Physiology of Hormones and Fluid Balance
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Questions and Answers

Vasodilation and increased urinary excretion of sodium and water, leading to a decrease in blood volume, are the primary actions of which hormone?

  • Aldosterone
  • Antidiuretic hormone (ADH)
  • Atrial natriuretic factor (ANF) (correct)
  • Renin

    • What physiological response would you expect to observe in a patient experiencing decreased renal perfusion?

  • Increased release of atrial natriuretic factor (ANF)
  • Suppression of the renin-angiotensin-aldosterone system (RAAS)
  • Decreased sodium and water reabsorption in the renal distal tubules
  • Activation of the renin-angiotensin-aldosterone system (RAAS) (correct)

    • Which of the following factors would cause the greatest percentage of total body water?

  • Increased adipose tissue
  • Lean body mass (correct)
  • Female sex
  • Increased age

    • A patient is experiencing fluid retention due to excessive ADH secretion. Which electrolyte imbalance is most likely to occur?

    <p>Hyponatremia (low sodium) (B)</p> Signup and view all the answers

    A patient with a traumatic brain injury (TBI) is at risk for hyperosmolality because:

    <p>Patients with TBIs may not recognize the sensation of thirst. (A)</p> Signup and view all the answers

    Which of the following best describes the primary function of ADH on the kidneys?

    <p>Promotes the retention of water (B)</p> Signup and view all the answers

    What is the primary role of ADH (antidiuretic hormone) in regulating water balance?

    <p>To cause the kidneys to reabsorb water. (D)</p> Signup and view all the answers

    How does aldosterone contribute to restoring fluid volume when it is low?

    <p>By increasing sodium and water reabsorption in the renal distal tubules (A)</p> Signup and view all the answers

    Which of the following mechanisms is triggered by increased plasma osmolality?

    <p>Secretion of ADH (C)</p> Signup and view all the answers

    Considering both insensible water loss and normal urine production, approximately how much total fluid output does the average person experience daily?

    <p>2400 mL (B)</p> Signup and view all the answers

    A patient with hyponatremia and hypovolemia requires intravenous fluid administration. Which type of solution would be most appropriate?

    <p>Hypertonic solution (B)</p> Signup and view all the answers

    A patient with a traumatic brain injury is experiencing increased intracranial pressure (ICP). Which intravenous solution is most likely to be administered to reduce cerebral edema?

    <p>3.0% NaCl (A)</p> Signup and view all the answers

    Which of the following patients would be most at risk for complications if administered a hypertonic solution?

    <p>A patient with heart failure (A)</p> Signup and view all the answers

    A patient's arterial blood gas reveals a pH of 7.30. Which of the following conditions is most likely contributing to this acid-base imbalance?

    <p>Uncontrolled diabetes mellitus (B)</p> Signup and view all the answers

    Following an increase in hydrogen ion concentration, which buffer system reacts immediately to minimize the effect on blood pH?

    <p>Buffer system (D)</p> Signup and view all the answers

    Why does hyperkalemia cause cells to become weak and paralyzed?

    <p>It causes membrane depolarization, altering cell excitability. (C)</p> Signup and view all the answers

    Which ECG finding is typically associated with hyperkalemia?

    <p>Tall, peaked T wave (C)</p> Signup and view all the answers

    Which intervention is most appropriate for managing hyperkalemia?

    <p>Administering IV insulin to shift potassium into cells (C)</p> Signup and view all the answers

    Which of the following is a common cause of hypokalemia?

    <p>Diuresis, when circulating blood volume is low (C)</p> Signup and view all the answers

    How does hypokalemia alter the membrane potential of cells?

    <p>It is associated with hyperpolarization (increases negative charge within cell). (C)</p> Signup and view all the answers

    What ECG finding is associated with hypokalemia?

    <p>Prominent U wave (B)</p> Signup and view all the answers

    What is the significance of checking AM labs in patients at risk for hypokalemia?

    <p>To evaluate potassium levels and other electrolytes. (C)</p> Signup and view all the answers

    Low magnesium levels can contribute to hypokalemia. What mechanism explains this relationship?

