Lecture 3: Care of Clients with Fluid and Electrolyte Imbalance - BSN 3101 PDF

LECTURE 3: CARE OF CLIENTS WITH PROBLEM IN FLUID AND ELECTROLYTE BALANCE 1st SEMESTER AY 2024-2025 – BSN 3101 SOURCE: PPT/Notes TRANSCRIBER: Tetel Marasigan TOPIC OUTLINE Body...

LECTURE 3: CARE OF CLIENTS WITH PROBLEM IN FLUID AND ELECTROLYTE BALANCE 1st SEMESTER AY 2024-2025 – BSN 3101 SOURCE: PPT/Notes TRANSCRIBER: Tetel Marasigan TOPIC OUTLINE Body fluid is found in intracellular and extracellular 1 Fluids and Electrolyte's Introduction compartment 2 Basic Fluid and Electrolyte Concepts BODY FLUIDS 3 Extracellular Body Fluid 4 Fluid Movement 5 Solute Movement 6 Fluid and Electrolyte Regulation 7 Water Balance 8 Intravenous Solutions 9 Electrolytes 10 Acid-Base Balance 11 Analyzing ABG Results FLUIDS AND ELECTROLYTE'S INTRODUCTION The human body maintains a delicate balance of fluids and electrolytes to help ensure proper functioning and homeostasis. Fluids in our Body - Water, plasma, blood plasma, When fluids or electrolytes become imbalanced, electrolytes, proteins, cells, other soluble particles individuals are at risk for organ system dysfunction. (solute) EXAMPLES OF BODY FLUIDS Amniotic fluid, Peritoneal fluid, Aqueous humor Pleural fluid, Bile Pus, Blood plasma Saliva, Breast milk Sebum, Cerebrospinal Serous fluid, fluid, Semen, Cerumen Sputum, Chyle, Synovial fluid, Exudates, Sweat, Gastric juice, Tears, Lymph, Urine, Mucus, Vomitus Pericardial fluid, As we age the percentage of our body fluid is decreasing FUNCTIONS OF WATER IN THE BODY 1. Transporting nutrients to cells and wastes from cells 2. Transporting hormones, enzymes, blood platelets, and red and white blood cells o Blood is the primary transport of fluid, made up of water 3. Facilitating cellular metabolism and proper cellular chemical functioning o Dissolved proteins lipoprotein, dissolve to be transported on cells for organs to function, so we need homeostasis on fluid Intracellular fluids (ICF) 4. Acting as a solvent for electrolytes and o are found inside cells and are made up of nonelectrolytes protein, water, electrolytes, and solutes. 5. Helping maintains normal body temperature o Most abundant electrolytes found in icf: 6. Facilitating digestion and promoting elimination potassium 7. Acting as a tissue lubricant o Body composed of 60% of icf o Amniotic Fluid – acts as cushion o 40% of your weight is icf Extracellular fluids (ECF) BASIC FLUID AND ELECTROLYTE o are fluids found outside of cells. CONCEPTS o Most abundant in ECF: Sodium – our body The body is in a constant state of change as fluids regulate sodium level to control the and electrolytes are shifted in and out of cells within movement of water into and out of ECF due the body in an attempt to maintain a nearly perfect to osmosis balance. o Salt attracts water A slight change in either direction can have significant consequences on various body systems EXTRACELLULAR BODY FLUID Understand physiologic changes in body if you have TYPES OF EXTRACELLULAR FLUID prob in fluid and electrolyte  The first type is known as Urine output per hour- 30-40 ml intravascular fluid that is o 1500 ml ang naiihi sa isang araw or 1.5 urine found in the vascular excrete system that consists of o Kidney and liver filtrate our waste arteries, veins, and HOW TO DIAGNOSE capillary networks. Blood test- sodium potassium magnesium Intravascular fluid is whole Urine test- creation. Dapat walang protein sa ihi blood volume and also and wala rin dapat na sugar na inilalabas sa ihi. includes red blood cells, Blood disorder- problems in acid base balances white blood cells, plasma, Xray, mri- depending on the underlying causes such and platelets. as predisposing factors, precipitating factors INTRAVASCULAR Loss of intravascular fluids A second type of FLUID causes the nursing extracellular fluid is diagnosis Deficient Fluid interstitial fluid that refers to Volume, also referred to as fluid outside of blood hypovolemia. vessels and between the Most important component cells. of your body’s overall fluid INTERSTITIAL Example is edema balance that’s why if you FLUID Clients who have have loss of intravascular congestive heart failure- fluid it may lead to most client have edema, hypovolemia- deficient that edema is interstitial fluid volume. fluid. Factors