Fluids And Electrolytes

• Sodium (Sodium Swells) (Sodium causes the body to retain water)

  • 135-145
• Potassium (Potassium Pumps)(Potassium helps the heart muscle to pump blood to the body)

  3.5-5 (There are about 3-5 in every bunch and you want them half ripe!)
• Phosphorus(Phosporus think Perfect Teeth)(Phosphorus helps the body to use vitamins to maintain tooth and bone health)

  2.5-4.5

  Phor- 4

  Us- 2 (Me and You=2)
• Calcium(Calcium think Creating bone)(Calcium Imbalances can lead to an increased risk for pathological fractures)

  9-11 (Call 911)
• Magnesium(Magnesium Manages Muscle)(Magnesium acts like a sedative)

  1.5-2.5 (MAGnifying glass you see 1.5-2.5 bigger than normal)
• Chloride(Chloride thinks Carrying fluids)(Chloride helps to balance the acid and bases in the body)

  95-105(Think of a CHLORInated pool that you want to go in when its SUPER HOT: 95-105F)
• Hypernatremia

  Signs and Symptoms(FRIED SALT)

  • Flushed Skin
  • Restless
  • Increased BP & Fluid Retention
  • Edema(Pitting)
  • Decreased Urine Output
  • Skin is Dry
  • Agitation
  • Low Grade Fever
  • Thirst
• Hypernatremia

  Treatment

  • Restrict Sodium Intake
  • Administer IVF if due to fluid lost(Isotonic/ Hypotonic Solutions)
  • If the cause of Sodium retention is inadequate renal excretion. Give DIURETICS that promotes sodium loss.
• Hyponatremia

  Signs and Symptoms (SALT LOSS)

  • Stupor/Coma
  • Anorexia (Nausea and Vomitting)
  • Lethargy
  • Tachycardia
  • Limp Muscles(Muscle Weakness)
  • Orthostatic Hypotension
  • Seizures
  • Headache
  • Stomach Cramping(Hyperactive Bowels Sounds)
• Hyponatremia

  Risk Factors: (5D’s)

  • Diaphoresis
  • Diarrhea and Vomitting
  • Drains (NGT Suction)
  • Diuretics
  • siaDH(Dilution)

  
  

  • Fresh Water Drowning
  • Heart Failure
• Hyponatremia

  Treatments:

  • Tolvaptan
  • Administer IV Fluids(Hypertonic Solutions)
  • Hyponatremia with SIADH - Medication to antagonize Anti-Diuretic Hormone
  • Hyponatremia with Hypervolemia- Osmotic Diuretics
  • Hyponatremia With Hypovolemia- Sodium Chloride IV
  • Place in High Sodium Diet
  • Place on SEIZURE PRECAUTION
  • Place the patient on fluid restriction if due to SIADH
  • Place patient on airway protection(NPO)
• Hyperkalemia (Muscles Contract for TOO long)

  Signs and Symptoms (MURDER)

  • Muscle Cramps & Weakness
  • Urine Abnormalities
  • Respiratory Distress
  • Decreased Cardiac Contractility (👇HR, 👇BP)
  • ECG Changes (Vfib , Asystole) (Tall Peak T-Waves)
  • Reflexes (👇DTR)
• Hyperkalemia

  Risk Factors:

  • Increased Intake of Potassium
  • Adrenal Gland Issues (Addisons Disease)
  • Rhabdomyolysis
  • Tumor Lysis Syndrome
  • High level of acidosis (Metabolic or Respiratory)
  • Insulin Deficiency/ Hyperglycemia
  • NSAIDS (Ibuprofen, Naproxen)
  • ACE Inhibitors- Inhibits aldosterone secretions
  • Potassium-Sparring Diuretics(Spironolactone)
• Hyperkalemia

  Treatments:

  • Give Sodium Bicarbonate
  • Give Calcium Gluconate- To prevent VTACH
  • Potassium Execreting Diuretics (IF KIDNEY IS OKAY)
  • Sodium Polystyrene Sulfonate rectally - Inhibits K+ absorption in the intestines (IF KIDNEY IS NOT OKAY) (DON’T GIVE TO CONSTIPATED PATIENTS) (MUST EXCRETE POOP WITHIN 6HOURS)
  • Beta Adrenergic Agonists (Albuterol)
  • Insulin(To facilitate K+ to get inside the cell) + D5050 (For the side effects of the insulin)= GI Solution
• Hypokalemia(Generalized Weakness in the Muscles)

  Signs and Symptoms:

  • Weak Muscles
  • 👇Reflexes
  • Shallow Breathing
  • Slowing of GI system
  • 👇 Blood Pressure(Especially position change)
  • Nausea, Vomitting, Bloating
  • ECG Changes(PAC, PVC)(Flattened T-wave or inversion of Twave)
• Hypokalemia

  Risk Factors:

  • Cushing’s Syndrome
  • Corticosteroids
  • Low Potassium Intake
  • Vomitting, Diarrhea
  • Gastric Suction
  • Alkalosis
  • Potassium Wasting Diuretics(Loop or Thiazide)
  • Kidney Disease
  • Excessive Diaphoresis
• Hypokalemia

  Treatment:

  • Incorporate Potassium In Diet (PABOWS)- Potato, Avocado/Apricot, Banana, Orange, Watermelon, Strawberry)
  • Oral Potassium Supplement (Always with meals)
  • IV Potassium (10mEq/L per hour)
  • (Nursing Intervention)- Always dilute in Fluid , Infuse slowly it can burn the vein. NEVER DO IV PUSH
• Hypercalcemia

  Signs and Symptoms: (BACKME)

  • Bone Pain
  • Arrythmias
  • Cardiac Arrest(Bounding Pulses), Constipation
  • Kidney Stones(Renal Calculi)
  • Muscle Weakness
  • Excessive Urination
• Hypercalcemia

  Risk Factors:

  • 👆 Calcium Absorption
  • 👇 Calcium Excretion
  • Kidney Disease
  • Use of Thiazide Diuretics
  • HYPERparathyroidism and HYPERthyroidism
  • Bone Breakdown from Metastatic Cancer
  • Highly Concentrated Blood(Hemoconcentration) which can results from dehydration
  • Glucocorticosteroids
• Hypercalcemia

  Treatment:

  • Stop Calcium Intake(IV or PO)
  • Administer Drugs to👇Calcium Levels
  • Phosporus
  • Calcitonin(CalciTONin helps TONe down calcium levels in the blood and pull calcium from blood to bone)
  • Patient with Calcium Imbalance is at risk for a PATHOLICAL FRACTURE. Move the patient carefully and slowly
• Hypocalcemia(CATS GO NUMB)

  Signs and Symptoms:

  • Convulsion
  • Arrythmias
  • Tetany
  • Spasms & Stridor
  • GO NUMB- Numbness in fingers, face, limbs
  • Positive Trousseau’s (Carpal Spasm by inflating a BP Cuff by 3 minutes)
  • Positive Chvostek’s Signs (Contraction of facial muscles with light tap over the facial nerve)(C for Cheesy Smile)
• Hypocalcemia

  Risk Factors:

  • GI Issues in regards to absorption of Calcium (Celiac Disease, Chrons Disease)
  • Kidney Disease(👆Phosphorus and 👇Vitamin D= Hypocalcemia)
  • Diuretics
  • Diarrhea
  • Drainage from Wounds
• Hypocalcemia

  Treatments:

  • Calcium Supplements
  • 👆Calcium Intake in Diet (Cheese,Collard Greens,Milk and Soy Milk,Rhubarb,Sardines,Tofu,Yogurt)
  • Vitamin D - aids calcium absorption
  • Calcium Gluconate (Warm the injection solution to body temp and SIVP. Attach the pt. to cardiac monitor and watch out for hypercalemia)
  • Aluminum Hydroxide to reduce phosporus levels
  • Initiate Seizure Precaution
  • Prepare Tracheostomy Set at Bedside due to Laryngospasms
• Hypermagnesemia (Low Everything)(Sedated)

  Signs and Symptoms:

  • 👇 Energy (Drowsy, Coma)
  • 👇 HR (Bradycardia)
  • 👇 BP (Hypotension)
  • 👇 RR (Bradypnea)
  • 👇 Respiration( Shallow)
  • 👇 Bowel Sounds
• Hypermagnesemia

  Risk Factors:

  • 👆 Magnesium Intake
  • Magnesium- Containing Antacid(TUMS)
  • Laxative
  • Excessive administration of Mg IV
  • Renal Insufficiency
  • 👇 Renal Excretion of Mg= 👆Mg in the blood
  • DKA
• Hypermagnesemia

  Treatment:

  • Administration Loop Diuretics
  • IV Administration of Calcium Chloride or Calcium Gluconate
  • Restrict Dietary Intake of Mg containig foods(Almonds

  ,Avocado,Canned White Tuna,Cauliflower,Cooked rolled oats 

  ,Green Leafy Vegetables,Milk, Peanut butter,Peas,Pork, Beef,Chicken,Potatoes,Raisins,Soybeans,Yogurt)