    <p>Low magnesium stimulates renin release and increases aldosterone, leading to potassium excretion. (C)</p> Signup and view all the answers

    Why does cellular edema occur in the context of hyponatremia?

    <p>Because the body attempts to compensate by shifting fluid from the ECF into the cells. (C)</p> Signup and view all the answers

    Which of the following neurological symptoms is often associated with hyponatremia due to cellular swelling?

    <p>Nonspecific symptoms like headache, irritability, and difficulty concentrating. (A)</p> Signup and view all the answers

    Why is it important to restrict fluids in some cases of hyponatremia?

    <p>May require fluid restriction (C)</p> Signup and view all the answers

    What is a significant risk associated with rapidly increasing sodium levels during the treatment of hyponatremia?

    <p>Osmotic demyelination syndrome with potential permanent nerve damage. (D)</p> Signup and view all the answers

    Which assessment is LEAST useful for monitoring sodium and volume imbalances?

    <p>Range of motion (D)</p> Signup and view all the answers

    What is the primary role of potassium (K+) within the body's cells?

    <p>Critical for nerve impulse transmission, cardiac rhythms, and muscle contraction. (A)</p> Signup and view all the answers

    How do the kidneys contribute to maintaining potassium balance in the body?

    <p>By serving as the primary route for potassium loss. (D)</p> Signup and view all the answers

    What effect do factors that cause sodium retention typically have on potassium levels?

    <p>They cause potassium loss due to an inverse relationship. (B)</p> Signup and view all the answers

    Which of the following conditions would most likely cause potassium to shift from the ICF to the ECF?

    <p>Acidosis. (B)</p> Signup and view all the answers

    Which of the following is the MOST common cause of hyperkalemia?

    <p>Impaired renal excretion. (A)</p> Signup and view all the answers

    How does the respiratory system compensate for metabolic acidosis?

    <p>By increasing the respiratory rate to eliminate more CO2. (B)</p> Signup and view all the answers

    Which of the following conditions can cause the greatest risk for respiratory alkalosis?

    <p>Hyperventilation due to anxiety (D)</p> Signup and view all the answers

    How do the kidneys compensate for respiratory acidosis?

    <p>By reabsorbing bicarbonate (HCO3-) and excreting hydrogen ions (H+). (D)</p> Signup and view all the answers

    A patient with severe COPD is at risk for respiratory acidosis because:

    <p>They are retaining too much CO2 due to impaired gas exchange. (C)</p> Signup and view all the answers

    In respiratory acidosis, why can hyperkalemia occur?

    <p>Cellular shift of potassium in exchange for hydrogen ions. (D)</p> Signup and view all the answers

    If a patient is hyperventilating, what changes in carbonic acid concentration and hydrogen ion concentration would you expect?

    <p>Decreased carbonic acid and decreased hydrogen ions. (B)</p> Signup and view all the answers

    A patient presents with drowsiness, disorientation, and a decreased respiratory rate. An arterial blood gas (ABG) reveals a pH of 7.20 and elevated PaCO2. Which acid-base imbalance is the patient most likely experiencing?

    <p>Respiratory acidosis (A)</p> Signup and view all the answers

    After a traumatic brain injury, a patient begins to hyperventilate. Which of the following acid-base imbalances is most likely to develop if the hyperventilation persists?

    <p>Respiratory alkalosis with decreased PaCO2. (C)</p> Signup and view all the answers

    Flashcards

    Homeostasis

    The body's ability to maintain internal equilibrium through fluid and electrolyte balance.

    Water Regulation

    Balance between water intake and excretion, regulated by osmoreceptors and ADH.

    ADH (Antidiuretic Hormone)

    Hormone that promotes water reabsorption in the kidneys, stored in the pituitary.

    Hyperosmolarity Risks

    Conditions that lead to a risk of high plasma osmolality, often affecting those who cannot sense thirst.

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    Insensible Water Loss

    Approximately 900ml of water lost daily through unnoticed means, such as breathing.

