Fluid And Electrolyte Balance

Front 1

What are the functions of water?

Back 1

- Cellular metabolism (without water, our cells can't function)
- Transportation of nutrients
- Digestion of food
- Temperature regulation (temp. increases when not enough water)
- Maintenance of ECF
- Acid-base balance
- Waste excretion

Front 2

The body has 50- 80% of water. List the factors that makes this percentage vary.

Back 2

- Age (younger the individual, greater the water composition)
- Body weight (the more muscle, the more water)
- Sex (men have more water than women)

Front 3

What is the difference between sensible and insensible water loss?

Back 3

- Insensible water loss is hard to measure (ex: sweating, water loss from lungs, ryv.z)
- Sensible water is measurable

Front 4

How do you determine a person's output per hour?

Back 4

- 1 ml per kilogram of body weight per hour
- Normal output is 40-80 ml per hour
- Less than 30 ml could indicate renal failure

Front 5

How much body fluid is in the intracellular fluid (ICF)?

Back 5

75%

Front 6

How much body fluid is in the extracellular fluid (ECF)?

Back 6

25%

Front 7

What are the two components of extracellular fluid?

Back 7

- Intravascular (circulatory system) : 5%
- Interstitial (third space): 20%

Front 8

What is edema?

Back 8

- Increase fluid in interstitial space

Front 9

What is the #1 way of maintaining and regulating fluid balance?

Back 9

Thirst

Front 10

How is thirst regulated?

Back 10

- The hypothalamus regulates thirst which has osmoreceptors
- Osmoreceptors sense osmotic pressure of body fluids
- As osmotic pressure (concentration) increase, we become thirsty/thirst reflex is stimulated
- As we have decrease concentration osmoreceptors sense, there is a decrease thirst

Front 11

Define osmosis.

Back 11

The movement of water between areas and cells of the body.

Front 12

Describe the action of antidiuretics (ADH).

Back 12

- ADH causes kidneys to reabsorb water; thus decreasing urine output.
- The body notices fluid volume deficit
- This stimulates the posterior pituitary to send out ADH
- Releases anti "urine" hormone
- Kidneys reabsorb water
- Increases circulating volume of water, increases blood volume, and decreases osmolarity

Front 13

Describe the action of Aldosterone.

Back 13

- Aldosterone holds sodium, therefore water.
- Juxtoglomuler (JG) in kidney repond to decrease blood pressure or volume
- JG cells stimulate the renin angiotension feedback loop
- Causes kidney to hold sodium.
- Remember water and Na stick together.
- Thus, water is retained.
- K+ is given away during process.

Front 14

How many kg equals a liter of water? How many ml equals a pound (lb)?

Back 14

- 1 kg = 1 liter
- 1 lb = 500 ml

Front 15

What is hypovolemia?

Back 15

- Decrease fluid volume
- Fluid volume deficit
- Dehydration

Front 16

What are the risk factors for fluid volume deficit (FVD)?

Back 16

- Age (infants and elderly kidneys less able to compensate; unable to quickly and aggressively released ADH and aldosterone)
- Increased loss of fluid
- Decreased intake (nausea, anorexia, confusion)

Front 17

What are some things that lead to FVD?

Back 17

- Nasogastric drainage
- Vomiting, diarrhea, drainage
- Diuresis, diaphoresis
- Fluid losses through the skin from surgery, trauma, burns

Front 18

Dehydration symptoms arise when fluid loss is more than what percentage of body weight?

Back 18

Dehydration symptoms arise when fluid los is more than 2% of body weight

Front 19

What is hypervolemia?

Back 19

- Overhydration
- Fluid volume excess
- Acute weight gain of 5% of body weight

Front 20

What are the risk factors for fluid volume excess (FVE)?

Back 20

- Decreased urinary output (renal failure and decreased cardiac output)
- Increased intake (IV therapy)

Front 21

What do you see in babies with fluid volume deficit (FVD)?

Back 21

- Sunken fontanels
- No tears
- Very dry mouth and tongue
- Decrease skin turgoe
- Sunken abdomen

Front 22

What are the FVE symptoms?

Back 22

- Neck vein distention
- Congestive heart failure
- Pulmonary edema
- Full bounding pulses
- Elevated blood pressure
- Peripheral edema
- Weight gain
- First sign is at the scene (the lungs); thus, listen to the lungs to see if there's fluid in the lungs (crackles and rales)

Front 23

What are the three types of Saline Intravenous Solution. What are their purpose?

Back 23

- 0.45% Sodium Chloride given to a person with hypernatremia
- 0.9% Sodium Chloride given to some if dehydrated; equal to our normal healthy body concentration of sodium chloride in the fluid
- 3% Sodium Chloride - given to person with hyponatremia

Front 24

What is the normal range of serum K+ levels?