may lead to deficient fluid volume: diarrhea Pitting edema – to grade (bata prone sa dehydration) , vomiting, inadequate edema oral fluid intake, excessive diuretic use, insufficient The remaining extracellular fluid replacement. fluid, also called Adequate in intravascular fluid is decrease of blood transcellular fluid, refers to pressure due to additional work load of your heart TRANSCELLULAR fluid in areas such as that will supply to your body FLUID cerebrospinal, synovial, Severe loss can lead to hypovolemic shock and intrapleural, and cellular death because organs are not able to receive gastrointestinal system oxygen rich blood supply If you have hypovolemia: o low extracellular volume because there is FLUID MOVEMENT loss of water and sodium in your body. Fluid movement occurs inside the body due to osmotic pressure, hydrostatic pressure, and osmosis PROPER FLUID MOVEMENT DEPENDS ON: 1. Intact and properly functioning vascular tissue lining o If you have intact vascular tissue lining, it prevent fluid from leaking out of your blood vessels 2. Normal levels of protein content within the blood o Protein in our blood is in form of albumin. 3. Adequate hydrostatic pressures inside the blood vessels o Before hydrostatic pressure there should be osmotic pressure- pressure that holds the water inside you blood vascular compartment. o Hydrostatic pressure- Pressure exerted by your blood against the capillaries CAUSES OF HYPOVOLEMIA HYDROSTATIC PRESSURE Weakness Pressure that a contained fluid exerts on what is Fatigue confining it. Dizziness Orthostatic hypotension Hypovolemic shock- severe intravascular fuid loss Increase thirst Dehydration- pag sobrang init nag eevaporate. You were not able to replace fluid loss Trauma- severe bleeding from trauma. Ex: blood loss due to vehicular accident Execessive fluid accumulation between your cells- example sepsis, due to spsis nagkakaron ng inflammation Renal disease- body were not able to properly filtrate toxins in your body FILTRATION Congestive heart failure- additional workload on Occurs when hydrostatic pressure pushes fluids heart, mapapagod and solutes through a permeable membrane so Signs and symptoom they can be excreted.  Happens in kidney, fluid and waste are being filtered Involves moving solutes and ions across a cell in kidney, on glomerular capillaries. membrane from an area of lower concentration to an Filtration process happen through excrete toxins or area of higher concentration. waste products from your body. Example: Sodium Potassium Pump – use energy to Waste products are excreted in the form of urine maintain higher of K in the intracellular and sodium Excess fluid and waste product to be excreted from Sodium Potassium Pump – Regulate sodium and your body in the form of urine potassium level in IC and EC compartment Sa nag dadialysis- yung dializer and nagsisilbing kidney nila OSMOSIS Water movement through a semipermeable membrane, from an area of lesser solute concentration to an area of greater solute concentration, in an attempt to equalize the solute concentrations on either side of the membrane. Osmosis causes fluid movement between the intravascular, interstitial, and intracellular fluid compartments based on solute concentration. Movement of fluid If there are more particles in volume. It is considered as concentrated FLUID AND ELECTROLYTE If you eat amount of large salty foods, soium level will REGULATION increase. So magiging concentrated The body must carefully regulate intravascular fluid Due to elevated solute concetration in your blood accumulation and excretion to prevent fluid volume stream- osmosis cause fluid to be pulled form your excesses or deficits and maintain adequate blood interstial and intrancellular to balance. Habang pressure. lumalabas ang fluid sa cell it will shrink. Shrink in cell causes many symptom of dehydration- dry mucus Water balance is regulated by several mechanisms memberane. That why those who experience including ADH, thirst, and the Renin-Angiotensin- dehydration they have headache, esp if inaadequete Aldosterone System (RAAS). fluid replacement Anti diuretic hormone (ADH)- release from your kidneys, sa hypothalumus we have osmo receptors, osmo receptors senses increase serum osmolality levels.Serum osmolarity measure concentration of dissolve solutes in your blood. (if there increase in serum osmolality levels, it triggers the release of adh to retain fluids. This hormones tells kidney to keepp more water inside blood vessles so that the urine will become more concentrated.) Thirst- fluid intake is regulated by your thirst RENIN-ANGIOTENSINALDOSTERONE SYSTEM (RAAS) RAAS plays an important role in regulating fluid output and blood pressure. 