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    Aldosterone

    A mineralocorticoid hormone that promotes sodium retention and potassium excretion, activated by low renal perfusion.

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    Atrial Natriuretic Factor (ANF)

    A hormone released by the heart that decreases blood volume by promoting vasodilation and sodium excretion.

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    RAAS (Renin-Angiotensin-Aldosterone System)

    A hormonal system that regulates blood pressure and fluid balance, activated by decreased sodium or renal perfusion.

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    Fluid Overload Symptoms

    Clinical signs of excess ADH, including decreased urine output, weight gain, and fluid retention symptoms like crackles in lungs.

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    Cellular Edema

    Swelling of cells due to fluid shift from ECF to ICF.

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    Hyponatremia Symptoms

    Nonspecific neurological issues like headache, irritability, and severe confusion.

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    Hypertonic Saline

    Infusion used to manage hyponatremia and increase serum sodium levels.

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    Osmotic Demyelination Syndrome

    Condition caused by rapid sodium increase, leading to permanent nerve damage.

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    Sodium and Volume Imbalances

    Monitoring includes cardiovascular, respiratory, and neurological assessments.

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    Potassium Functions

    Crucial for nerve impulses, cardiac rhythm, and muscle contraction.

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    Dietary Sources of Potassium

    Typical sources include fruits, dried fruits, and vegetables.

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    Renal Potassium Loss

    Kidneys regulate potassium levels but cannot conserve it well when low.

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    Factors Shifting Potassium

    Insulin and exercise move potassium between ECF and ICF.

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    Hyperkalemia Causes

    High potassium due to intake, renal failure, or ICF to ECF shifts.

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    Lactated Ringer's solution

    An isotonic fluid similar to plasma, lacking Cl-, Mg2+, and HCO3-.

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    Hypertonic Solutions

    Solutions that raise osmolality of ECF and can expand it, beneficial in specific medical conditions.

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    Indications for Hypertonic Solutions

    Used in treating hyponatremia and hypovolemia, and for reducing brain swelling in ICP cases.

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    Contraindications for Hypertonic Solutions

    Not recommended if a patient is dehydrated, hypernatremic, or has fluid overload risks.

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    Buffer System

    Immediate response system that neutralizes excess H+ in blood, regulating acid-base balance.

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    Role of Lungs in pH Regulation

    Lungs maintain body pH by excreting CO2 and water, affecting carbonic acid levels.

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    Respiration Impact on pH

    Increased respiration reduces CO2, lowering carbonic acid, and H+ concentration in blood.

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    Respiratory Compensation for pH

    Respiratory system compensates for pH changes by hyperventilation or hypoventilation.

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    Consequences of Respiratory Failure

    If respiratory failure occurs, the lungs can't properly correct pH imbalances.

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    Kidneys Role in acid-base balance

    Kidneys reabsorb bicarb, generate more bicarb, and eliminate H+ to correct acidosis.

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    Mechanisms of Acid Elimination in Kidneys

    Kidneys eliminate acids via H+ secretion, ammonia combination, and weak acid excretion.

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    Respiratory Acidosis Causes

    Respiratory acidosis can result from COPD, hypoventilation, and certain drug overdoses.

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    Symptoms of Respiratory Acidosis

    Common symptoms include drowsiness, disorientation, dizziness, headache, and hypotension due to hyperkalemia.

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    Hyperkalemia Symptoms

    Symptoms include leg cramping, muscle weakness, and paralysis, along with ECG changes like tall T waves.

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    Hyperkalemia Management

    Management involves reducing potassium intake, using diuretics, dialysis, or shifting K+ into cells with insulin.

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    Hypokalemia Symptoms

    Symptoms include flat T waves, U waves, muscle cramping, and respiratory paralysis due to altered membrane potential.

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    Management of Hypokalemia

    Management includes regular lab checks, monitoring potassium before medications, and being aware of nutritional status.

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    ECG Changes in Hyperkalemia

    ECG shows tall peaked T waves, wide QRS, and prolonged PR intervals due to altered excitability.

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    Diuretics and Potassium

    Diuretics increase potassium loss in urine, leading to potential hypokalemia.

