Fluid And Electrolytes Chapter 40 Pt 4 Disturbances In Electrolytes, Fluids, And Acid Base Balances

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When there is a loss of body fluids because of burns, illnesses, or trauma, the client is also at risk for

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Electrolyte imbalances

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This electrolyte imbalance is a result of lower than normal concentration of sodium in the blood (serum), which can occur with a net sodium loss or a net water excess. It occurs frequently in seriously ill clients.

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Hyponatremia

Front 3

In this electrolyte imbalance the body initially adapts by reducing water excretion and thus sodium excretion occurs in order to maintain serum osmolality at near normal levels. As the sodium loss continues, the body continues to preserve the blood and interstitial (tissue) volume. As a result the sodium in ECF becomes diluted.

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Hyponatremia

Front 4

These diseases are know to cause what electrolyte imbalance?
Kidney disease resulting in salt wasting
Adrenal insufficiency
GI losses
Increased sweating
Use of diuretics, especially when on a low-sodium diet
Psychogenic Polydipsia
Syndrome of inappropriate ADH(SIADH)

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Hyponatremia

Front 5

These are signs and symptoms of what electrolyte imbalance? Apprehension
Personality change
Postural Hypotension
Postural dizziness
Abdominal Cramping
Nausea and Vomiting
Diarrhea
Tachycardia
Convulsions and coma
Fingertips remaining on sternum after palpation

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Hyponatremia

Front 6

These Laboratory findings suggests what electrolyte imbalance?
Serum Sodium below 135mEq/L
Serum Osmolality 280mOsm/kg
Urine specific gravity below 1.010 (if not caused by SIADH)

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Hyponatremia

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This electrolyte imbalance is greater than normal concentration of sodium in the ECF that can be caused by excess water loss or an overall sodium excess.

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Hypernatremia

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When the cause of hypernatremia is an increased aldosterone secretion, sodium is retained and potassium is

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excreted

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When hypernatremia occurs, the body attempts to conserve as much water as possible through

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renal absorption.

Front 10

These Diseases and occurances cause what electrolyte imbalance?
Ingestion of large amounts of concentrated salt solutions
Iatrogenic administration of hypertonic saline solution parenterally
Excess aldosterone secretion
Diabetes insipidus
Increased sensible and insensible water loss
Water deprivation

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Hypernatremia

Front 11

These are signs and symptoms of what electrolyte imbalance?
Thirst
Dry flushed skin
Dry and Sticky Tongue and Mucous Membranes
Fever
Agitation
Convulsions
Restlessness
Irritability
Tachycardia

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Hypernatremia

Front 12

These Laboratory findings are found for what electrolyte imbalance?
Serum levels above 145mEq/L
Serum Osmolality 295mOsm/kg

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Hypernatremia

Front 13

In this electrolyte imbalance inadequate mounts of the electrolyte circulates the ECF. When severe, it can affect cardiac conduction and function.

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Hypokalemia

Front 14

These occurances can cause what electrolyte imbalance?
Use of potassium-wastin diuretics
Diarrhea, Vomiting and other GI losses
Alkalosis
Excess aldosterone secretion
Polyuria
Extreme Sweating
Excessive use of potassium-free intravenous solutions
Treatment of diabetic ketoacidosis with insulin

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Hypokalemia

Front 15

Signs and symptoms of what electrolyte imbalances include these?
Weakness and Fatigue
Decreased Muscle Tone
Intestinal Distention
Decreased Bowel sounds
Ventricular Dysrhythmias
Parasthesias and weak irregular pulse

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Hypokalemia

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Laboratory findings for Hypokalemia include Serum Potassium level below 3.5mEq/L and

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electrocardiogram (ECG) abnormalities (eg. ventricular dysrhythmias)

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This electrolyte imbalance can occur from severe illnesses, some of which directly affect the thyroid and parathyroid glands. Another cause is Renal insufficiency or prolonged bed rest.

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Hypocalcemia

Front 18

These occurances can cause what electrolyte imbalance?
Rapid administration of blood transfusion containing citrate
Hypoalbuminemia
Hypoparathyroidism
Vitamin D deficiency
Pancreatitis
Alkalosis

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Hypocalcemia

Front 19

These are signs and symptoms of what electrolyte imbalance?
Numbness and tingling of the fingers and circumoral region
Hyperactive reflexes
Positive Trousseaus sign (carpopedal spasm with hypoxia)
Positive chvostek's sign (contraction of facial muscles when facial nerve is tapped)
Tetany
Muscle Cramps
*Pathological fractures

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Hypocalcemia
*Chronic Hypocalcemia

Front 20

These laboratory findings can reflect what type of electrolyte imbalance? X
x-ray exam shows generalized osteoporosis
Widespread bone cavitation,
Radiopaque urinary stones
Elevated blood Urea Nitrogen (BUN)level 25mg/100ml
Elevated creatinine level 1.5mg/100ml caused by fluid volume deficit (FVD) or renal damage caused by urolithiasis
EGC abnormalities
Serum Calcium level above 5.5mEq/L or 10.5mg/100ml

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Hypercalcemia

Front 21

These laboratory findings can reflect what type of electrolyte imbalance?
Serum calcium level below 4.5mEq/L or 8.5mg/100mL and ECG Abnormalities

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Hypocalcemia

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Signs and symptoms of this electrolyte imbalance can be related to a diminished function of the neuromuscular, cardiac, and renal systems (renal failure).