Back 24

3.5-5 mEq/l

Front 25

What are the functions of Potassium?

Back 25

- Transmission of nerve impulses: cardiac and skeletal muscles
- Acid/Base Balance: control H ion concentration
- Carrier for glucose and insulin

Front 26

What is the range for hyperkalemia?

Back 26

- More than 5 mEq

Front 27

What can lead to hyperkalemia?

Back 27

- Excess intake (IV replacement therapy, multiple blood transfusion, potassium supplement without need to replace)
- Decreased loss (potassium-sparing diuretics, renal failure: decrease output)
- Shifting of K+ out of cell

Front 28

What are the signs and symptoms of hyperkalemia?

Back 28

- Gastronintestinal (nausea, vomiting, diarrhea, hyperactive bowel sounds)
- CNS (numbness, paraesthesia: tingling sensations)
- Muscles (irritability, hyperactive reflexes)
- Cardiovascular (peak T waves, ventricular fibrillation, CARDIAC ARREST)
- Kidneys (oliguria: decrease urine output)

Front 29

Can we IV push K+?

Back 29

- Never IV push K+
- K+ is adminstered on a pump or witin a bag

Front 30

What are the treatments for hyperkalemia?

Back 30

- Give Lasix to those with a functional kidney; avoid additional IV and oral intake
- For those with decreased kidney function, give insulin and dextrose infusion as it causes K+ to go into the cell
- Dialysis

Front 31

What is considered hypokalemia?

Back 31

- Less than 3.5 mEq/l
- Kidney is not good at conserving K+ frequently occuring, develops quickly

Front 32

What can cause hypokalemia?

Back 32

- Dcreased intake (failure to replace losses, decreased food and fluid intake)
- Increased loss (GI losses, the biggest loss: vomiting and diarrhea, potassium losing diuretics, long term steroid therapy)
- Shift of K+ into cells
- Excess aldosterone secretion

Front 33

What are the signs and symptoms of hypokalemia?

Back 33

- Gastrointestinal (anorexia, nausea, paralytic ileus: no bowel sounds)
- CNS: lethargy, confusion, diminished deep tendon relexes
- Muscles: weakness, paralysis
- Cardiovascular: dyshythmias, EKG changes, flattened T waves, "U" waves
- Kidneys: renal damage, < capacity to concentrate urine

Front 34

What is the treatment for hypokalemia?

Back 34

- Stop loss
- Monitor patient: blood level and signs and symptoms
- Replacement with foods (dried fruit), oral meds (take with good due to GI irritant), IV therapy (irritating to the vein) , never IV push

Front 35

What is the normal range for sodium levels?

Back 35

-135-145 mEq/L

Front 36

What may be the causes of hypernatremia?

Back 36

- Decrease water intake (comatose, NPO)
- Increased water output (watery diarrhea, diaphoresis, fever with inrcreased respiration, diabeters insipidus)
- Increased NA intake: IV solution (0.9% NaCl), near drowning in sea water, increase aldosterone secretion

Front 37

What are the signs and symptoms of hypernatremia?

Back 37

- Think DRY
- Intense thirst
- Red dry tongue
- Flush skin
- Nonelastic skin turgor
- Dry, sticky mouth membranes
- Restlessness, agitation
- Anuria, oliguria (retain water)

Front 38

What is the treatment for hypernatremia?

Back 38

- Monitor patient: blood level and signs and symptoms
- Replace water until NA level returns to normal: Oral intake, IV replacement (5% D/W); don't give IV with sodium chloride, just solution that dilutes the fluid
- Protect patient if confused

Front 39

What is the sodium level if a person has hyponatremia?

Back 39

- < 135 mEq
- Think LOTS OF WATER
- Loss of Na+ without loss of water
- Excess water, low Na+

Front 40

What can be the causes for hyponatremia?

Back 40

- Increased water intake: Na+ free IV fluids (hypotonic solution), tap water eneam
- Decreased water output: renal disease, excess water
- Increased Na+ loss: vomiting, irrigating NG tube with water
- Decreased Na+ intake: low Na+ diet, Na+ free liquids with diaphoresis (loss of more Na+ in proportion to water)

Front 41

What are the signs and symptoms of hyponatremia?

Back 41

- Absence of thirst
- Abdominal cramping
- Clammy skin
- Finger printing on the sternum
- Disorientation
- Headaches
- Fatigue

Front 42

What is the treatment to hyponatremia?

Back 42

- Stop the cause
- Monitor patient: Blood level and signs and symptoms
- Decrease water intake
- Fluid replacement with NA+ (Oral and IV); would give hypertonic 3% sodium chloride solution IV
- Irrigate NG tube with Nacl, NOT WATER.