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    Role of Magnesium in Potassium Balance

    Low plasma magnesium can lead to potassium depletion and affects renin and aldosterone release.

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    Study Notes

    Fluid and Electrolytes

    • Fluid and electrolyte balance is crucial for homeostasis in the body.
    • Maintaining a proper balance of fluids and electrolytes is essential for nurses.
    • The composition of body fluids must be kept within narrow limits.
    • Water makes up about 60% of body weight.
    • Water content in the body varies based on sex, body mass, and age (lean body mass has more water than adipose tissue).
    • Older adults have lower water content due to decreased mass.

    Homeostasis

    • Homeostasis is the balance of fluid and electrolytes in the body's internal environment.
    • Maintaining equilibrium is essential for the body to function.
    • The composition of body fluids must be kept within narrow limits.
    • This is vital for nurses to anticipate fluid and electrolyte imbalances.

    Regulation of Water Balance

    • Water balance is maintained by controlling intake and excretion.
    • Osmoreceptors in the hypothalamus sense a change in body fluid deficit or excess in plasma osmolality.
    • It triggers thirst and stimulates ADH (antidiuretic hormone) release.
    • ADH stored in the pituitary acts on kidney tubules to reabsorb water.
    • When plasma osmolality is normalized, ADH is suppressed.

    Water Balance - Insensible water loss

    • The body loses roughly 900ml of water daily due to insensible water loss.
    • Kidneys produce approximately 1.5 liters of urine daily.

    Risk Factors for Hyperosmolality

    • Patients who cannot sense thirst (e.g., TBI, neurological disorders)
    • Alzheimer's patients
    • Elderly people
    • People with diabetes
    • Patients taking certain antipsychotics
    • Patients with altered kidney function
    • Patients with hormonal imbalances (e.g., Addison's, SIADH)

    Mechanisms of Water Balance in the Body

    • Hypothalamic and Pituitary Regulation: Body fluid imbalance triggers thirst and ADH secretion. ADH, stored in the pituitary, acts on kidney tubules to retain water. Normalization of plasma osmolality decreases ADH and restores healthy urinary excretion.
    • Adrenal Cortical Regulation: Aldosterone, a potent hormone, retains sodium while excreting potassium. Decreased renal perfusion or sodium levels in the distal renal tubules trigger the renin-angiotensin-aldosterone system (RAAS), leading to aldosterone release, which increases sodium and water reabsorption in renal distal tubules, returning plasma osmolality and fluid volume to normal.
    • Cardiac Regulation: Atrial natriuretic factor (ANF) is released by the cardiac atria in response to increased atrial pressure and high serum sodium levels. ANF increases urinary sodium and water excretion, thereby decreasing blood volume.

    NCLEX Style Question - Fluid Overload

    • Following pituitary gland injury affecting ADH secretion, monitor for fluid overload symptoms in the patient.
    • Clinical manifestations of too much ADH secretion include decreased urine output, nausea and vomiting, weight gain, and crackles in lung fields.

    Sodium

    • Sodium is the major cation of the extracellular fluid (ECF).
    • Changes in sodium correlate with changes in osmolality.
    • Sodium is critical for nerve impulse generation and transmission, and acid-base balance.
    • Daily sodium intake exceeds daily requirements.

    Hypernatremia

    • Serum sodium elevated due to water loss or sodium gain.
    • Not typically a problem for people who can sense thirst and swallow.
    • Often caused by impaired consciousness and inability to obtain fluids.
    • Deficiency in ADH synthesis, release, or kidney responsiveness to ADH can also lead to profound diuresis, water deficit and hypernatremia.

