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Questions and Answers
What percentage of a typical adult's weight is made up of fluids?
Which fluid compartment contains plasma?
What is considered the smallest division of the extracellular fluid compartment?
Which of the following is NOT a major cation in body fluid?
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How does body fluid normally move between compartments?
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What is third-space fluid shifting?
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Which major anion is present in body fluids?
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What is the total average blood volume in adults?
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What is a common cause of hypernatremia related to fluid loss?
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Which symptom is associated with hyponatremia?
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What is the primary medical management for hypokalemia?
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What clinical manifestation might indicate hypernatremia?
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Which condition can lead to hypokalemia due to potassium loss?
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What is a crucial nursing management practice for someone experiencing hyponatremia?
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Which of the following disorders is directly associated with potassium retention?
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What is the first-line treatment for hypernatremia caused by fluid loss?
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What is the normal range for sodium levels in mEq/L?
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Which process describes the movement of water from an area of low solute concentration to high solute concentration?
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What is the typical daily urine volume produced by the kidneys?
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Which type of pressure is exerted by proteins and contributes to the osmotic balance?
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What is the primary source of water loss in the lungs?
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Which mechanism allows substances to move from an area of higher concentration to one of lower concentration?
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What is the maximum typical level of chloride in mEq/L considered normal?
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What does an increase in urine output due to the excretion of specific substances refer to?
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What is a potential cause of hypercalcemia?
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Which diagnostic finding is NOT typically associated with hypomagnesemia?
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Which clinical manifestation is most commonly associated with hypermagnesemia?
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What is the primary treatment for hypomagnesemia?
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Which nursing management strategy is appropriate for a patient with hypercalcemia?
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What is a possible complication of hypomagnesemia?
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Which medical intervention is least effective in treating hypermagnesemia?
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Which of the following is a common symptom of hypomagnesemia?
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What is the primary characteristic of metabolic acidosis?
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Which of the following is a common cause of metabolic alkalosis?
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What abnormal Arterial Blood Gas measurement indicates respiratory acidosis?
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Which clinical manifestation is associated with metabolic acidosis?
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What treatment is generally aimed at correcting metabolic alkalosis?
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In metabolic acidosis, which of the following is often noted in blood chemistry findings?
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Which of the following conditions is likely to lead to respiratory acidosis?
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Which statement describes the effect of sodium bicarbonate during cardiac arrest?
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Study Notes
Hyponatremia
- A deficiency of aldosterone, as occurs in adrenal insufficiency, also predisposes to sodium deficiency and use of certain medications.
- Common causes include diarrhea, sodium diet deficiency, IV fluid overload, diuretics, SIADH, Addison's disease, vomiting, and excessive physical exertion.
- Clinical manifestations include loss of appetite, orthostatic hypotension, shallow respiration, muscle spasm, seizure/stupor, abdominal cramps, and lethargy.
- Medical management includes sodium replacement, IV fluids, and AVP receptor antagonists to treat hyponatremia by stimulating free water excretion.
- Nursing management involves monitoring I&O, weighing the client daily, increasing sodium intake/diet, and restricting/decreasing oral fluid intake.
Hypernatremia
- Serum sodium levels are high, caused by a gain of sodium in excess of water or by a loss of water more than sodium.
- With water loss, the patient loses more water than sodium, resulting in an increased serum sodium concentration.
- Common causes include fluid deprivation in patients who cannot respond to thirst, hypertonic enteral feedings without adequate water supplements, watery diarrhea, and greatly increased insensible water loss.
- Other causes include Cushing's disease, hypertonic solutions, diabetes insipidus, burns, and increased intake of sodium.
- Clinical manifestations include fatigue, restlessness, agitation, increased reflexes, extreme thirst, decreased urine output, and dry mouth/skin.
- Medical management includes IV fluids, diuretics, and synthetic ADH medication if diabetes insipidus is the main cause.
- Nursing management involves monitoring I&O, restricting sodium intake, and monitoring neurological behavior.
Hypokalemia
- Usually indicates a deficit in total potassium stores.
- Common causes include potassium-losing diuretics, diarrhea, vomiting, gastric suctioning, hyperaldosteronism, insulin therapy, and poor nutrition.