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Hypocalcemia

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This electrolyte imbalance is usually a symptom of an underlying disease resulting in excess bone reabsorption with release of calcium.

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Hypercalcemia

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In these electrolyte imbalances symptoms are the result of changes in neuromuscular excitability. It can occur with malnutrition and with malabsorption disorders, and signs and symptoms are directly related to the neuromuscular system.

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Hypomagnesium

Front 25

These occurances can cause what type of electrolyte imbalance?
Inadequate intake: malnutrition and alcoholism
Inadequate Absorption:diarrhea, vomiting, nasogastric drainage,fistulas; diseases of small intestine
Excessive loss resulting from thiazide diuretics
Aldosterone excess
Polyuria

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Hypomagnesium

Front 26

These symptoms are a result of what electrolyte imbalance?
Muscular Tremors
Hyperactive deep tendon reflexes
Confusion and disorientation
Dysrhythmias
Positive Chvostek's sign and
Trousseau's sign

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Hypomagnesium magnesium levels below 1.5mEq/L

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With this electrolyte imbalance the skeletal muscles and nerve functions are depressed. Depression of acetylcholine leads to a sedative effect, which can lead to bradycardia, ECG changes, Cardiac arrhythmias, and decreased respiratory rate and depth. Decreases muscle cells.

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Hypermagnesium

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These occurances could cause what electrolyte imbalance?
Renal failure
Excess oral or parenteral intake of magnesium

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Hypermagnesium

Front 29

These finding occur in what electrolyte imbalance?
Hypoactive deep tendon reflexes, decreased depth and rate of respiration, hypotension, and flushing

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Hypermagnesium Laboratory findings of serum magnesium level above 2.5mEq/L

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Vomiting or prolonged and excessive nasogastric or fistula drainage can result in what electrolyte imbalance because of the loss of hydrocholric acid.

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Hypochloremia

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The use of loop and thiazide diuretics also results in increased loss of this electrolyte as sodium is excreted. When serum levels for this electrolyte fall, matabolic alkalosis results as the body adapts to increasing reabsorbption of the bicarbonate ion to maintain electrical neutrality.

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Chloride. Hypochloremia

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This electrolyte imbalance usually occurs when the serum bicarbonate value falls or sodium level rises.

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Hyperchloremia

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What exist when water and electrolytes are gained or lost in equal proportions?

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Isotonic defecit and excess

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What occurs when losses or excesses of only water so that the concentration of the serum is affected?

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Osmolar Imbalances

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What is the best way to evaluate acid base balances?

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Arterial Blood Gas analysis (ABG)

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What are the six components of acid-base balances?

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pH,PaCO2,PaO2, oxygen saturation, base excess, and HCO-3.

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Normal pH values is

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7.35-7.45

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a pH value of 7.35 is

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acidic

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a pH value of 7.45 is

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alkalotic

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pH measures what ion concentration in the body fluids?

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hydrogen ions (H+)

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True or False. A slight change in pH balance can be potentially life threatening.

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True

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An increase in concentration of H+ makes a solution more

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acidic

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An decrease in concentration of H+ makes a solution more

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alkaline

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PaCO2 is the partial pressure of carbon dioxide in arterial blood and is a reflection of the depth of

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pulmonary ventilation.

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The normal ranges for PaCO2 are

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35-44mm Hg

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There is an indication that hyperventilation has occurred when the PaCO2 is

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less than 35mm Hg. As rate and depth or respiration increases, more carbon dioxide is exhaled and the carbon dioxide concentration decreases.

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There is an indication that hypoventilation has occurred when the PaCO2 is

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more than 45mm Hg. As the rate and depth of respiration decreases, less carbon dioxide is exhaled and more is retained, increasing the concentration of carbon dioxide.

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PaO2 is the partial pressure of what component in arterial blood?

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Oxygen

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A PaO2 less than ___mm Hg can lead to anaerobic metabolism, resulting in lactic acid production and metabolic acidosis.

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60mm Hg.

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Normal Range for PaO2 is

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80-100mm Hg

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True or False. There is a normal incline in the PaO2 in older adults.

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False. There is a normal DECLINE in the PaO2 in older adults.

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Hypoxemia also may cause hyperventilation, resulting in

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respiratory alkalosis.

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Saturation is the point at which hemoglobin is saturated with

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oxygen (O2)

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When a client is _____and uses up readily available oxygen, the reserve oxygen (oxygen attached to the hemoglobin) is drawn upon to provide oxygen t the tissues.

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hypoxic

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Oxygen can be affected by changes in

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temperature,pH, and PaCO2.

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When the PaCO2 falls below____mmHg there is a large drop in saturation.

