Fluid And Electrolytes

Front 1

Normal Sodium Range

Back 1

135-145 mEq/liter

Front 2

Sodium Regulation

Back 2

• Maintains appropriate ECF volume & osmolarity
• Aids impulse transmission in nerve and muscle fibers
• Affects the concentration, excretion and absorption of K+ and (I-
• Na+ balance regulated by the kidneys
• When Na+ falls, kidneys promote water excretion under the influence of ADH
• When Na+ rises, release of ADH causes kidneys to retain more water to dilute Na+ to
normal levels
• Major Cation of the extracellular fluid
-CHF & kidney failure= decrease Na+ because water follows Na+, fluid overload

Front 3

Potassium Regulation

Back 3

Potassium (K+) 3.5 - 5.0 mEq/Liter
• Major cation in the intracellular fluid
• Affects cardiac muscle contraction, electrical conductivity, and cell excitability.
• Aids neuromuscular transmission of nerve impulses.
• Eliminated via the kidneys and feces
• Aldosterone secretion results in renal Na+ reabsorption and renal K+ excretion.

Front 4

Magnesium Regulation

Back 4

Magnesium (Mg ++) 1.5 - 2.5 mg/dl
• Affects neuromuscular irritability and contractility of cardiac and skeletal muscle.
• Affects peripheral vasodilation and causing changes in BP and cardiac output.
• Facilitates transport of Na+ and K+ across cell membrane.

Front 5

Calcium Regulation

Back 5

Calcium (Ca++) 8.5 -10.5 mg/dl
• Helps maintain cell membrane structure, function and permeability
• Affects activation, excitation and contraction of cardiac and skeletal muscle
• Helps activate steps in blood coagulation
• Parathyroid hormone promotes Ca++ transfer from bone to plasma and aids intestinal
and renal Ca++ absorption

Front 6

Phosphorus Regulation

Back 6

Phosphorus (HP04- - -)
• 80% exist in bone with Ca++
• Majors role in acid-base balance through its action as a urinary buffer
• Mobilization phosphorus from bone is influenced by PTH levels
• Essential role in muscle, RBC, neurological function, and metabolism of carbs, protein,

Front 7

Chloride Regulation

Back 7

Chloride (CI-) 96 - 106 mEq/liter
• Maintains serum osmolarity along with Na+
• Through production of HeL, (1- plays a major role in maintaining acid-base balance.
• CI- and Na+ levels usually change in direct proportion to one another.
• Decrease Cl- level results in increased HCO---level to balance anions and cations in ECF

Front 8

Osmolarity

Back 8

Osmolality reflects the concentration of fluid that affects the movement of water between
fluid compartments by osmosis

Front 9

Osmotic pressure

Back 9

Osmotic pressure is the amount of hydrostatic pressure needed to stop the flow of water by osmosis

Front 10

Osmosis & Diffusion

Back 10

• Osmosis is the diffusion of water caused by fluid gradient.
• Diffusion is the movement of a substance from area of higher concentration to one of
lower concentration.

Front 11

Isotonic

Back 11

Isotonic - same solute concentration; equal; no movement across membrance

Front 12

Hypertonic

Back 12

Hypertonic/hyperosmotic - greater osmotic pressure (concentration); water pulled into
fluid to equalize

Front 13

Hypotonic

Back 13

Hypotonic/hypo-osmotic - lesser osmotic pressure (concentration); water pulled out of
fluid to equalize.

Front 14

Intravenous Therapy
,• Systemic Complications

Back 14

-fluid overload
-air embolism

Front 15

IV therapy
• Local Complications

Back 15

Infiltration and extravasation
-Phlebitis
- Thrombophlebitis
-Hematoma
-Clotting and Obstruction

Front 16

Anti-diuretic Hormone (ADH)

Back 16

Stimulates water conservation and the thirst center
i Blood osmolality = i ADH
- Stops water loss in kidney
-Increases thirst feeling.
-More fluid in blood = t in osmolality

Front 17

Aldosterone

Back 17

Aldosterone: most important mineralocorticoids in humans
• Increase reabsorption Na+ from distal tubes and collecting duets of kidney into plasma
• Increase excretion K+ and H+ fluid volume
Increased aldosterone=hypokalemia, alkalosis
Decreased aldosterone
hyponatreuria, hyperkalemia

