1st Spacing
-normal distribution of ICF and ECF
2nd Spacing
- build up of ECF (edema)
3rd Spacing
- build up in part of body that is not easily exchange with ECF
- Signs- weight gain, less UO, edema
Age concerns with fluids
- structure changes of kidney= cant conserve a lot of water
- decreased ADH, ANP
- less subQ = more moisture lost
- reduced thirst
Hypovolemia
- diarrhea, fistula drainage, hemorrhage, polyuria, plasma to ECF
Hypervolemia
- excessive intake
- abnormal fluid retention (CHF, renal failure)
- ECF to plasma
Respiratory Fluid Overload
- dyspnea, cough, crackles
Resp Fluid Deficit
- tachypnea b/c less perfusion
Sodium functions
- Helps maintain ECF concentration
- Important in generation of nerve impulses
- Acid-base balance
How is sodium balanced?
- By kidneys, execrating or retaining water
- (ADH) Aldosterone reabsorbs Na
Hypernatremia causes
- water deficiency/ impaired LOC
- ADH deficiency
- Osmotic diuresis (increased peeing)
Hypernatremia manifestations
-lethargy, agitation, seizures, and coma
Hypernatremia Management
- dilute Na with salt free hypotonic solution
- diuretics to excrete Na
Hyponatremia causes
- diarrhea, vomiting, NG suction, diuretics
- CHF
- Excess ADH
Hyponatremia manifestations
-confusion, N&S, seizures and coma
Hyponatremia Management
- fluid restriction
- small amount of IV hypertonic saline (NaCl)
- if r/t abnormal fluid lose, give NS
Potassium functions
- transmission and conduction of nerve impulses
- Normal cardiac rhythm
- muscle contraction
- Acid-base
Hyperkalemia causes
- increased intake
- impaired excretion
- shift from ICF to ECF (acidosis)
Hyperkalemia manifestations
- weak/paralyzed muscles (legs)
- leg cramps
- bradycardias/ cardiac stand still
- Peaked T wave
- abdominal cramping and diarrhea
hyperkalemia management
- stop K intake
- increase elimination of K
- force K out of ECF with IV insulin or Na
- Ca gluconate counteracts cardiac effects
hypokalemia causes
- dietary deficiency
- too much loss
- diuretics
- GI losses
- ECF-> ICF (alkalosis)
hypokalemia manifestations
- tachy/bradycardaia
- makes digoxin more toxic
- increased U wave
- skeletal muscle weakness
- muscle cell breakdown
hypokalemia management
- replace
- teach prevention (diet)
Calcium functions
- transmission of nerve impulses
- myocardial contraction
- blood clotting
- formation of teeth and bones
- muscle contraction
hypercalcemia causes
- hyperparathyroidism
- malignancy
- Vit D overdose
- prolonged immobilization
hypercalcemia manifestations
- bad memory
- confusion
- disorientation
- fatigue
- constipation
- kidney stones
hypercalcemia management
- excrete Ca with loop diuretic
- hydrate with isotonic saline
- synthetic calcitonin
- mobilization
Hypocalcemia causes
- decreased production of PTH
- acute pancreatitis
- multiple blood transfusions
- Alkalosis
- less intake
hypocalcemia manifestations
- trousseaus or Chvostek’s sign
- laryngeal stridor tetany
- dysphagia
- tingling around the mouth or in the extremities
hypocalcemia management
- treat cause
- supps
- treat pain and anxiety to prevent hyperventilation
magnesium functions
- coenzyme in metabolism of protein and carbs
- factors that regulate Ca influence Mg
- acts directly on myoneural junction
- cardiac function
hypermagnesemia causes
- increase intake or ingestion with renal insufficiency or failure
hypermagnesemia manifestation
- lethargy, drowsiness, N&V, impaired reflexes, somnolence, respiratory and cardiac arrest
hypermagnesemia management
- prevention
- IV CaCl or Ca gluconate
- fluids to promote excretion
hypomagnesemia causes
- prolonged fasting/starving
- chronic alcoholism
- fluid loss from GI
- prolonged parental nutrition
- diuretics
hypomagnesemia manifestations
- confusion
- hyperactive deep tendon reflexes
- tremors
- seizures
- cardiac dysthymias
hypomagnesemia management
- oral supplements
- increased intake