- Diagnostic findings include electrocardiogram, arterial blood gas, and blood chemistry.
- Clinical manifestations include muscle weakness, GI tract issues, heart problems, lung issues, and low blood pressure.
- Medical management includes potassium IV supplementation, but avoid bolus administration, instead use an infusion pump.
Hyperkalemia
- Causes:
- Renal failure
- Use of potassium-sparing diuretics
- Excessive potassium intake
- Acidosis
- Tissue injury (burns, crush injuries)
- Cell lysis (tumour lysis syndrome)
- Clinical manifestations:
- Muscle weakness
- Cardiac arrhythmias
- Paralysis
- Nausea and vomiting
- Medical management:
- Stop potassium intake
- Administer calcium gluconate
- Administer insulin and glucose
- Administer sodium bicarbonate
- Dialysis
Hypocalcemia
- Refers to a below-normal serum calcium concentration.
- Common causes include increased calcium intake, hyperparathyroidism, glucocorticoids, hyperthyroidism, poor calcium excretion, Addison's disease, and Lithium toxicity.
- Diagnostic findings include blood chemistry, ECG, double-antibody PTH test, x-rays, and urinalysis.
- Clinical manifestations include weak muscles, ECG changes, absent tendon reflexes, impaired mental status, and decreased bowel motility.
- Medical management includes administration of calcium reabsorption inhibitors, bisphosphonates, and prostaglandin synthesis inhibitors.
- Nursing management includes increasing oral fluid intake, decreasing calcium-rich foods, turning the patient's head to the side if seizure occurs, and avoiding strenuous activity, thiazides, and calcium supplements.
Hypercalcemia
- Refers to an above-normal serum calcium concentration.
- Causes:
- Hyperparathyroidism
- Malignancy
- Vitamin D toxicity
- Thiazide diuretics
- Immobilization
- Clinical manifestations:
- Fatigue
- Weakness
- Confusion
- Constipation
- Polyuria
- Polydipsia
- Kidney stones
- Bone pain
- Medical management:
- Hydration
- Calcitonin
- Bisphosphonates
- Loop diuretics
- Dialysis
Hypomagnesemia
- Refers to a below-normal serum magnesium concentration.
- Common causes include suctioning, diarrhea, intestinal fistulas, inflammatory bowel disease, alcohol consumption, diabetic ketoacidosis, and hypomagnesemia.
- Diagnostic findings include blood chemistry.
- Clinical manifestations include tachycardia, ECG changes, torsades de pointes, rapid shallow breathing, diarrhea, mental status changes, and insomnia.
- Medical management includes magnesium salt and IV magnesium sulfate.
- Nursing management includes increasing magnesium intake, monitoring deep tendon reflexes and ECG, and putting the patient in seizure precautions.
Hypermagnesemia
- Serum magnesium is high, a rare electrolyte abnormality because the kidneys efficiently excrete magnesium.
- Common causes include kidney injury, untreated diabetic ketoacidosis, and excessive use of magnesium-based antacids.
- Diagnostic findings include blood chemistry and ECG findings.
- Clinical manifestations include CNS depression, respiratory depression, muscle weakness, hypotension, and absent DTR.
- Medical management includes loop diuretic, sodium chloride, IV lactated ringers, IV calcium gluconate, and hemodialysis.
- Nursing management involves monitoring vital signs, deep tendon reflexes, and level of consciousness. It also includes avoiding magnesium-containing medications for compromised renal function and magnesium-rich foods.
Metabolic Acidosis
- A common clinical disturbance characterized by a low pH and a low plasma bicarbonate concentration.
- Results in direct loss of bicarbonate.
- Common causes include diarrhea, lower intestinal fistulas, ureterostomies, and use of diuretics.
- Assessment and diagnostic findings include low pH (7.35) and low bicarbonate (22mEq/L) in arterial blood gases, hyperkalemia in blood chemistry, and ECG findings.
- Clinical manifestations include headache, confusion, drowsiness, and tachypnea.