240ml - measure by baso on board exam Solute movement- diffusion, active transport, filtration SOLUTE MOVEMENT DIFFUSION Diffusion is the movement of molecules from an area of higher concentration to an area of lower concentration to equalize the concentration of solutes throughout an area. Movement of solutes When we inhale there are oxygen molecules that will travel from your alveoli to capillaries to be distributed in your body If you have decreased bp due to fluid loss, your specialized kidney cells will make and secrete renin in to your bloodstream and your renin acts on angiotensinogen release by the liver and convert it into you angio-tensin 1 which will be converted into angiotensis 2, and this angiotensin 2 causes vasoconstriction to increase the blood flow to your vital organs, it also stimulate you adrenal cortex to ACTIVE TRANSPORT release aldosterone (steroid hormone) which is a  hormone that trigger sodium reabsorption by your o Patients taking diuretics and other kidney and subsequent increase serum osmolarity medications that cause increased urine (causes osmosis) in your bloodstream. output Aldosterone saves salt and water follows salt o Individuals who exercise or work outdoors in hot weather o Most common cause: Diarrhea, vomitting, WATER BALANCE excessive exercise, poor oral fluid intake exp in: older adults, infants, and children o Dm and kidney disease o Diuretic- diomide k- tinatake sa umaga (ang ihi ay waterfalls, magandang diuretics), o Exercise or workout outdoors INTRAVENOUS SOLUTIONS Deficient fluid volume they are the one who are being prescribed with IV fluid IV fluids- restore fluid in intravascular compartment Facilitate movement of fluids between compartment There are three types of IV fluids: 1. Isotonic 2. Hypotonic 3. Hypertonic We need to monitor fluid intake ISOTONIC SOLUTIONS If client have cases of kidney failure, diabetes, Isotonic solutions are IV stroke, CHF- monitor input and output fluids that have a similar Halos lahat ng output is in the form of urine from concentration of kidney. You should have 1.5 liters of urine that you dissolved particles as will excrete. blood. Fluid loss can also through you perspiration, stool, The fluid stays in your insensible losses (pawis, luha) intravascular space and If you have pediatric monitor the diaper, check the osmosis does not cause color fluid movement between If urine output is inadequate, inform the physician your compartments Administer or use on FLUID IMBALANCE clients with : fluid volume Two types of fluid imbalances are excessive fluid deficit/ low blood volume (also referred to as hypervolemia) and pressure. deficient fluid volume (also referred to as Use to raise blood hypovolemia) pressure, Imbalances happens in your extracelllular Volume per volume replacement: pedia: kukunin ang components but can also be cause due to diaper titmbangin yung timbang ng diaper ay intracellular compartment. Fluid imbalances, usually irereplace mo with fluid. Kung ano nawala yun ang based on sodium level in your blood. irereplace mo. EXCESSIVE FLUID VOLUME Fluid has something to do with thermoregulation Patients at risk for developing excessive fluid volume kaya kailangan niffast drip ang IV. pag may lagnat are those with the following conditions: mag water therapy. o Heart Failure - weak heart muscle, it does not Cells will neither shrink or swell, since no water loss pump blood the way that it should. and no net gain of water. o Kidney Failure - ephrotic syndrome, small No osmotic flow blood vessels in the kidneys are damage. It An example of an isotonic IV solution is 0.9% filters waste and excess fluid in your blood. If Normal Saline (0.9% NaCl). you have damaged you can not get rid of the HYPOTONIC SOLUTIONS excess fluid Hypotonic solutions have o Cirrhosis - scar causes accumulation of fluid in a lower concentration of peritoneal