    Hypernatremia: Symptoms

    • Dehydration
    • Thirst
    • Lethargy
    • Agitation
    • Seizures
    • Dry, swollen tongue
    • Normal or increased extracellular fluid (ECF) volume
    • Weight gain
    • Peripheral and pulmonary edema
    • Increased blood pressure

    Hypernatremia: Management and Nursing Interventions

    • Treat the underlying cause
    • Correct water deficit orally or via IV isotonic fluids to reduce serum sodium levels gradually and minimize risk of cerebral edema
    • Reduce sodium excess by administering IV fluids (e.g., 5% dextrose in water) and diuretics
    • Restrict oral sodium intake
    • Monitor fluid intake and losses closely

    Clinical Scenario - Elevated Sodium

    • Patient with acute kidney injury, prior history of vomiting and diarrhea.
    • Significant symptoms including low blood pressure (90/60), elevated heart rate (110), mild skin tenting, dry mucus membranes and cracked lips.
    • Sodium level of 152 mmol/L, requiring immediate intervention.

    Clinical Scenario - Fluid Overload Symptoms

    • Patient experiences increased shortness of breath (SOB), new onset swelling in hands and feet, and fine crackles in lower lung fields upon auscultation.
    • Heart sounds are regular, without S3 or S4 sounds. vital signs indicate BP of 140/90, RR of 22, HR of 99, SpO2 of 94%, and temperature of 36.8.

    Potassium

    • Potassium is the major intracellular cation (ICF).
    • Vital for cellular metabolic functions, nerve impulse transmission, and maintaining normal cardiac rhythms.
    • Dietary intake is primarily from fruits, vegetables, and dried fruits.
    • Kidneys are the primary route for eliminating potassium.
    • Sodium and potassium have an inverse relationship; factors that increase sodium retention can cause potassium loss.

    Hyperkalemia

    • High potassium levels may be caused by massive potassium intake, impaired kidney function, shift from ICF to ECF, massive burn or crush injury, or certain medications (e.g., spironolactone, ACE inhibitors).
    • Renal failure is the most common cause.

    Hyperkalemia: Symptoms

    • Causes membrane depolarization, weakening and paralyzing cells
    • Leg cramping is one of the first signs
    • ECG findings may include a tall peaked T-wave, wide QRS, and prolonged PR interval.
    • Heart block and ventricular fibrillation can occur

    Hyperkalemia: Management and Nursing Interventions

    • Stop potassium intake, increase diuretics, dialysis, use potassium-binding agents (e.g., kayexalate)
    • Use IV insulin or sodium bicarbonate to shift potassium from ECF to ICF
    • Increased fluid intake enhances renal elimination
    • Moderate levels may only need decreased potassium intake with increased fluids/diuretics.
    • Severe level require a shift of potassium into cells.

    Hypokalemia

    • Can arise from abnormal potassium loss (ECF to ICF), dietary deficiency, or excessive use of diuretics.
    • Common causes include patients with excessive diuresis, low serum magnesium, and administration of insulin.

    Hypokalemia: Symptoms

    • Alters membrane potential leading to hyperpolarization, impacting excitability
    • Symptoms can include paralysis of respiratory muscles, cramping, rhabdomyolysis (muscle breakdown), flat T-wave, U wave presence in EKG (ECG or electrocardiogram).
    • Prolonged hypokalemia can impair kidney concentration, leading to diuresis and impaired insulin release.

    Hypokalemia: Management and Nursing Interventions

    • Address underlying causes and monitor patient potassium levels closely.
    • Encourage potassium-rich foods, supplemental potassium based on labs.
    • Monitor for changes in patient status & serum potassium levels as guides for IV therapy

    Calcium

    • Obtained from dietary sources
    • Balanced by parathyroid hormone (PTH), calcitonin, and vitamin D.
    • PTH increases bone resorption, calcitonin decreases GI absorption, and vitamin D is necessary for absorption.
    • Crucial for blood clotting, nerve impulse transmission, and bone and muscle health.

    Hypercalcemia

    • More than 90% of cases caused by hyperparathyroidism and malignancy.
    • Excess calcium interferes with sodium action in skeletal muscles, impairing muscle and nerve function.

    Hypercalcemia: Symptoms

    • Impaired memory, confusion
    • Fatigue, disorientation
    • Muscle weakness, constipation
    • Cardiac dysrhythmias, renal calculi

    Hypercalcemia: Treatment

    • Promote calcium excretion in the urine using loop diuretics (e.g., Lasix).
    • Administer hydration with isotonic saline.
    • Give synthetic calcitonin.
    • Monitor for sodium/fluid overload, particularly if renal function is impaired.

