Electrolytes Imbalances PDF

ELECTROLYTES IMBALANCES ELECTROLYTES IMBALANCES LEARNING OBJECTIVES: In this chapter, we were able to learn ways to assess a patient’s fluid status ways to identify patients at risk for fluid imbalances signs and symptoms of fluid imbala...

ELECTROLYTES IMBALANCES ELECTROLYTES IMBALANCES LEARNING OBJECTIVES: In this chapter, we were able to learn ways to assess a patient’s fluid status ways to identify patients at risk for fluid imbalances signs and symptoms of fluid imbalances teaching tips for patients with fluid imbalances tips for ensuring proper documentation of fluid imbalances. ELECTROLYTES IMBALANCES ELECTROLYTES - are active chemicals (cations that carry positive charges and anions that carry negative charges) CATIONS ANIONS Sodium 135-145 mEq/L Chloride 98-106 mEq/L Potassium 3.5-5.0 mEq/L Bicarbonate 24-31 mEq/L Calcium 8.5-10.5 mg/dL Phosphate 2.5-4.5 mg/dL Magnesium 1.3-3.0 mg/dL Sulfate Hydrogen Ions Negatively charged protein ions Electrolyte concentrations in the ICF differ from those in the ECF ELECTROLYTES IMBALANCES Sodium Imbalances Sodium levels: Sodium (Na+) is the most abundant electrolyte in ECF : (136 to 145 mEq/L the ECF. [mmol/L]), ICF: (about 14 mEq/L [mmol/L]). Keeping this difference in sodium levels between the two compartments is vital for muscle contraction, cardiac contraction, NA+ and nerve impulse transmission. Sodium levels and movement influence water balance because “where sodium goes, water follows.”  ELECTROLYTES IMBALANCES NA+ Sodium enters the body REGULATES SODIUM through the HOW THE BODY ingestion of When sodium many foods levels are low, Thirst and ADH secretion are The and fluids minimum kidneys suppressed, and the kidneys daily essentially hold excrete more water to restore requirement is on to the Increasednormal serumosmolality. 0.5 to 2.7 g; sodium. sodium levels however, a When sodium cause the ADH causes the kidneys salty diet levels are high, individual to feel to retain water, which provides at kidneys excrete thirsty and the dilutes the blood and least 6 g/day the excess in posterior pituitary normalizes serum urine. gland to release osmolality. antidiuretic hormone ELECTROLYTES IMBALANCES FACTORS HYPONATREMIA DEFICIENCY OF Causes a lack of sodium NA+ refers to a serum sodium level ALDOSTERONE and water reabsorption into that is less than 135 mEq/L the bloodstream at the (135 mmol/L) nephrons When serum osmolality NONRENAL CAUSES: Both sodium and water decreases because of Vomiting, Diarrhea, Fistulas, levels decrease in the decreased sodium Gastric suctioning, extracellular area, but concentration, fluid moves Excessive sweating, Cystic sodium loss is greater than by osmosis from the fibrosis water loss extracellular area to the Burns and wound drainage. intracellular area. *** Diuretics use: promote RENAL CAUSES: sodium loss and volume osmotic diuresis, salt-losing Acute hyponatremia depletion from the blood nephritis, adrenal is commonly the result vessels, causing the insufficiency of a fluid overload in a individual to feel thirsty and diuretic use surgical patient. his kidneys to retain water. Drinking large quantities of water can Chronic hyponatremia is worsen hyponatremia. seen more frequently in patients outside the hospital SYNDROME OF Causes excessive release of setting, has a longer INAPPROPRIATE ADH, which causes duration, and has less ANTIDIURETIC HORMONE inappropriate and  Serum sodium levels decrease ELECTROLYTES IMBALANCES (HYPONATREMIA), and fluid shifts occur. NA+ Blood vessels contain A normally functioning sodium, fluid Water moves into nephrons, gets rid of moves from the the cell, causing excess water by extracellular area into swelling secreting less ADH the more concentrated intracellular area by FACTOR osmosis. A small amount of S HYPERVOLEMI swelling can reduce HYPOVOLEMIC cell function. C HYPONATREMI HYPONATREMI A Larger amounts of Less ADH causes A swelling can make the diuresis both sodium and both water and cell burst (lysis) and water levels decrease sodium levels die. in the extracellular increase in the area, but sodium loss extracellular is greater than water area, but the loss water gain is more impressive Caused by nonrenal and renal Causes include heart failure, liver factors and failure, nephrotic syndrome, diuretics use excessive administration of hypotonic I.V. fluids, and hyperaldosteronism. ELECTROLYTES IMBALANCES NA+ SERUM CLINICAL MANIFESTATIONS LEVELS 115 - 120 Acute initial signs and symptoms of mEq/L nausea, vomiting, and anorexia 110 -115 The patient may complain of a headache mEq/L or irritability or become disoriented. The patient may experience muscle twitching, tremors, or weakness. Changes in level of consciousness (LOC) may start as a shortened attention span and progress to lethargy or confusion.