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60mm Hg

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Normal Oxygen saturation range is

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95%-100%

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True or False. Base excess is the amount of blood buffer (hemoglobin and bicarbonate) that exist.

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True

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A high value of base excess (amount of blood buffer) can indicate

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alkalosis. and can result from the ingestion of large amounts of sodium bicarbonate solutions (some antacids), citrate excess with rapid blood transfusions, or intravenous infusion of sodium bicarbonate to correct ketoacidosis.

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A low value of base excess (amount of blood buffer) can indicate

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acidosis. and is usually the result of the elimination of too many bicarbonate ions. eg. diarrhea, where the increased intestinal motility that accompanies diarrhea forces the bicarbonate-containing fluid to be lost instead of being absorbed.

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The normal range for base excess (amount of blood buffer) is

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+-2

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What is the major renal component of acid-base balance and is excreted and reproduced by the kidneys to maintain a normal acid-base environment.

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Serum bicarbonate (HCO-3)

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The normal range for Serum bicarbonate (HCO-3) is

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22-26 mEq/L

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What value indicates metabolic acidosis for Serum bicarbonate (HCO-3)

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Less than 22mEq/L

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What value indicates metabolic alkalosis for Serum bicarbonate (HCO-3)

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More than 26mEq/L

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What are the four primary types of acid-base imbalances?

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respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis.

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What Acid-Base imbalance is marked by an
Increased arterial carbon dioxide concentration(PaCO2)
Excess Carbonic Acid (H2CO3)
Increased Hydrogen ion concentration (decreased pH)

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Respiratory Acidosis

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With what acid base imbalance does the cerebralspinal fluid and brain cells become acidic, causing neurological changes.

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with Respiratory Acidosis. Hypoxia occurs because of respiratory depression, resulting in further neurological impairment.

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Respiratory acidosis may be accompanied by

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electrolyte changes such as hyperkalemia and hypercalcemia

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What Acid-Base imbalance is marked by
Decreased PaCO2 & increased pH

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Respiratory Alkalosis

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Like respiratory acidosis, Respiratory alkalosis can begin outside the respiratory system for example

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anxiety with hyperventilation

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Like respiratory acidosis, Respiratory alkalosis can begin within the respiratory system for example

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initial phase of an asthma attack.

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Respiratory acidosis is equal to

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hypoventilation

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Respiratory alkalosis is equal to

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hyperventilation

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What acid base imbalance occurs because of the high acid content of the blood, which also causes a loss of sodium bicarbonate, the alkaline half of the carbonate buffer system.

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Metabolic Acidosis

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In an attempt to identify the cause of the metabolic acidosis, an anaylysis of serum electrolytes to detect an___ ____ may be helpful

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Anion Gap

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Reflects unmeasurable anions present in plasma and is calculated by subtracting the sum of chloride and bicarbonate from the amount of plasma sodium concentration.

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Anion Gap

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What acid base imbalance is marked by the heavy loss of acid from the body or by increased levels of bicarbonate

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Matabolic alkalosis

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Vomiting and gastric suction is the most common cause for

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Metabolic alkalosis

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Overcorrection of metabolic acidosis, potassium deficiency, hyperaldosteronism, and the use of thiazide therapy that causes an increase of renal excreted acid are other causes of

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Metabolic Alkalosis

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Normal anion gap values are

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12 (+-2)mEq/L

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Increased anion gap values are

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>14mEq/L

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Normal anion gap values
12(+-2)mEq/L causes

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diarrhea, renal tubular acidosis, or pancreatic fistula causing a direct loss of HCO-3; addition of chloride-containing acids

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Increased anion gap values
>14mEq/L causes

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lactic acidosis, uremia, diabetic ketoacidosis (DKA), or salicylate and methanol toxicity, resulting in accumulation of nonvolatile acids with decrease in HCO-3

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In an attempt to identify the cause of the metabolic acidosis, an anaylysis of serum electrolytes to detect an___ ____ may be helpful

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Anion Gap

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Reflects unmeasurable anions present in plasma and is calculated by subtracting the sum of chloride and bicarbonate from the amount of plasma sodium concentration.

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Anion Gap

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What acid base imbalance is marked by the heavy loss of acid from the body or by increased levels of bicarbonate

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Matabolic alkalosis

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Vomiting and gastric suction is the most common cause for

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Metabolic alkalosis

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Overcorrection of metabolic acidosis, potassium deficiency, hyperaldosteronism, and the use of thiazide therapy that causes an increase of renal excreted acid are other causes of

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Metabolic Alkalosis

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Normal anion gap values are

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12 (+-2)mEq/L

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Increased anion gap values are

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>14mEq/L

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Normal anion gap values
12(+-2)mEq/L causes

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diarrhea, renal tubular acidosis, or pancreatic fistula causing a direct loss of HCO-3; addition of chloride-containing acids

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Increased anion gap values
>14mEq/L causes

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lactic acidosis, uremia, diabetic ketoacidosis (DKA), or salicylate and methanol toxicity, resulting in accumulation of nonvolatile acids with decrease in HCO-3