cavity, causes asytis- they undergo dissolved solutes than parasynthesis- drain excess peritoneal fluid blood. o Pregnancy - polyhydramnios (sometimes Treat cellular dehydration cause is GDM), in early stage you’ll have pre term labor Cell is swelling and pop or break DEFICIENT FLUID VOLUME Decreased solute Loss of fluid greater than your output concentration and net Hypovolemia or dehydration movement of water Individuals who have a higher risk of dehydration inside your cell so it can include the following: cause swelling or o Older adults breakage o Infants and children An example of a o Patients with chronic diseases such as hypotonic IV solution is diabetes mellitus and kidney disease 0.45% Normal Saline (0.45% NaCl).  HYPERTONIC SOLUTIONS dilute plasma electrolyte Osmotic flow out in your concentrations. cell 0.45% Sodium Chloride Increase concentration of (0.45% NaCl) dissolved solutes your Used to treat intracellular intravascular space dehydration and hypernatremia compared to cells, that’s and to provide fluid for renal why it shrinks. excretion of solutes. Hypertonic solutions Monitor closely for have a higher hypovolemia, hypotension, or HYPOTONIC concentration of confusion due to fluid shifting dissolved particles than into the intracellular space, blood. which can be life-threatening. An example of hypertonic Avoid use in patients with liver IV solution is 3% Normal disease, trauma, and burns to Saline (3% NaCl). prevent hypovolemia from worsening. Monitor closely for IV solutions were given depending on you cases cerebral edema Pregnant woman diagnose with GDM- D5 NSS 5% Dextrose in Water (D5W) (yellow), kasi kapag D5LR it contain glucose. Provides free water to promote COMPARISON OF OSMOTIC EFFECTS OF renal excretion of solutes and HYPERTONIC, ISOTONIC, AND HYPOTONIC IV treat hypernatremia, as well as some dextrose FLUIDS ON RED BLOOD CELLS supplementation. Monitor closely for hypovolemia, hypotension, or HYPOTONIC confusion due to fluid shifting out of the intravascular space, which can be life-threatening. Avoid use in patients with liver disease, trauma, and burns to prevent hypovolemia from worsening. Monitor closely for cerebral edema 3% Sodium Chloride (3% 0.9% Normal Saline (0.9% NaCl) NaCl) Used to treat severe Fluid resuscitation for hyponatremia and cerebral hemorrhaging, severe vomiting, edema. diarrhea, GI suctioning losses, Monitor closely for ISOTONIC wound drainage, mild hypervolemia, hypernatremia, HYPERTONIC hyponatremia, or blood and associated respiratory transfusions. distress. Do not use it with Monitor closely for patients experiencing heart hypervolemia, especially with failure, renal failure, or heart failure or renal failure. conditions caused by cellular Lactated Ringer’s Solution dehydration because it will (LR) worsen these conditions. Fluid resuscitation, GI tract fluid 5% Dextrose and 0.45% losses, burns, traumas, or Sodium Chloride (D50.45% metabolic acidosis. Often used NaCl) ISOTONIC during surgery. Used to treat severe Should not be used if serum pH hyponatremia and cerebral is greater than 7.5 because it edema. will worsen alkalosis. May Monitor closely for elevate potassium levels if used HYPERTONIC hypervolemia, hypernatremia, with renal failure and associated respiratory 5% Dextrose in Water (D5W) distress. Do not use it with *starts as isotonic and then patients experiencing heart changes to hypotonic when failure, renal failure, or dextrose is metabolized conditions caused by cellular Provides free water to help dehydration because it will renal excretion of solutes, worsen these conditions hypernatremia, and some 5% Dextrose and Lactated ISOTONIC Ringer’s (D5LR) D10 dextrose supplementation. Should not be used for fluid Used to treat severe resuscitation because after hyponatremia and cerebral dextrose is metabolized, it edema HYPERTONIC becomes hypotonic and leaves Monitor closely for the intravascular space, hypervolemia, hypernatremia, causing brain swelling. Used to and associated respiratory distress. Do not use it with patients experiencing heart  failure, renal failure, or Hyponatremia can be conditions caused by cellular caused by excess water dehydration because it will intake or excessive worsen these conditions. administration of hypotonic IV solutions. ELECTROLYTES