Glossary of Fluids and Electrolytes

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Fluid balance
Fluid mostly shifts between the intravascular and interstial spaces to maintain balance.
Third-spacing or Third-space fluid shift
Loss of ECF into a space that does not contribute to equilibrium between ICF and ECF.
Cations (+)
Sodium, Potassium, Calcium, Magnesium and Hydrogen ion
Anions (-)
Chloride, bicarbonate, Phosphate, Sulfate, Proteinate ions
The diffusion of water by a fluid concentration gradient through a membrane
The natural tendancy of a substance to move from an area of high concentration to an area of lower concentration.
Hydrostatic pressure in the capillaries tends to filter fluid out of the vascular compartment into the interstitial fluid
-Ex: filtration of water and electrolytes from the arterial capillary bed to the interstial fluid (hydrostatic pressure is supplied by the pumping heart)
Active Transport
Implies that energy must be expanded for the movement to occur against the concentration gradient
-Ex: sodium/potassium pump in the cell membrane
Routes of gains and losses
-Kidney: urine 1ml/kg per hour, abour 1-2L daily for adults
-Skin: Visible loss (sweat) 0-1L, Not visible (evaporation) 600mL per day
-Lungs: water vapor 400mL per day
-GI tract: 100-200mL per day
Urine Specific Gravity
Measures the kidneys ability to excrete or conserve water
Blood Urea Nitrogen (BUN)
Urea, an end product of protein metabolism
An end product of muscle metabolism
Measures the volume percentage of RBCs in whole blood
-D/T: abnormal losses through kidneys, skin, GI tract, decreased intake, bleeding, 3rd spacing shift
-S/S: increased HR, decreased B/P, reduced urine output, dizziness, weakness, dry mucus memebranes, increased specif gravity
-Tx: Isotonic fluids (LR, NS) are used if patient is hypotensive, hypotonic fluids are given once normotension is reached (1/2NS)
D/T: body retaining water and electrolytes in ECF, often occurs with CHF, renal failure, cirrhosis, steroid use
S/S: edema, pulmonary edema, low HGB, increased HR, increased B/P
Tx: low Na, restrict fluids, normal saline IV
Respiratory Acidosis
-D/T: pneumonia, pulmonary edema, drowning, asthma, cystic fibrosis, emphysema, CNS depression, inadequate excretion of CO2 (H2CO3 excess)
-S/S: increased pulse and resp. and B/P, SOB, confusion, lethargy
Lab: reduced pH (<7.35, PaCO2 > 45)
Tx: Improving ventilation, hydrate
Respiratory Alkalosis
-D/T: H2CO3 deficit, excessive loss of CO2, anxiety, fever, hyperventilation
-S/S: hyperventilation, difficulty concentrating, tingling
-Labs: pH > 7.45, PaCO2 < 35
-Tx: Breathing into paper bag, antianxiety drugs, reduce fever
Metabolic Acidosis
-D/T: HCO3 deficit, products from renal impairment (excessive acid), Diabetes Mellitus, starvation, loss of bicarbonate d/t diarrhea, excessive infusion of NaCl (IV)
-S/S: fruity breath, rapid and deep breathing, lethargy and weakness
-Labs: pH < 7.35, HCO3 < 21
-Tx: Na bicarb through IV push, restore F&E, correct underlying problem ie diarrhea...