    Hypocalcemia

    • Occurs due to decreased parathyroid hormone (PTH) or other conditions.
    • Also associated with trauma, thyroid injury, neck surgery, or sudden alkalosis which causes calcium to bind to proteins.
    • Low calcium levels increase sodium movement into cells, leading to depolarization, increased nerve excitability, and prolonged muscle contractions.

    Hypocalcemia: Symptoms

    • Chvostek's and Trousseau's sign
    • Muscle spasms, cramps
    • Nervousness, confusion, seizures
    • Cardiac arrhythmias

    Hypocalcemia: Treatment

    • Correcting underlying conditions or administering calcium supplements
    • Mild imbalance: calcium-rich foods, vitamin D
    • Severe imbalance: IV calcium

    Phosphate Imbalances

    • Phosphorus is an important anion found primarily in the intracellular fluid (ICF).
    • Essential for muscle function, RBC structure, bone formation, and acid-base balance.
    • Kidney function is crucial for maintaining normal phosphate balance.

    Hyperphosphatemia

    • Caused by acute or chronic renal failure; excessive use of particular medications; or excessive consumption of milk.
    • May manifest with CNS dysfunction, rhabdomyolysis, cardiac dysrhythmias, muscle weakness; and calcium-phosphate deposits in soft tissues and joints.

    Hyperphosphatemia: Treatment

    • Adequate hydration
    • Restricting phosphate-rich foods.
    • Correcting associated hypocalcemia

    Hypophosphatemia

    • Can arise due to malnutrition, malabsorption, alcohol withdrawal, or use of phosphate-binding antacids.
    • May lead to ATP deficiency, hemolytic anemia, and muscle weakness.

    Hypophosphatemia: Treatment

    • Supplementation of high-phosphorus foods (e.g., dairy)
    • IV treatment in severely low levels.
    • Frequent serum monitoring is crucial to guide IV therapy.

    Magnesium Imbalances

    • Magnesium is an important intracellular cation and a cofactor for many enzymes.
    • Crucial for carbohydrate, DNA, and protein metabolism.
    • Manifestations are often confused with calcium imbalances, and all three cations (Mg, Ca, K) should be assessed together
    • Magnesium is involved in many metabolic processes.

    Hypermagnesemia

    • Common in patients with chronic renal failure or those who ingest magnesium-containing products (like milk of magnesia).
    • Excess magnesium interferes with acetylcholine release, impeding nerve and muscle function.
    • Symptoms can include hypotension, facial flushing, lethargy, urinary retention, nausea, vomiting, loss of deep tendon reflexes, muscle paralysis, and cardiac/respiratory arrest.

    Hypermagnesemia: Treatment

    • Avoid magnesium-containing medications.
    • Limit dietary intake of magnesium-rich foods.
    • Increase fluids and diuretics.
    • Dialysis may be necessary in cases of impaired kidney function.
    • Calcium gluconate can be administered to oppose the effect of magnesium on cardiac muscle (if symptomatic).

    Hypomagnesemia

    • Can result from limited magnesium intake or increased GI/renal losses.
    • Commonly associated with starvation, chronic alcoholism or uncontrolled diabetes.

    Hypomagnesemia: Symptoms

    • Symptoms mirror hypocalcemia including: neuromuscular (Muscle cramps, tremors, increased reflexes), Chvostek's sign, Trousseau's sign, and cardiac dysrhythmias.

    Hypomagnesemia: Treatment

    • Oral supplements and/or increasing dietary magnesium intake.
    • IV or IM magnesium sulfate (too rapid an infusion can lead to hypotension and cardiac/respiratory arrest)

    IV Fluids

    • Common for treating various fluid and electrolyte imbalances
    • Important for patients with significant fluid losses to maintain proper hydration and electrolyte balance.
    • Different types used when the patient is losing certain electrolytes, or losing too much water

    Hypotonic Solutions

    • Provide more water than electrolytes, diluting extracellular fluid (ECF)
    • Leading to water movement from ECF to intracellular fluid (ICF).
    • Often used for maintaining normal hydration levels due to normal daily losses which are hypotonic.

