Fluid and Electrolytes Pt. 2 PDF

Wk. 2 Monday, January 20, 2025 4:30 PM Fluid and electrolytes pt.2 Electrolytes: substance whose molecule dissociate into ions (charged molecule) when placed in water...

Wk. 2 Monday, January 20, 2025 4:30 PM Fluid and electrolytes pt.2 Electrolytes: substance whose molecule dissociate into ions (charged molecule) when placed in water - Cations: positively charged particles: one less electron Osmolarity: measurement of hydration - Anions: negatively charged particles: one extra electron - Concentration of all solutes in blood or urine compared to water concentration - How concentrated or dilute blood or urine is 1. Potassium K: 98% in ICF, maintained by Na -K pump - The higher osmolarity the more solutes, the lower osmolarity the more dilute (less - Regulation by kidneys, excreted in urine or retained in bloodstream by kidneys solutes) - Transmission and conduction of nerve and muscle impulses Tonicity: ability of solution to cause a cell to gain or lose water -- ability of IV fluid to - Maintenance of cardiac rhythms hydrate or dehydrate cell - Cellular growth and acid base balance - As tonicity decreases, the cell gains water 2. Sodium Na: 95% in ECF - As tonicity increases, the cell loses water - Osmoreceptors help regulate by activating thirst center to help bring sodium levels down Hypotonic: cell gains water - ADH and RAAS regulating fluid in body - 0.45% NaCl (1/2 Normal saline NS), D5W- causes cellular rehydration, treating - Key in determining osmolarity in blood (how concentrated/diluted it is) and key in how water is hypernatremia distributed Hypertonic: cell loses water - Transmission of nerve impulses and acid base balance - 3% NaCl, saline - 3x salt concentration than 0.9, causes water to be drawn out 3. Calcium Ca: and shriveled up--- to treat severe hyponatremia 4. Magnesium Mg: Isotonic: cell neither gains nor loses water - 5. Phosphorous PO: - normal saline (0.9% sodium chloride, NaCl [NS]) and lactated ringers (LR) -- expand blood volume, do not cause cells to gain or lose water -- low BP Serum proteins- proteins in the blood Hyponatremia: excessive water intake, administration of fluids - Oncotic pressure: pulls fluid into intravascular space, when proteins floating around, Sodium--- neuro/ LOC oncotic pressure draws fluid into intravascular space (water magnet) - Sodium rich diet - Draw fluid from tissues back into blood stream - Hypertonic saline can only be given through central line (so concentrated in salt, causes irritation - Filtraiton: low level serum protein: not enough oncotic pull force, water and fluid in veins) SLOWLY to slowly correct hyponatremia to prevent brain damage (demyelination of seep from capiliaries into tissues pons) SIADH--- endocrine disorder where pituitary gland releases too much ADH - No net movement: normal amount protein in serum- creates equilibrium, oncotic - Hyponatremic, but hypervolemic: fluid restriction to try to bring up sodium level force that is equal to hydrostatic force and does not cause a fluid shift Hypernatremia: excessive water loss, sweating, hypertonic fluid administration, thirsty - Reabsorption: a lot of serum proteins, huge oncotic pressure gradient, pulling - Isotonic IV fluids slight hypernatremia pressure drawing fluid into blood vessels - Hypotonic fluids severe hypernatremia SLOWLY to prevent cerebral edema and seizures Albumin: most abundant serum protein Sodium: - Also a medication when patients have low serum protein levels (hypoalbuminemia - Bottled/canned food or drinks and hypovolemia) which causes a lot of leaking into third space, the medication - Salt increases oncotic pulling force and causes fluid to shift back into intravascular space--kidneys--urine Hypokalemia: GI losses--- diarrhea, vomiting, gastric suctioning, insulin drip (insulin pulls glucose but Hypoalbuminemia: also pulls K at the same time into the cell) - Low proteins in blood- not enough oncotic puling force, causing