Fluids & Electrolytes Flashcards
CO2 level (bicarb)
23 - 29 mmol/L
Specific gravity level
1.005 - 1.030
- Less than 1.005 = dilute urine, hypervolemia
- Greater than 1.030 = concentrated urine, hypovolemia
Creatinine level
0.6 - 1.2 mg/dL
BUN level
6 - 20 mg/dL
Glucose level
70 - 110 mg/dL
Platelet level
150,000 - 450,000 /uL
Hemoglobin level
M: 13.5 - 17.5 g/dL
F: 12 - 16 g/dL
WBC level
4500 - 10,500 / uL
Hyperkalemia medical management
- Dietary modifications
- IV dextrose and insulin administration (glucose shift which K follows)
- Loop diuretics
- Kay-exalate (promote GI excretion of K)
- Severe: calcium to reverse arrythmias, not lower K
Hyperkalemia clinical manifestations
- *Palpitations
- *EKG changes
- Paresthesias
- Generalized fatigue
- Muscle cramps
- Weakness
- Serious complications: cardiac arrest
Hyperkalemia causes
- Acute or chronic renal failure (bc major excretor of K)
- Excessive intake of foods high in potassium: banana, potato, leafy greans
- Medications: potass-sparing diuretics, NSAIDs, potass supplements, beta blockers, digitalis
- Shift of intracellular potass to extracellular space: crush injuries, metabolic acidosis
Hypokalemia medical management
- Potass supplement (oral preferred)
- Cardiac monitoring
- Intravenous access
*Monitor digoxin levels and administer potass slowly d/t arrhythmias + irritation
Hypokalemia clinical manifestations
- Weakness and lethargy (d/t Na/K pumps & AP)
- N/V
- Constipation
- Abd cramping
- *ST depress on EKG
- Severe complication: cardiac or resp arrest
Hypokalemia causes
- Losses in GI Tract (vomit, diarrhea, gastric suction, excessive laxative)
- Medications: loop diuretics, thiazide diuretics, aminoglycosides (antibiotic type), steroids, albuterol
- Lack of potassium rich foods
Potass levels
3.5 - 5.0 mEq/L
Chloride levels
97 - 107 mEq/L
Hypernatremia medical management
- Limit sodium intake
- Replace water deficits w hypotonic fluids (anything less than 0.9% normal saline: D5W, 0.45%…)
Hypernatremia clinical manifestations
- Nonspecific neurological symptoms: agitation, restlessness, neuromuscular irritability
- Severe: hallucinations, delusions, disorientation, coma
- Thirst
- Signs of dehydration: dry mouth, poor skin turgor, low BP, rapid HR, dark yellow urine
Hypernatremia causes
- Reduced water intake
- Diabetes insipidus
- Hyperglycemia
- Hypercalcemia
- Hyperkalemia
- Age
Normal saline
0.9% sodium
Hyponatremia medical management
- Sodium replacement (oral, enteral, parenteral)
- Fluid restriction 1500-2300
- Parenteral replacement w isotonic IV fluids: 0.9% normal saline
- Diuretics
- Setting of neurological involvement: hypertonic IV fluids (3-5% saline solutions)
Hyponatremia clinical manifestations
- *Neurological
- Cerebral edema
- Lethargy/weakness
- Headache
- Confusion
- Muscle cramps and altered gait
- N/V
- Serious complications: seizures, coma, death
Hyponatremia causes
- Heart failure
- Meds (diuretics)
- Vomit/diarrhea
- Hyperglycemia w glucosuria
- Perspiration
Sodium levels
135 - 145 mEq/L
Hypovolemia treatment
- Fluid replacement (oral, enteral, parenteral)
- Parenteral fluids: 5% dextrose with 0.45% NS or 0.45% NS
Hypovolemia causes
- Fluid shifts (third spacing)
- Excessive loss of fluid
- Lack of fluid intake
- Diabetic ketoacidosis
Hypovolemia clinical manifestations
- Weight loss
- Decreased skin turgor
- Dry mucous membranes
- Concentrated urine output
- Oliguria (decreased urine output)
- Thirst
- Anxiety/restlessness
- Decreased BP / tachycardia (bc heart is trying to compensate)
Hypervolemia causes
- Heart failure (fluid backs up)
- Increased water and sodium retention
- Increased sodium intake
- Cirrhosis
Hypervolemia clinical manifestations
- Weight gain
- Ascites / edema
- Polyuria
- Pulmonary edema (function of heart failure –> backflow into pulmonary veins)
- Jugular vein distension
- Extra heart sounds (S3) and adventitious lung sounds
- SOB, increased RR, increased BP
Hypervolemia treatment
- Restrict fluid intake
- Discontinue IV fluids
- Diuretics
- Dialysis
Hypotonic fluids
- 0.45% sodium chloride
- 0.34% sodium chloride
- 2.5% dextrose in water
Hypotonic fluid movement
Move fluid into cell (osmolarity is lower than plasma and body fluids)
Hypotonic fluid indications
- Hypernatremia
- Diabetic ketoacidosis
Isotonic fluids
- 0.9% sodium chloride
- 5% dextrose in water
- Lactated ringers
Isotonic fluid movement
Equilibrium
Isotonic fluid indication
Fluid deficits
Dehydration
Hypertonic fluid
- 3% sodium chloride
- 5% dextrose in LR
- 20% dextrose in water
- Albumin 25%
Hypertonic fluid movement
Fluid moves out of cell (osmolarity is higher than plasma and body fluids)
Hypertonic fluid indications
- Severe hyponatremia
- Severe dehydration
- Severe electrolyte imbalances
Hypovolemia assessment
- Daily weight
- Monitor I&O
- Skin assess, vital signs, neurological status
- *Altered H&H
- *Increased BUN
- *Increased serum sodium
- *Decreased serum potassium
- *Increased urine specific gravity
Hypervolemia assessment
- Daily weight
- Measure I&O
- Skin assess, vital signs, neurological & pulm status
- *Decreased H&H, BUN (dilutional)
- *Decreased sodium
- *Decreased urine specific gravity
Hyponatremia / hypernatremia assessment
- Daily weight
- Measure I&O
- Vital signs
- Neurological checks
- Monitor Na lvls
Hypokalemia assessment
- Monitor serum K level
- Physical exam
- *EKG monitor
- Ensure IV access
- *Monitor digoxin lvl: hypokalemia can increase effect of digoxin causing cardiac change, visual disturbance, N/V
Hyperkalemia assess
- Monitor serum K lvl
- Monitor serum digoxin lvl
- Physical exam
- *EKG monitoring
- Ensure IV access
- Monitor BUN/Cr: increased lvls signify renal dysfunction, which may result in hyperkalemia
Hematocrit level
Male: 42-52%
Female: 37-47%
Respiratory acidosis S&S
- Anxiety
- Blurred vision
- Confusion
- SOB
- Headache
- Wheezing
Respiratory acidosis lab values
- PaCO2 > 40
- pH < 7.35
- Normal bicarb: 23-29
