fluid and electroyltes

• 60%


  % of body weight that is fluid
• bodyweight


  #1 indicator of hydrations
• 1L of water


  1kg (2.2lbs)
• intracellular fluid


  within cells, 2/3 of body fluid
• extracellular


  outside cells, 1/3 of body fluid
• interstitial


  extracellular fluid that is between cells
• vascular (plasma) compartment


  extracellular fluid within blood vessels
• transcellular


  extracellular fluid that is synovial fluid, cerebrospinal fluid, GI fluids
• hemocrit


  (36-52%) number of cells/solution- guide for hydration

  increased- dehydrated, decreased-overhydrated
• sodium (Na+)


  (135-145mEq/L) regulates fluid volume
• chloride (Cl-)


  (97-107mmol/L) close affinity to sodium, rise and fall together
• potassium (K+)


  (3.5-5mEq/L) controls muscle contraction- heart
• calcium (Ca2+)


  (8.2-10.2mg/dL) controls muscle contractions like twitching and spasms, clot formation
• phosphorous (PO4-)


  (2.5-4.5mg/dL) seesaw effect with calcium, one rises as other falls
• magnesium (Mg2+)


  (1.6-2.6mg/dL) nerve innervation to muscles- diaphragm
• bicarbonate (HCO3-)


  (22-26mEq/L) acid base control
• serum creatinine


  (0.5-1.2mg/dL) kidney function, if elevated- kidneys failing
• bun urea nitrogen (BUN)


  (8-21mg/dL) kidney function, hydration, if elevated- kidney dysfunction or dehydration
• plasma proteins


  total proteins (6.4-8.3g/dL)

  albumin (3.5-5g/dL) check if edemic or suspected liver failure
• specific gravity


  (1.005-1.030) particles/solution of urine, high-concentrated, low-dilute
• urine pH


  4-7
• isotonic iv fluids


  same concentration as blood, fluid stays put- volume builder for low BP or hemorrhage
• isotonic iv fluid examples

  0.9% NaCl (NS)

  Lactated Ringers (LR)

  5% Dextrose in LR (D5LR)

  Plasmalyte
• hypertonic iv fluid


  solution higher concentration than blood, fluid moves into vascular compartment- cells shrink and increased vascular volume

  *pulmonary edema risk- for very low sodium
• hypertonic iv fluid examples


  3% NaCl

  10% Dextrose in water (D10W)

  20% Dextrose in water (D20W)

  5% Dextrose and ½ NS (D5 ½)
• hypotonic solution


  solution lower concentration then blood, fluid moves from vascular compartment into cells

  *not for those with increased brain swelling, cerebral edema, or children as brain cells swell- for very high sodium
• hypotonic iv fluid examples


  0.45% NaCl (1/2 NS)

  5% Dextrose in water (D5W)

  5% Dextrose and ¼ NS (D5 ¼)

  0.33% NaCl
• protein deficiency causes


  inadequate protein intake, protein loss, decreased protein synthesis
• protein deficiency s/s


  edema, slow wound healing, muscle wasting and atrophy, weakness, weight loss, anemia
• dependent edema


  from gravity- typically look at legs
• weeping edema


  fluid leaks through pores of skin
• anasarca


  generalized edema- all over body no matter position
• protein deficiency care


  diet high in carbs and protein, iv or tube feeding with amino acids
• consequences of fluid disturbances


  impaired oxygen and perfusion, impaired cerebral function, impaired neuromuscular function (cramping)
• fluid shift from plasma to interstitial space

  too little fluid in vascular compartment- from increased capillary hydrostatic pressure, decreased plasma proteins, increased permeability
• plasma to interstitial s/s


  increased HR to keep blood pumping (1), decreased BP, decreased urine output, edema, altered mental status
• plasma to interstitial care


  f/e replacement, rapid response, if shock- emergency
• fluid shift from interstitial to plasma


  too much fluid in vascular compartment from increased vascular protein or burns
• interstitial to plasma s/s

  HR 70s strong and bounding to pump extra fluid, increased BP and urine output, risk for pulmonary edema- crackles, signs of hypoxia (restless, altered mental status, tachycardia)
• interstitial to plasma care


  diuretics and dialysis