    Isotonic Solutions

    • Ideal for replacing ECF deficits as the administration of an isotonic solution expands the ECF, but has no net loss or gain from ICF.
    • Used for hydration.

    Hypertonic Solutions

    • Used for treating hyponatremia and hypovolemia, raises ECF osmolality.
    • Used for reducing brain swelling in patients with increased intracranial pressure (ICP).

    Acid-Base Imbalances

    • pH values range from 7.35 to 7.45
    • Patients with conditions like diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and kidney disease are at risk for imbalances.
    • Metabolic processes constantly produce acids in the body, requiring a buffering system, respiratory system, and renal systems to regulate balance.

    The Buffer System

    • Reacts immediately when the concentration of H+ changes.
    • Maximizes its effectiveness in maintaining pH levels within a few hours.
    • Chemically neutralizes strong acids by shifting H+ in and out of cells.
    • Substances like carbonic acid, phosphate, proteins, and hemoglobin help reduce/minimize the effects of acids.

    The Respiratory System

    • Assists in regulating pH by removing CO2 and water from the body.
    • Increased respiration rate reduces CO2, carbonic acid, and H+ concentration.
    • Decreased respiration rate increases CO2, carbonic acid and H+ concentration.
    • The respiratory system tries to compensate for pH changes via hyperventilation/hypoventilation.

    The Renal System

    • Crucial for maintaining acid-base balance, including reabsorbing bicarbonate (HCO3-) and eliminating excess hydrogen ions (H+).
    • 3 Mechanisms: secretion of H+, combining H+ with ammonia, and excreting weak acids.
    • Loss of the kidneys' ability to maintain pH can be a cause of acid-base disturbances.

    Respiratory Acidosis

    • Blood pH < 7.35, and high PaCO2 (>45 mmHg)
    • Common causes include COPD, hypoventilation, barbiturate overdose, and severe pneumonia with atelectasis or respiratory muscle weakness.
    • Symptoms include drowsiness, disorientation, dizziness, headache, coma, decreased blood pressure, and ventricular fibrillation (potential).

    Respiratory Alkalosis

    • High blood pH (>7.45), low PaCO2 (<35 mmHg).
    • Causes include hyperventilation (due to factors like hypoxia, pulmonary embolism (PE), anxiety, fear, pain, exercise) and other conditions like sepsis or brain injury.
    • Symptoms include lethargy, lightheadedness/confusion, tachycardia/dysrhythmias (potential from hypokalemia), nausea/vomiting, numbness, hyperreflexia, and seizures.

    Metabolic Acidosis

    • Low blood pH(<7.35), low HCO3- (<21 mmol/L). It is a gain of fixed acid or an inability to excrete acid or loss of base.
    • Causes include diabetic ketoacidosis, lactic acidosis, starvation, severe diarrhea, renal failure, and shock.
    • Symptoms include drowsiness, confusion, headache, coma, decreased blood pressure, and potential dysrhythmias and hyperkalemia.

    Metabolic Alkalosis

    • High blood pH (> 7.45), high HCO3- (>28 mmol/L).
    • Marked by loss of strong acid or gain of base, often due to severe vomiting, prolonged gastric suctioning, diuretics, or potassium deficiency.
    • Symptoms can include dizziness, irritability, nervousness, confusion, tachycardia/dysrhythmias (from hypokalemia), nausea/vomiting, muscle cramps, tingling/numbness, and hypoventilation.

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    Week 1 - Fluid and Electrolytes Student Version NRSG 311 PDF

    Description

    This quiz covers essential topics related to hormones such as ADH and aldosterone, and their roles in fluid balance and electrolyte regulation. Questions explore physiological responses to fluid retention, decreased renal perfusion, and the impacts of various hormone activities on total body water. Test your knowledge regarding these critical processes in human physiology.

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