Fluid and Electrolytes Flashcards
Sodium (Na)
135-145 mEq/L
Needed for Neuro Function and Muscle Contraction
Biggest particle of Osmolality
What is Hyponatremia, it’s causes, it’s symptoms, and treatment?
Na <135mEq/L-cells swell with fluid
Causes: Excess loss of Na, or too much water for Na. Vomiting, Diarrhea, sweating, diuretics, Adrenal Insufficiency, meds, SIADH, fluid overload in surgery.
Symptoms: Poor skin turgor, dry membranes, Headache, decreased salivation, decreased BP, Neurological changes (cell swelling), abdominal cramping, nausea.
Treatment: Elevate Na slowly, treat underlying condition, water restriction, I&O, Daily Weights, Encourage increased Na intake in diet, monitor for CNS changes.
What is hypernatremia, it’s causes, symptoms, and treament?
Na >145 mEq/L-cells shrink
Causes: Fluid deprivation, excess sodium administration, diabetes insipidus, HEAT STROKE, Hypertonic IV solutions, Tube feedings, saltwater drowning, dialysis machine malfunction.
Symptoms: Thirst, elevated temp, swollen dry tongue, sticky membranes, hyperreflexia, increased BP, Hallucinations, etc
Treatment: Lower Na slowly=too quick could cause rebound cerebral edema, 0.3 NS or D5W, Diuretics, Assess for abnormal water loss and low water intake, assess OTC sources of sodium, Monitor for CNS changes.
Potassium (K)
3.5-5.3 mEq/L
Most important for Cardiac, also used in skeletal muscle.
Excreted in Urine
SALT SUBSTITUTES ARE HIGH IN POTASSIUM!=can be used for potassium replacement.
What is Hypokalemia, it’s causes, symptoms, and treatment?
Potassium <3.5 mEq/L
Causes: vomiting, suctioning, inadequate intake, excessive diuretics or laxatives, tumor of intestine, recent ileostomy, alteration in Acid-base balance, Hyperaldosteronism.
Symptoms: ECG changes (flat T waves, prominent U waves-rare, associated with repolarization of purkinje fibers, ST segment depression, prolonged PR interval), dysrhythmias, dilute urine, decreased bowel motility,muscle weakness, parasthesias.
Treatment: Potassium replacement (Never push K, always given slowly usually at 10 mEq/hr)-patients w/NG tubes will typically have IV potassium. Monitor ECG, Monitor ABGs (alkalosis can shift K inside cells). Oral Potassium-Can cause GI upset, listen to patients, watch for Dig toxicitiy-can occur while getting K and Dig.
What is Hyperkalemia, it’s causes, symptoms, and treatment?
Potassium >5.3 mEq/L=More instance of Cardiac Arrest, it seldom occurs in patients with adequate renal function (important for patients for renal patients to follow their diet). Above 6 will see some ECG changes, Above 8 their will be changes present.
Causes: IMPAIRED RENAL FUNCTION, Rapid administration of potassium, Hypoaldosteronism, Meds, Tissue trauma, Acidosis
Symptoms: ECG Changes and Dysrhythmias (Tall tented T waves, Prolonged PR and QRS, Absent P waves, ST depression), muscle weakness, parasthesias, anxiety, GI manifestations.
Treatment: Calcium Gluconate to protect heart, then Kayexalate cation exchange med (don’t give to paralytic ileus, can cause rupture), then IV Regular insulin and dextrose, albuterol and diuretics can lower K as well.
Calcium (Ca)
8.2-10.2 mEq/L
99% in teeth and bones, 1% bound to proteins
Needed for CHEMICAL REACTIONS, neuro, mucle contraction, and CLOTTING
What is Hypocalcemia, it’s causes, symptoms, and treatment?
Ca <8.2 mEq/L-controlled by calcitonin and parathyroid hormone.
Causes: hypoparathyroidism, malabsorption, osteoporosis, pancreatitis, alkalosis, transfusion of citrated blood (citrate binds to calcium which can lower Ca level), kidney injury, medications.
Symptoms: tetany, circumoral numbness, paresthesias, hyperactive DTRs, Trousseau sign, Chvostek sign, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, anxiety
Treatment: IV Calcium Gluconate for emergencies, seizure precautions, Oral calcium and vitamin D (split up Ca throughout day not all at once), IV Calcium can cause bradycardia-give slowly, education on diet, exercise and meds-diuretics can cause Ca loss, exercise can reduce bone loss
What is Hypercalcemia, it’s causes, symptoms, and treatment?
Ca >10.2 mEq/L-High mortality if untreated=50%
Causes: malignancy and hyperparathyroidism, bone loss related to immobility, diuretics
Symptoms: polyuria, thirst, muscle weakness, intractable nausea, abdominal cramps, severe constipation, diarrhea, peptic ulcer, bone pain, ECG changes, dysrhythmias
Treatment: Treat underlying cause, Administer IV fluids, furosemide, phosphates, calcitonin, IV bisphosphonates, encourage fluids (stone prevention), dietary education, increase mobility
Magnesium (Mg)
1.6-2.6 mEq/L
Found in leafy greens, chocolate, and nuts
Enzyme activator, needed for Carb and protein metabolism
2/3 bound to protein
Decreases muscle cell excitability
Important for movement and Cardiac
What is Hypomagnesmia, it’s causes, symptoms, and treatment?
Mg <1.6 mEq/L-Usually associated with Hypokalemia and Hypocalcemia
Causes: : alcoholism, GI losses (diarrhea, not so much vomiting), enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood, DKA, refeeding after starvation
Symptoms: Chvostek and Trousseau signs (more associated with low Ca, but Low Mg is usually associated with low Ca), apathy, depressed mood, psychosis, neuromuscular irritability, muscle weakness, tremors, ECG changes and dysrhythmias
Treatment:
