Dehydration and Electrolyte Imbalances Quiz

Fluid Imbalances

• Dehydration is a loss of water without a corresponding loss of sodium. It shifts fluid from the intracellular fluid (ICF) to the extracellular fluid (ECF), causing cell shrinkage. Dehydration is often associated with sodium excess or water deficit.

• The initial sign of dehydration is thirst, while weight loss and decreased urine output are objective indicators.

• Vital signs impacted by dehydration include elevated body temperature, increased pulse rate (tachycardia), increased respiratory rate (tachypnea) and decreased blood pressure (hypotension).

• Other dehydration symptoms and signs include: dry mouth and throat, warm and flushed dry skin, soft and sunken eyeballs, dark and concentrated urine, altered level of consciousness (LOC), increased hematocrit, increased blood urea nitrogen (BUN), and increased serum electrolyte levels.

• Collaborative management for dehydration focuses on fluid replacement, oral care, safety measures for altered consciousness and identification and treatment of any underlying cause, such as, enteral feedings, renal failure, or diabetes mellitus (DM).

Fluid Imbalances - Hyposmolar Imbalance (Water Intoxication)

• Water intoxication shifts fluid from the ECF to the ICF, causing cell swelling. It is characterized by sodium deficit or water excess.

• Increased intracranial pressure (ICP) is a major concern in water intoxication.

• Clinical indications of water intoxication include changes in mental status (e.g., confusion, loss of coordination, seizures), sudden weight gain, and peripheral edema.

• Collaborative management for water intoxication includes fluid restriction, administration of diuretics (as prescribed), infusion of hypertonic saline, maintaining patient safety and identifying and treating underlying causes, like excessive intake of fluids, repeated tap water enemas, syndrome of inappropriate antidiuretic hormone (SIADH), or sodium deficit.

Fluid Imbalances - Isotonic Volume Deficit (ECF Volume Deficit)

• Isotonic volume deficit results from the loss of water and electrolytes.

• Clinical presentations include weight loss, oliguria, high urine specific gravity, dry mucous membranes, poor skin turgor (less reliable in the elderly as their skin is normally wrinkled), and postural hypotension along with tachycardia and tachypnea.

• Collaborative management for isotonic volume deficit involves administering fluids containing sodium, such as lactated Ringer's solution or 0.9% sodium chloride (NaCl). Other elements are meticulous oral care and promotion of safety. Underlying causes (e.g., hemorrhage, profuse sweating, vomiting, diarrhea, draining fistulas, or colostomies) must be identified and addressed.

Fluid Imbalances - Isotonic Volume Excess (ECF Volume Excess)

• Isotonic volume excess, also known as edema or overhydration, is the accumulation of fluid in the interstitial spaces.

• Edema can result from increased capillary hydrostatic pressure (e.g., excessive IV fluids) or decreased colloidal/oncotic pressure (e.g. hypoalbuminemia).

• Symptoms of edema may include weight gain, dependent edema (especially in the sacral, ankle, and foot areas), tight, smooth, and shiny skin, cool and pale skin, and potential for pressure sores. Neck vein engorgement and weeping edema may also appear.

• Collaborative management focuses on sodium and fluid restriction , diuretics, and identification of underlying causes, which could include damage to blood vessels (burns), vasodilation (inflammation), lymphatic obstruction (e.g., lymph node removal in mastectomies or malignant metastasis), and conditions such as congestive heart failure (CHF), renal failure, and hypersecretion of aldosterone. Measures of safety are essential.

Electrolyte Imbalances

• Sodium imbalances include hyponatremia (sodium deficit) and hypernatremia (sodium excess).

• Hypokalemia (potassium deficit), and hyperkalemia (potassium excess).

• Hypocalcemia (calcium deficiency), and hypercalcemia (calcium excess).

• Hypomagnesemia (magnesium deficiency), and hypermagnesemia (magnesium excess).

Electrolyte Imbalances - Sodium Imbalances

• Hyponatremia (Sodium Deficit)

  • Causes include diuretic use, low sodium diets, low adrenal function (Addison's disease), edema, ascites, burns and diaphoresis.
  • Symptoms include headache, muscle weakness, fatigue, apathy, anorexia, nausea, vomiting, abdominal cramps, postural hypotension, and seizures/coma.
  • Collaborative management focuses on administering 0.9% saline or plasma expanders, and a diet rich in sodium. Patient safety needs to be maintained.

• Hypernatremia (Sodium Excess)

  • Causes include hyperventilation, diarrhea, excess sodium intake, or water deprivation.
  • Symptoms include extreme thirst, dry and sticky mucous membranes, oliguria, firm and rubbery tissue turgor, red and swollen tongue, restlessness, tachycardia, fatigue, disorientation, and hallucinations.
  • Collaborative management focuses on monitoring intake and output, restricting sodium in the diet, increasing oral fluids or administering dextrose 5% in water (D5W) IV, prescribing diuretics, or performing dialysis if necessary, while maintaining patient safety.

Electrolyte Imbalances - Potassium Imbalances

• Hypokalemia (Potassium Deficit)

  • Causes include decreased food and fluid intake (starvation), increased potassium loss (hypersecretion of aldosterone), gastrointestinal losses, potassium-wasting diuretics, shifting of potassium into cells (treatment of diabetic ketoacidosis (DKA), or metabolic alkalosis).
  • Symptoms include gastrointestinal tract issues (anorexia, nausea, vomiting, abdominal distention, paralytic ileus), Central Nervous System (CNS) symptoms (CNS: lethargy, depression, diminished deep tendon reflexes, confusion), muscle weakness, fatigue, leg cramps, flaccid paralysis, respiratory arrest, hypotension, dysrhythmias, and possible cardiac arrest.
  • ECG changes in cases of hypokalemia can include ST-segment depression, flattened T-waves, and the presence of U-waves.
  • Collaborative management involves administering potassium supplements (never via IV push), ensuring adequate potassium-rich foods in the diet, and treating underlying issues.

• Hyperkalemia (Potassium Excess)

  • Causes include excess potassium intake (foods, or parenteral administration), decreased potassium excretion (potassium-sparing diuretics, renal failure, adrenal insufficiency), or shifting of potassium out of cells (extensive trauma, crushing injuries, metabolic acidosis).
  • Symptoms of hyperkalemia include gastrointestinal tract issues (nausea, vomiting, diarrhea, colic), neurological symptoms (numbness and tingling), muscle issues (irritability/weakness to paralysis), and cardiovascular abnormalities like possible ventricular fibrillation and cardiac arrest.
  • Collaborative management focuses on decreasing potassium in the diet, dextrose 10% in water with regular insulin per IV, potassium-binding resins (kayexalate), and, if necessary, dialysis.

Electrolyte Imbalances - Calcium Imbalances

• Hypocalcemia (Calcium Deficiency)

  • Causes include decreased ionized calcium (large blood transfusions, alkalosis), excess calcium loss (renal disease, draining fistulas), inadequate calcium-rich foods, impaired absorption of calcium (Vitamin D deficiency), or conditions such as hypoparathyroidism, hyperthyroidism or hypermagnesemia.
  • Symptoms include CNS issues (tingling, convulsions), gastrointestinal concerns (increased peristalsis, nausea, vomiting, diarrhea), muscle issues (muscle cramps, tetany - Chvostek's and Trousseau's signs), cardiac issues (dysrhythmias), cardiac arrest, and skeletal problems (osteoporosis, fractures).
  • Collaborative measures are focused on increasing calcium intake (oral calcium salts), Vitamin D and parathyroid hormone supplements, phosphate binding agents (like amphogel), intravenous calcium gluconate, patient safety, and addressing underlying causes.

• Hypercalcemia (Calcium Excess)

  • Causes may include calcium loss from bones (immobilization or bone metastases), excess calcium intake (from high calcium diets, calcium-containing antacids), hyperparathyroidism, hypervitaminosis D, or steroid therapy.
  • Symptoms of hypercalcemia include CNS symptoms (diminished deep tendon reflexes, lethargy, coma), gastrointestinal concerns (decreased peristalsis, constipation), muscle issues (fatigue, hypotonia, weakness), cardiac abnormalities (abnormal electrical activity, dysrhythmia and cardiac arrest), and bone problems (osteoporosis, fractures).
  • Collaborative management involves increasing fluid intake, administering normal saline, using calcium-lowering agents (like mithramycin), protecting the patient from injury to prevent fractures, and correcting any underlying condition.

Electrolyte Imbalances - Magnesium Imbalances

• Hypomagnesemia (Magnesium Deficiency)

  • Causes include prolonged malnutrition, starvation, malabsorption syndrome, hypercalcemia, alcohol withdrawal or draining fistulas.
  • Typical symptoms may include CNS issues (convulsions, paresthesia, tremors, ataxia) mental changes (agitation, depression, confusion), and muscle symptoms (cramps, spasticity, tetany), tachycardia, hypertension, and cardiac dysrhythmias. Collaborative management involves providing foods rich in magnesium, promoting safety to prevent injury, monitoring for airway concerns (laryngeal stridor), and administering magnesium supplements.

• Hypermagnesemia (Magnesium Excess)

  • Often caused by excessive intake of magnesium-containing antacids or related to conditions like renal failure or diabetic ketoacidosis.
  • Expect symptoms that include decreased blood pressure, thirst, nausea, and vomiting, drowsiness, and diminished or absent reflexes. Collaborative management focuses on administering calcium gluconate IV, dialysis if renal failure is present, and managing the underlying cause. High impact concepts include remembering signs and symptoms, decreased acetylcholine release, and decreased neuromuscular irritability.

Respiratory Acid-Base Imbalances

• Metabolic Acidosis (Bicarbonate Deficit):

  • Characterized by an abnormal accumulation of fixed acids or loss of bicarbonate.
  • Clinical features include symptoms like headache, mental dullness, and Kussmaul's breathing (deep, rapid breathing).
  • Management involves restoring potassium balance, administering sodium bicarbonate intravenously, identifying and treating underlying causes (renal failure, diabetes mellitus, starvation ketoacidosis, shock, chronic diarrhea, or aspirin toxicity).
  • Important to maintain respiratory function and rehydrate accordingly.

• Metabolic Alkalosis (Bicarbonate Excess):

  • Resulting from loss of hydrogen ions or addition of base to body fluids.
  • Clinical presentations often include hypoventilation, mental confusion, dizziness, numbness/tingling in extremities and with muscle symptoms such as twitching and tetany, and seizures.
  • Management includes maintaining respiratory function, preventing patient injury/seizures, administering sodium chloride or ammonium chloride, using carbonic anhydrase inhibitors (like diamox) to increase bicarbonate excretion, and identifying and treating causes like excessive soda/bicarbonate ingestion, vomiting, gastric suctioning, or intestinal fistulas, which may necessitate IV sodium chloride or ammonium chloride.

• Respiratory Acidosis (Carbonic Acid Excess):

  • Results from the respiratory system's inability to remove carbon dioxide (CO2) efficiently, which results in excess carbonic acid accumulating in the body.
  • It can be caused by issues like, restrictive and obstructive lung disease, impaired thoracic cage movement, depressed respiratory centers or neuromuscular disease, and hypoventilation during surgeries or other clinical conditions.
  • A key feature may include Kussmaul's respiration. Treatment includes maintenance of respiratory function, and fluid replacement. Respiratory assessment, and treating any underlying cause.

• Respiratory Alkalosis (Carbonic Acid Deficit):

  • Due to CO2 loss from the lungs at a faster rate than it's produced,
  • Common triggers include anxiety, fever, meningitis, or using medications such as salicylates.
  • Often presenting with lightheadedness, numbness/tingling in fingers or toes, late-stage tetany, and convulsions,
  • Key management focuses on treating symptoms, maintaining respiratory function, treating underlying causes and monitoring electrolyte imbalances. (Potassium may be low).

High-Impact Concepts (for all imbalances)

• Acidosis: In acidosis, the body often displays CNS depression leading to coma. In acidosis the body vasodilates, causing intracranial pressure (ICP) to increase and potentially resulting in cerebral edema. Peripheral vasoconstriction is also a common finding leading to BP issues.

• Alkalosis: Alkalosis leads to CNS stimulation, which often results in seizures. In alkalosis, the body vasoconstricts to protect from Cerebral ischemia and hypoxia. Peripheral vasodilation is also a common result leading to hypertension issues.

• Understand the body systems affected by each imbalance and how these changes impact vital functions, including the central nervous system (CNS), cardiovascular system, and respiratory system.

• Remember the key causes, clinical manifestations, and appropriate interventions for each disorder.

Test your knowledge on dehydration, water intoxication, and electrolyte imbalances with this quiz. Explore various clinical manifestations, vital sign changes, and management strategies related to these conditions. Perfect for nursing students or healthcare professionals seeking to reinforce their understanding of fluid and electrolyte balance.