- Medical management is directed at correcting the metabolic acidosis. When necessary, bicarbonate is given, but its administration during cardiac arrest can result in paradoxical intracellular acidosis.
Metabolic Alkalosis
- A clinical disturbance characterized by a high pH and a high plasma bicarbonate concentration. It can be produced by a gain of bicarbonate or a loss of hydrogen ions.
- Common causes include vomiting, NG tube suctioning, pyloric stenosis, use of thiazides, and hypokalemia.
- Assessment and diagnostic findings include pH greater than 7.45 and serum bicarbonate concentration greater than 26mEq/L in arterial blood gases, and hypokalemia in blood chemistry.
- Clinical manifestations include dizziness and respiratory depression.
- Medical management is aimed at correcting the underlying acid-base disorder. Because of volume depletion from GI loss, the patient’s I&O must be monitored.
- Sufficient chloride is needed for the excretion of excess bicarbonate. H2 receptor antagonists decrease HCL secretion.
Respiratory Acidosis
- A clinical disorder in which the pH is less than 7.35 and the PaCO2 is greater than 45mmHg.
- Common causes include pulmonary edema, foreign object aspiration, atelectasis, and overdose of sedatives.
- Assessment and diagnostic findings include pH less than 7.35 and PaCO2 greater than 45mmHg in arterial blood gases, and chest X-ray to identify respiratory disease.
Respiratory Alkalosis
- A clinical disorder in which the pH is greater than 7.45 and the PaCO2 is less than 35mmHg.
- Common causes include hyperventilation, anxiety, pain, fever, and pulmonary embolism.
- Assessment and diagnostic findings include pH greater than 7.45 and PaCO2 less than 35mmHg in arterial blood gases.
- Clinical manifestations include lightheadedness, dizziness, tingling in the extremities, and tetany.
- Medical management involves addressing the underlying cause of hyperventilation and providing reassurance.
Body Fluids and Electrolytes
- Approximately 60% of a typical adult's weight consists of fluids.
- Body fluid is located in two compartments: intracellular and extracellular space, which is further divided into three: intravascular, interstitial, and transcellular fluid spaces.
- Transport of body fluids happens to maintain equilibrium between the two major compartments. Third-space shifting refers to the loss of Extracellular fluid (ECF) into a space that does not contribute to equilibrium.
- Electrolytes are active chemicals. Major cations are sodium, potassium, calcium, magnesium, and hydrogen ions. Major anions are chloride, bicarbonate, phosphate, sulfate, and proteinate ions.
- Normal movement of fluids depends on hydrostatic pressure at both the arterial and venous ends of the vessel and the osmotic pressure exerted by the protein of plasma.
Regulation of Body Fluid Compartments
- Osmosis and Osmolality: Movement of fluid through a membrane from a region of low solute concentration to a region of high solute concentration until the solutions have equal concentrations.
- Tonicity: Ability of all solutes to cause an osmotic driving force that promotes water movement.
- Osmotic Pressure: Amount of hydrostatic pressure needed to stop the flow of water by osmosis.
- Oncotic Pressure: Pressure exerted by proteins.
- Osmotic Diuresis: Increase in urine output caused by the excretion of a substance.
- Diffusion: Natural movement of a substance from an area of higher concentration to lower concentration.
- Filtration: Hydrostatic pressure in the capillaries filters fluid out of the intravascular compartment into the interstitial fluid.
- Sodium-Potassium Pump: Sodium concentration is greater in ECF than in ICF, sodium tends to enter the cell by diffusion. Potassium is pumped into the cell to maintain high intracellular concentration, this movement is called active transport.
Systemic Routes of Gains and Losses
- Kidneys: Usual daily urine volume is 1-2L, 1ml of urine per kg of body weight per hour (in all age groups).
- Skin: Sensible perspiration refers to visible water and electrolyte loss through sweating.
- Lungs: Normally eliminates water vapor at a rate of approximately 300ml every day.
- Gastrointestinal Tract: Usual loss is 100 – 200 mL daily.
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Description
Test your knowledge on hyponatremia and hypernatremia, including their causes, clinical manifestations, and management strategies. This quiz covers essential nursing considerations and medical treatments for sodium imbalances in patients.