Hyponatremia can be caused by excess water Important for our vital organs to help us have a good intake or excessive body function and fluid regulation administration of SODIUM hypotonic IV solutions. Sodium levels in the blood typically range from 136- Using more sodium than 145 mEq/L water Sodium is the most abundant electrolyte in the You have more water extracellular fluid (ECF) and is maintained by the than sodium that your sodium-potassium pump. blood, masyadong Sodium plays an important role in maintaining diluted adequate fluid balance in the intravascular and Ex: if you are a runner interstitial spaces. who only rehydrates Minerals that the body need in large amount with water you can But daily we only need 500mg of sodium for our vital developed organs to function hyponatremia because Located in our blood and in the fluid around our cells you need to intake fluid It has a role in normalizing balance fluid in our body. but that fluid needs to We need Normal nerve and muscle function. For our contain solute nerve contraction control and relax our muscles and (gatorade, to maintain fluid balance. Ex for diarrhea or We obtain through food and drink and we lose those vomiting, you can primarily through are sweat and urine develop hyponatremia, Our kidney, if healthy we can maintain a consistent you lose sodium if you level of sodium by adjusting the amount excreted in replace it with just water our urine your sodium in your An elevated sodium blood will be diluted. level in the blood Typically, hypernatremia is caused by excess water loss due to lack of fluid intake, vomiting, or diarrhea. As you recall, elevated sodium levels in the blood cause the osmotic movement of water out of the cells to dilute the blood. As fluid cell shrinks we HYPERNATREMIA can see symptoms like: Vasopressin (also called lethargy, confusion, antidiuretic hormone) is a irritability because it has substance naturally produced something to do with in the body that helps nerve function regulate the amount of There are some water in the body by treatment: decrease controlling how much water is sodium intake, increase excreted by the kidneys. oral water intake, Pituitary gland produces and rehydrate with releases especially when you hypotonic IV solution so bp or blood volume goes that you can maintain down or if your electrolytes fluid balance in and out ROLE OF become too high particularly of your cell VASOPRESSIN sodium concentrated Vasopressin decreases water excretion by the kidneys, which retains more water in the body and dilutes the sodium. if you have too much sodium your pituitary gland will signal your kidney to stop excreting water because your body A decreased sodium needs water to dilute your HYPONATREMIA excess sodium level in the blood The syndrome of inappropriate secretion of  antidiuretic hormone PATHOPHYSIOLOGY: regulation of potassium by develops when too much aldosterone in your kidneys and your aldosterone antidiuretic hormone cause reabsorption of sodium and excretion of (vasopressin) is released potassium. For example, in response in your by the pituitary gland under potassium level rising or falling your adrenal cortex certain inappropriate will release aldosterone and it will target your kidney conditions, causing the body in response your kidneys will excrete potassium and to retain fluid and lower the will reabsorb sodium so it can normalize blood blood sodium level by sodium potassium levels SYNDROME OF dilution. INAPPROPRIAT if you have too much sodium E SECRETION your pituitary gland will OF signal your kidney to stop ANTIDIURETIC excreting water because your body needs water to HORMONE dilute your excess sodium (SIADH) Antidiuretic hormone (ADH) mainly affects our kidneys’ ability to reabsorb water. Under normal circumstances, our body signals ADH release for a variety of reasons. Example: if you are dehydrated your body will signal release of antidiuretic hormone so that your kidney release less water through your urine in order to save more water in your body, if you treat dehydration by drinking water, your body will stop signaling the release of HYPERKALEMIA your antidiuretic hormones There is an increased potassium levels in the and your body will release blood. more water through your Hyperkalemia can be caused by kidney