms and treatment for hypokalemia
< 3.5 mmol/L
Symptoms: muscle weakness or leg cramps, paresthesia, fatigue
Cardiac irregularities, G.I. complaints, EKG changes, decreased reflexes
Treatment: oral supplements of potassium, IV potassium chloride
Causes for hyperkalemia?
> 5.0 mmol/L
Reduced excretion by the kidneys, oliguria due to shock or severe dehydration, potassium sparing diuretics
Symptoms and treatment for hyperkalemia
Symptoms: irritability, paresthesia and numbness in extremities, skeletal muscle weakness, cardiac arrhythmias
Treat treatment: kayexalate (a cation exchange resin, orally or by enema)
Reference values for calcium
Adult: 8.6 - 10 mg/dL
Panic values for calcium
<6.0 and > 14.0 mg/dL
Normal ionized calcium levels
4.5-5.5 mg/dL
Panic levels for ionized calcium?
<2.8 and > 7 mg/dL
What are some important roles for calcium
Major component of bones and teeth
Role in transmitting nerve impulses
Regulates muscle contractions
What are the three components of calcium
Protein bound 47%
Ionized (free) 43%
Complex 10%
How can you get hypocalcemia?
Results from abnormalities of parathyroid hormone (PTH) secretion or from inadequate dietary intake or excessive losses of bound, ionized (unbound), or total body calcium
What are symptoms and treatments for hypocalcemia?
Symptoms: muscle cramps, or tremors, tetany, positive Trousseau’s sign, positive Chvostek’s sign, irritability and anxiety, seizures, arrhythmias, angina, bradycardia, and hypotension
Treatment: calcium supplements orally
or IV Calcium gluconate or calcium chloride.
How do you get hypercalcemia?
Results from increased intestinal absorption of calcium, renal abnormalities can interfere with calcium secretion and excretion, patients with metastatic cancer are especially high risk
Symptoms and treatments of hypercalcemia?
Symptoms: lethargy, muscle weakness or flaccidity, hyporeflexia and decreased muscle tone, polyuria, polydipsia, arrhythmias and cardiac arrest
Treatment: adequate hydration (IV fluids/oral intake), biphosphonates, ambulation
Reference values for magnesium
Adults: 1.5-2.5 mg/dL
Panic values for magnesium
<1.2 and > 4.9 mg/dL
Important roles for magnesium
Second most abundant cation after potassium
Helps maintain normal nerve and muscle functions
Required for the heart to beat normally
Plays a role in almost all chemical processes in the body
How do you get hypomagnesemia?
Excessive losses from G.I. and kidneys, chronic alcoholism, and medications
Symptoms and treatments for hypomagnesemia
Symptoms: neuromuscular irritability, weakness, tremors, dizziness, cardiac irritation, mood changes, tetany, and convulsions
Treatment: oral magnesium, IV magnesium, rich magnesium diet
How could you get hypermagnesemia
Renal failure, adrenal insufficiency, and excessive intake, sepsis, magnesium containing medications
Symptoms and treatments of hypermagnesemia?
Symptoms: feeling of warm/ flushing, hypotension, SOB, drowsiness, and hypoactive reflexes
Treatment: IV calcium gluconate, Lasix, glucose and insulin
Reference values for phosphorus?
2.5- 4.5 mg/dL
Panic value for phosphorus?
< 1.5 mg/dL
Important roles for phosphorus
Second most abundant mineral in the body after calcium
Extremely important in building strong bones and teeth
Needed for repair of all tissues/cells in the body
Plays an essential role in how the body stores and uses energy
Symptoms and treatments for hypophosphetemia?
Symptoms: altered mental status, cardiac arrhythmia, dyspnea, and heart failure
Treatment: oral phosphates, IV phosphates, control the intake through diet
Symptoms and treatments for hyperphosphatemia?
Symptoms: tingling around the mouth, fingertips, delirium, numbness, and muscle cramps
Treatment: control the intake through diet, acetazolamide
What is phosphorus inversely proportional with?
Calcium
What can cause hyperphosphatemia?
Exercise, excessive enema usage, hypoparathyroidism, and dehydration
Reference values for chloride
97-107 mEq/L
Panic values for chloride?
<80 and > 115 mEq/L
Some roles of chloride
Major ECF anion
Acts with sodium to maintain osmotic pressure
Major component of interstitial and lymph fluid- gastric and pancreatic juices, sweat, bile and saliva
How can you get hypocholremia?
Over hydration, SIADH, severe vomiting, gastric suction, Addisons disease
Symptoms and treatment of hypochloremia
Symptoms: hyperexcitability of muscles, hyperactive DTRs, tetany, muscle cramps
Treatment: oral sodium chloride, IV normal saline.
How can you get hyperchloremia?
Head trauma, dehydration, mineralocorticoid deficiency, increased sweating, laxative abuse
Symptoms and treatment for hyperchloremia
Symptoms: tachypnea, lethargy, altered mentation, weakness, extreme thirst
Treatment: depends on the cause. Hydration, stopping medications that contribute to increased chloride, correcting metabolic acidosis
What are liver function tests?
Bilirubin
SGOT/AST
SGPT/ALT
What are the renal function tests?
BUN
Creatinine
What are the lipid profile tests?
Total cholesterol
Triglycerides
LDL
HDL
What tests are in the coagulation panel?
PT: prothrombin time
INR
PTT: partial thromboplastin time
What is AST/SGOT testing?
Aspartate aminotransferase
Found everywhere in the body!
What is ALT/ SGPT testing for?
Alanine aminotransferase
Found primarily in the liver
Normal value for total cholesterol and triglycerides
Total cholesterol: <200
Triglycerides: <150
Normal values for LDL and HDL
LDL: <100
HDL: >40
What does it mean when both BUN and creatinine go up?
Kidney dysfunction.. but unfortunately they will not be outside the normal range until 60% of total kidney function is lost
What does it mean if BUN is elevated but creatinine is normal?
Dehydration
What does it mean when BUN is lowered but they have a normal creatinine
Overhydration
What test do we use if you’re on heparin?
PTT
What test would we use if you have afib?
INR.. especially if they are on warfarin (coumadin)
What is Hct testing for?
% of total blood volume that is RBC
Approx 3 x Hgb
What is Hgb testing for?
Oxygen carrying capacity of blood
What is leukocytosis
WBC > 11,000
Infection, inflammation, tissue necrosis
Sepsis: WBC is extremely high
Could also end in “philia”
What is leukopenia?
WBC < 4,500
Bone marrow failure following chemo/radiation, immune compromised, autoimmune disease, overwhelming infections
Most common cause though is cancer and having chemo
When you’re bleeding internally or dehydrated how does that change your vitals?
Heart rate will go up, bodies trying to pump more blood
