fluid and electrolytes

• normal Na levels: 135-145
• normal Cl levels: 97-107
• normal K levels: 3.5-5
• normal Mg levels: 1.6-2.1
• normal Ca 2+ levels: 8.2-10.2
• normal Ca ionized levels: 4.6-5.5
• normal PO4 levels: 2.5-4.5
• renal system: controls electrolytes, blood pH, and blood pressure
• fluid volume deficit manifestations: decreased weight, increased HR, decreased BP, clear respirations, decreased skin turgor, no edema, decreased urine output, increased urine specific gravity
• fluid volume excess manifestations: increased weight, increased HR, increased BP, crackles or wheezing, increased skin turgor, dependent edema, possible jugular distention, normal or low urine output, decreased urine specific gravity
• RAAS system: renin - angiotensin - aldosterone system
• RAAS system regulates blood pressure and fluid / electrolyte balance
• 1. drop in BP
  2. kidneys release renin
  3. renin goes to the liver
  4. liver released angiotensinogen
  5. angiotensinogen creates angiotensin 1
  6. ACE is released from the lungs to convert to angiotensin 2
  7. angiotensin 2 increases BP by vasoconstriction and release of aldosterone
• hypovolemic = DRY
• hypovolemic causes: loss (vomiting, diarrhea), insufficient intake, and a shift of fluid out of the blood
• hypovolemic labs: H & H decrease if bleeding, BUN/CR ratio increases, and Na increases
• hypovolemic correction: hydration (oral or IV isotonic) or correct cause
• hypervolemic = WET
• hypervolemic causes: increased water and sodium retention, cirrhosis, heart failure, stress conditions, use of corticosteroids, sodium intake
• hypervolemic labs: K is decreased, Na is decreased, H & H is decreased, serum and urine osmolarity is decreased, urine specific gravity is decreased
• hypervolemic correction: fluid restriction, diuretics (also pulls of sodium and potassium will follow), dialysis if needed
• hypovolemic versus hypervolemic labs: UP when your DRY and DOWN when your WET
• nursing management for hypovolemia: I&Os, monitor for cardiac arrhythmias (K +) and seizures (Na +), monitor HR and BP (orthostatic hypotension), seizure precautions
• nursing management for hypervolemic: I&Os, fluid restriction, monitor for crackles or wheezing), monitor HR (decreased) and BP (decreased), weight daily (in morning after they void), monitor for edema
• hyponatremia causes: medications (diuretics), diarrhea or vomiting, hyperglycemia with glucosuria, perspiration, hypothyroidism, adrenal insufficiency, heart failure, cirrhosis
• hypernatremia causes: reduced water intake, limited ability to express thirst, diabetes insipidus, hyperglycemia, neoplasms, hypercalcemia, hyperkalemia, medications