failure, urine. metabolic acidosis, and administration of In most people with SIADH, potassium-sparing diuretics or oral/intravenous drinking water doesn’t potassium supplements. adequately suppress ADH Signs and symptoms of hyperkalemia are release, and their urine generally cardiac in nature and include irritability, remains concentrated. cramping, diarrhea, and electrocardiogram (ECG) This leads to water retention, abnormalities. - Kasi potassium has something to which dilutes our blood. This do with our muscle contractions, and our heart is then leads to low levels of a muscle. sodium in our blood As hyperkalemia worsens, ECG abnormalities (hyponatremia). may progress to cardiac dysrhythmias and Hyponatremia- there is an cardiac arrest. - you should never administer IV Inappropriate secretion of potassium through IV push as it will cause cardiac antidiuretic hormone dysrhythmias and cardiac arrest. POTASSIUM Caused by administration of potassium-sparing Potassium levels normally range from 3.5 to 5.1 diuretics or oral/intravenous potassium mEq/L. supplements.- because potassium sparing Potassium is the most abundant electrolyte in diuretics is a type of diuretic that helps eliminates intracellular fluid and is maintained inside the cell by excess sodium and water from your body but the the sodium potassium pump. problem is it retains potassium in your body that's Potassium is necessary for normal cardiac function, why taking it can cause hyperkalemia. Example neural function, and muscle contractility, including Spiranolactone effective contractility of the cardiac muscles. TREATMENT FOR HYPERKALEMIA Abnormal potassium levels can cause significantly For mild symptoms: abnormal heart rhythms and contractility. o Decreased potassium intake in the diet. Regulated by aldosterone in your kidneys. o Adjustment to medications contributing Obtain in the diet through consumptions of food like to increased levels of potassium - banana, tomatoes, oranges Sometimes inaadjust ang intake ng Helps nerves to function and help muscles to spironolactone contract For severe symptoms: REMEMBER: Potassium Must never be o Administration of sodium polystyrene administered through IV push because it can sulfonate (Kayexalate) - helps body get immediately stop the heart, it should be diluted on rid off or excess potassium) orally or our IV solution as side drip. Sometime doctor orders rectally. are to incorporate potassium in your IV or plain NSS o Insulin - potassium wash. D5050 100 ml via solute plus KCL regulated at 20-30 drops medication (low sugar) - incorporate with for minute. IT SHOULD BE DILUTED ALWAYS!! 10 units of regular insulin and then you will run that medication through side drip  (5-15 minutes ubos na). Insulin is Calcium is important for nerve transmission muscle administer to push potassium in to our contraction, bones, teeth cells and decreased serum potassium Absorbed in both kidney and intestine level Parathyroid hormone is secreted in response to low o IV calcium gluconate - maybe given also calcium levels in blood, calcium is absorbed in to prevent excess potassium from intestine and kidney to release increased serum affecting cardiac muscle. Wears off calcium level. It is affected by dietary and intake and quickly physical activity. If you are active it causes calcium For severe symptomatic to move into your bones, if there’s immobility, there o Hyperkalemia: Temporary hemodialysis will be release of calcium from bones that’s why may also be used to quickly decrease nagkakaron ng weaknesss in your bone. potassium levels. Sources: sardines, dairy product, green leafy The body CARED too much about K+ vegetable In response to your severe burns or injuries it will release extra potassium. Tissue dame can HYPERCALCEMIA produce a shift production of potassium from Increased calcium level inside and outside or cell. Potassium is only found It can be caused by: in intracellular fluid. ✓ Prolonged immobilization - allows calcium Deficiency aldosterone will cause potassium to reach out (lumalabas) of your bones and retention because of that there is inability to into your serum excrete potassium in your kidney ✓ Many types of cancers ✓ Hyperparathyroidism and parathyroid tumors - cause too much parathyroid hormone secretion that causes