fluid to leak from Cardiac arrhythmias could be lethal, muscle cramps (eat a banana) blood vessels into tissues - Do not crush potassium pills, always want it in liquid form Edema, ascites fluid buildup, pleural effusion (fluid building between pleural - 10 mEq/100mL over an hour, never give IV K push, no more than 4 doses membrane and lung) - Often causes burning at site of infusion Causes: liver and kidney failure/injuries, malnutrition, blood loss, burns Hyperkalemia: renal failure, crushing injuries (cells bursts, releasing K) Muscle weakness Calcium: 99% in skeletal system (bones) - IV insulin: draws glucoses, brings K with it-- given with d50 to prevent hypoglycemia - Regulated through parathyroid hormone (increases serum calcium levels by - Calcium gluconate helps stabilize heart muscle to help prevent lethal arrhythmias stimulating osteoclasts and bone resorption-- takes Ca from bones to bloodstream - Loop diuretics increases renal filtration of K into urine - Calcitonin (decreases serum Ca by inhibiting osteoclasts-- promotes Ca to move back - Dialysis last resort into bones - Regulates muscle contraction/relaxation (including cardiac muscle) and nerve Calcium and phosphorous are the only electrolytes with an inverse relationship impulses - Blood coagulation - Inverse with phosphorous Hypocalcemia: hypoparathyroidism, hyperphosphatemia, vitamin d deficiency, kidney injury/disease - Tetany- muscle spasm/tight - Hyperreflexia - Bronchospasm and laryngospasm - Chovsteks sign (tap brush side of cheek, muscles twitch on side) trousseaus sign (BP cuff, hand twitches and moves inward to body - Calcium gluconate or calcium chloride - Closely monitor respiratory status bc of potential cut off to airway Isotonic elevate BP vause adding fluid hypovolemic Hypercalcemia: hyperparathyroidism (stimulating calcium to be released from bones into D5w hypotonic bloodstream), vitamin d overconsumption, cancer, hypophosphatemia - Hyporeflexia - Pathological bone fractures -- caused by weakened bone bc calcium is in bloodstream rather than bones - Urolithiasis - kidney stones - Isotonic fluids to dilute blood Potassium heart - Administer phosphate can cause calcium levels to decrease - Administer calcitonin, pushes calcium from bloodstream back into bones Phosphorous: 85% in bones and teeth 15% soft tissues and cells, regulated by parathyroid hormone and kidneys - Formation of ATP, dissociates oxygen from hemoglobin - Function of muscle and RBC - Acid base balance and nervous system Hypophosphatemia - Alcohol abuse, refeeding syndrome, same manifestations as hypercalcemia - IV repletion: sodium phosphate, monitor for signs of hypercalcemia Hyperphosphatemia: renal failure - Same manifestations as hypocalcemia - Sevelamer (binds with phosphorous in the gut so it can be excreted in the stool) - IV calcium gluconate 3111 Page 1  - IV calcium gluconate - Loop diuretics to increase renal excretion - Hemodialysis - Monitor for signs and symptoms of hypocalcemia Magnesium: 50-60% contained in bones, 1/3 bound to protein, 2/3 ionized - Regulated by kidneys and GI absorption - Important for muscle contraction - Normal cardiovascular function - Metabolism of protein and carbs - Production and release of parathyroid hormone Hypomagnesemia: refeeding syndrome, alcohol abuse, chronic diarrhea - Cardiac arrythmias and muscle weakness - Fresh or dried fruits, green leafy vegetables, nuts and seeds, seafood - Monitor cardiac rate, rhythm and BP - Always correct hypomagnesemia before hypokalemia or hypokalemia will persist - Monitor I&O Refeeding syndrome: occurs in pts who start eating after a period of starvation - Causes huge shift in fluid and electrolytes - Slowly initiate food and monitor electrolytes - Hallmark signs: hypomagnesemia and hypophosphatemia Total parenteral nutrition: TPN - Nutrition given through IV--- must be administered through central line -- PICC line bc of high concentration of sugar (hard on veins) 3111 Page 2