  • Avoid using of laxative and antacids containing magnesium
  • Use of Hemodialysis in severe cases
• Hypomagnesemia( High Everything!)(NOT SEDATED)

  Signs and Symptoms:

  • 👆DTR(Deep Tendon Reflexes)
  • 👆 HR (Tachycardia)
  • 👆 BP (Hypertension)
  • Shallow Respirations
  • Twitches, Paresthesias
  • Tetany & Seizures
  • Irritability & Confusion
  • Positive Trousseau’s(Same as Calcium Defiency)
  • Positive Chvosteks Sign(Same as Calcium Defiency)
• Hypomagnesemia

  Risk Factors:

  • Insufficient Mg Intake
  • Malnutrition/Vomitting/ Diarrhea
  • Malabsorption Syndrome
  • Celiac & Crohns Disease
  • Increase Magnesium Excretion
  • Diuretics or Chronic Alcoholism
  • Intracellular Movement of Mg
  • Hyperglycemia & Insulin Administration
  • Sepsis
• Hypomagnesemia

  Treatment:

  • Administer MgSO4 thru IV or PO
  • Place on Seizure Precaution
  • Advise to Increase Mg in Diet(Almonds,Avocado,Canned White Tuna,Cauliflower,Cooked Rolled Oats ,Green Leafy Vegetables,Milk,Peanut Butter,Peas, Pork, Beef, Chicken Potatoes,Raisins,Soybeans,Yogurt)
• Hyperphosphatemia(Directly leads to LOW Levels of Calcium)

  Signs and Symptoms:

  • Muscle Spasms & Tetany
  • Cardiac Arrhythmias
  • Seizures
  • Dry & Brittle Skin/Nails
• Hyperphosphatemia

  Risk Factors:

  • Kidney Dysfunction
  • Consistent use of Laxative or Enemas
  • Rhabdomyolysis(Tea Colored Urine)
  • Vitamin D Toxicity
  • Hypoparathyroidism
  • Acromegaly
• Hyperphosphatemia

  Treatments:

  • 👇 Intake of Food rich in Phosporus(Dairy products, Fish, Nuts,Pumpkin, Organ Meats, Pork,Beef, Chicken, Squash, Whole-grain Breads and Cereals)
  • Use Dialysis especially with patients who have end stage renal disease
  • Control Hypertension
• Hypophosphatemia

  Signs and Symptoms:

  • Fatigue & Weakness
  • Delayed Growth & Development in Children
  • Poor Bone Density & Frequent Fractures
  • Loss of appetite
  • Cardiac Arrythmias
• Hypophosphatemia

  Risk Factors: (Anything that causes loss of fluids)

  • Chronic Vomitting or Diarrhea
  • Overconsumption of Diuretics
  • Patient with Significant Burns
  • Malnutrition & Starvation
  • Alcohol Dependency
  • Refeeding Syndrome(when food is introduced too quickly after a period of malnourishment)
• Hypophosphatemia

  Treatment:

  • Increase Phosphorus in Diet(Dairy products,Fish,Nuts,Pumpkin,Organ Meats,Pork, Beef, Chicken,Squash,Whole-grain Breads and Cereals)
  • Administer Oral or IV Phosphate
  • Reintroduce Nutrients slowly especially in patient with hx of starvation to prevent refeeding syndrome
  • Reduce Diuretic Usage
  • Provide proper care and Recovery of Burns
• Hyperchloremia

  Signs And Symptoms:

  • HYPERtension
  • Fluid Retention
  • Generalized Swelling
  • Peripheral Edema
  • Cardiac Arrythmias
• Hyperchloremia

  Risk Factors:

  • Hypernatremia( Since Sodium and Chloride are besties)
  • Overused of IV PNSS
  • Metabolic Acidosis
  • Renal Damage
  • Dehydration
  • Uncontrolled Glucose Levels
  • DI (Diabetes Insipidus)
• Hyperchloremia

  Treatment:

  • Restrict sodium in Diet
  • Increase Oral or IV Fluid Intake to flush the salt
  • Start Glucose Management and Insulin
  • Dialysis
• Hypochloremia

  Signs and Symptoms: (Similar Signs and Symptoms of Hyponatremia)

  • Hypotension
  • Tachycardia
  • Changes of LOC
  • Muscle Weakness
  • Fatigue
• Hypochloremia

  Risk Factors:

  • Dehydration related to large fluid loss
  • Vomitting & Diarrhea
  • SIADH
  • Overuse of Diuretics
  • Addisons Disease
  • Metabolic Alkalosis
  • Excessive Gastric Suctioning
  • Potassium Imbalance