Metabolic Alkalosis
-D/T: HCO3 excess, loss of acid through vomiting, GI suction, diuretic, K loss (Lasix), excessive base intake (antacids, IV bicarb, baking soda)
-Labs: HCO3 > 26, pH > 7.45
-S/S: decreased resp. rate and depth, dizziness, tetany-like symptoms, irritability, confusion
Tx: IV admin of K, treat vomiting, rid body of excess bicarb and retain CO2
-Normal: 135-145
-Fx: controls and regulates water balance, conduction of nerves and muscles, stimulates thirst
-Most abundant electrolyte in ECF
-increase or loss in Na is almost always accompanied by and increase or loss in water
-Na < 135mEq/L
-Causes water to move out of vascular space into intracellular space (cell size increases)
-D/T: Losses through GI tract (diarrhea), profuse sweating, diuretics, drinking too much water, head injury, craniotomy, or stroke
-S/S: dry mucosa, cerebral edema, edema, hypotension, lethargy, confusion, muscle cramps, N/V, anorexia, poor skin turgor
-Tx: Encourage high Na diet, monitor I&Os, fluid restrictions, LR, or NS
-Na > 145
-Pulls water from the cells into the vascular space (dehydrating the cells)
-D/T: loss of fluids through diarrhea, hyperventilation, increased Na intake, Diabetes Insipidus, heat stroke, water deprivation
-S/S: thrist, dry mucus membranes, fatigue, disorientation, agitation, red tounge
-Tx: Restrict Na intake, administer diuretics, D5W or 1/2NS, I&Os monitored
-Normal: 3.5 - 5.0
-Major intracellular electrolyte
-Regulated by the kidneys
-Effects all body systems, escpecially cardiac and neuromuscular
-Plays a role in acid base balance (K losses in metabolic alkalosis)
-K < 3.5 mEq/L
-D/T: losses through vomiting, GI suction, diarrhea, drugs that cause K loss (lasix), low intake (alcoholic, anorexia, debilitaed pts), excessive loss through kidneys
-S/S: muscle weakness, leg cramps, anorexia, N/V, decreased bowel motility, cardiac arrhthmias, decreased deep tendon reflexes, increased pH and bicarbonate
Tx: admin of KCl (IV or PO), (K can burn the veins and is very upsetting to the stomach), encourage intake of potassium rich foods
-K > 5.0mEq/L
-D/T: Decreased losses through kindeys due to renal failure, hypoaldosteronism, K sparing diuretics, increased K intake, movement out of cells due to burns, tissue trauma
S/S: muscle weakness, cardiac arrhythmias, confusion, numbness in extremities, abscence of reflexes
Tx: Sodium bicarbonate (due to high K causing acidosis), Kayexalate, dialysis, avoid high K foods, Ca gluconate, IV glucose (pushes K back into cell)
-Normal: 8.5 - 10.5
-Controlled by the parathyroid
-Affects bone reabsorption and is found primarily in bones
-Fx: bone formation, transmission of nerve impulses, muscle contraction, and blood coagulation
-Calcium is bound primarily to albumin but is binds to phosphate, citrate, and carbonate
-Ca < 8.5mEq/L
-D/T: parathyroid or thyroid dysfunction, inadequate intake of Vitamin D, Excessive loss of intestinal secretions, alcohol abuse
S/S: numbness, tingling, muscle tremors, cardiac arrhythmias, tetany, seizures, hyperactive deep tendon reflexes, + Trousseau's and Chvostek's sign
Tx: IV Ca gluconate, Vit D supplement, Phoslo (Vit D and Ca), increase diet in vit D and Ca
-Ca > 10.5
-D/T: Prolonged immobilization, parathyroid and thyroid conditions, ingestion of antacids, bone malignancy
-S/S: Flank pain, urinary calculi, weakness, reduced muscle tone, depressed deep tendon reflexes, cardiac arrest
-Tx: Hydrate pt to dilute calcium and promote excretion, lasix, calcitonin
-Normal: 1.5 - 2.5
-Controlled by the parathyroid, kidneys, and K concentration
Fx: neuromuscular activity, metabolism of carbohydrates and proteins, influences vasodilation
-Mg < 1.5mEq/L
-D/T: Excessive losses through GI suctioning, diarrhea, fisula draining, diuretics, chemotherapy, alcoholism, renal disease, burns
-S/S: 3T's (tremors, twitching, tetany), increased reflexes, seizures, + Trousseau's and Chvostek's sign
-Tx: MgSO4 IV (watch for hypotension), monitor for reduced HR, seizure precautions
-Mg > 2.5mEq/L
-D/T: Retention d/t renal failure, increased intake (antacids)
-S/S: lethargy, coma, muscle weakness, hypotension, impaired respirations, depressed deep tendon reflexes
-Tx: Hemodialysis, diuretics, 1/2NS, Ca gluconate

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