Front 18

Hyponatremia

Back 18

Hyponatremia
-personality change, decreased BP, dizziness, abd cramping, n/v, diarrhea, dry mucous mem, coma
-Replace Na+ slowly; saline IV infusions;
- If excess fluid, mannitol
- Check ADH levels
-Monitor electrolytes if Na+ K+
- Diet therapy

Front 19

Hypernatremia

Back 19

-extreme thirst, dry flushed skin, dry mucous mem., decrease BP, fever, agitation, irritability
If fluid loss, hypotonic IV fluids;
- If fluid and Na+ loss, isotonic IV fluid
- Restrict Na+,

Front 20

Hypokalemia

Back 20

-shallow respirations, pulse thready
and weak, dysrhythmia, lethargic, confusion, coma, GI hypoactivity;weakness, fatigue, n/v, intestinal distention, decreased bowel sounds, decrease deep tendon reflexes, dysrhythmias, weak irregular pulse
-Administer K+ oral or ~ monitor lab work
-Renal failure: cannot ingest a lot of K+ because excrete it, teach to eat apples, bananas

Front 21

Hyperkalemia

Back 21

- EKGchanges, weakness, cramps, diarrhea
-Stop K+ - oral or IV;
-Administer K+ excreting diuretics (Iasix) and Kayexlate; dialysis if severe K+
insulin/D50 administration

Front 22

Hypercalcemia

Back 22

Causes: osteoporosis, prolonged immobilization
- decreased muscle tone, weakness, lethargy, kidney stones

Front 23

Hypocalcemia

Back 23

Causes: Vitamin D deficiency
- Numb and tingling fingers and circumoral region, muscle cramps

Front 24

Fluid Volume Excess

Back 24

+ALTERED MENTAL STATS
-HTN, crackles in lungs(listen to lungs), neck vein distension, dependent edema, increased body wieght, bounding pulses, dyspnea,

Front 25

Fluid Volume Deficit

Back 25

-Mental status
-decreased BP,sudden weight loss, increased USG, increased HR, dry skin, dehydration, thrist, weakness, dry mucous membranes, decreased skin turgor

Front 26

Hypotonic solutions

Back 26

1/2 NS

Front 27

Isotonic solutions

Back 27

NS
Lactated Ringers

Front 28

Parental fluid

Back 28

-provide water, electrolytes, and nutrition
-replace water, correct electrolyte imbalance
-admin meds and blood products

Front 29

Parental fluid Replacement Methods

Back 29

-Peripheral IV catheter (Regular IV)
-Peripheral Inserted central catheter (PICC)
-Central Line
-Port a cath: long-term therapy

Front 30

Total Parental Nutrition

Back 30

10-20% Dextrose, central cath, or PICC
-hypertonic solution of lipids, electrolytes, minerals
-insulin
-H2 blocker

Front 31

Renal Failure

Back 31

-increase K+, Na+, Cl-
-Metabolic acidosis
-Increase BUN/Creatinine
-fluid volume excess
-increased BP, swollen (edemas), urinary retension

Front 32

Heart Failure (CHF)

Back 32

-Decreased CO
-Decreased kidney perfusion
-Decreased UO
-Retain Na+ & water leads to circulatory overlaod
Meds- digoxin (restrict Na+), diuertics, Nitro (vasodilate, ACE inhib)

Front 33

SIADH

Back 33

-excess ADH secretion
-water intox
-hyponatremia
-Fluid volume excess
-concentrated urine--- increased USG

Front 34

Diabetes Insipidus

Back 34

-too little ADH secretion by pituitary
-large volume of diluted urine
-hypernatremia
-low USG

Front 35

Parathyroid

Back 35

controls Ca+

Front 36

Interstitial fluid

Back 36

in between the cells

Front 37

Intravascular

Back 37

in veins, arteries, blood plasma

Front 38

Transcelluar

Back 38

pleural space, peritoneal, senovial fluid

Front 39

Intracelluar Fluid

Back 39

42%
most fluid in ICF

Front 40

Extracellular Fluid

Back 40

17%

-includes interstitial, intravascular, transcellular