too much calcium to be reabsorbed in the kidney and intestine to be release from your bones SIGNS AND SYMPTOMS most s&s has something to do or Affects gastrointestinal and musculoskeletal system Nausea Vomiting Constipation HYPOKALEMIA Increased thirst and/or urination Decreased potassium level in the blood. Skeletal muscle weakness. Hypokalemia can be caused by excessive TREATMENTS vomiting, diarrhea, potassium-wasting diuretics, Decreasing calcium intake in the diet - wag laging and insulin use, as well as lack of potassium in the nakasardines diet. Phosphate supplementation - phosphate has TREATMENT FOR HYPOKALEMIA an inverse relation with your calcium, how- the o Increasing oral intake of potassium in the amount of phosphate in your blood affects level of diet calcium in blood. Calcium and phosphate in your o Oral or IV potassium in fluids body react in opposite ways, if you have increased supplementation. calcium level in blood your phosphate level decreases. Because it has something to do with parathyroid hormones because it balance the calcium and phosphate. Phosphate supplementation kapag nag increase ang calcium Hemodialysis Surgical removal of the parathyroid gland Weight-bearing exercises Pag naremove ang parathyroid gland- you'll have problem of parathyroid hormone resulting decreased calcium reabsorption HYPOCALCEMIA Decreased calcium level in the blood CALCIUM Hypocalcemia can be caused by Calcium levels normally range from 8.6-10.2 mg/dL hypoparathyroidism - there is not enough Calcium excretion and reabsorption are regulated by parathyroid hormone excreted that causes the parathyroid hormone (PTH) that is secreted from decreased reabsorption of calcium. decreased the parathyroid glands near the thyroid. release of calcium from your bones. Hypocalcemia is also caused by vitamin D deficiency and renal disease - (cause of hypocalcemia- inadequate exposure to sunlight, nagkaakron ng skin pigmentation, skin thinninng,- we need vit d to preven osteoporosis ) and renal disease.- phosphorus is reverse, abnormally high phosphorus level is seen with renal failure SIGNS AND SYMPTOMS Signs and symptoms of hypocalcemia often Circulate in our bloodstream bit majority is found in impact the musculoskeletal and nervous systems. our bones  These include paresthesis (numbness and Half of our body’s magnesium is stored in our bones. tingling) of the lips, tongue, hands and feet, 1% is found in extracellular fluid and the rest is found muscle cramps, and tetany in intracellular fluid Chvostek’s sign - sign wherein there is HYPERMAGNESEMIA involuntary twitching of facial muscle when your Elevated magnesium level in the blood. facial nerves is being tap It is usually the result of renal failure, excess Trousseau’s sign - developed a hand spasm magnesium replacement, or use of magnesium cause by inflating blood pressure cuff for a level containing laxatives or antacids. above systolic pressure for 3 mins Half of our body’s magnesium is stored in our. bones. 1% is found in extracellular fluid and the PHOSPHORUS rest is found in intracellular fluid Phosphorus levels typically range from 2.5-4.0 mg/dL Signs and symptoms of hypermagnesemia Phosphorus is stored in the bones and is include bradycardia, weak and thready pulse, predominantly found in the ICF with small amounts in lethargy, tremors, hyporeflexia, muscle the ECF. weakness, and cardiac arrest. Dietary phosphorus sources include dairy products, Treatment for hypermagnesemia involves fruits, vegetables, meat, and cereal. increasing fluid intake, discontinuing magnesium- For energy metabolism, nerve function, muscle containing medications, and in severe cases, function, bones and teeth hemodialysis or peritoneal dialysis. Excreted by our kidneys and absorbed by the intestine Additionally, administration of calcium gluconate HYPERPHOSPHATEMIA can be helpful to reduce the cardiac effects of Increased phosphorus level in the blood hypermagnesemia until the magnesium level can Can be caused by kidney disease, crush injuries, or be lowered. overuse of phosphate-containing enemas. HYPOMAGNESEMIA Hyperphosphatemia itself is usually asymptomatic, Decreased magnesium level in the blood. but signs of associated hypocalcemia may be It typically results from inadequate magnesium in present due to the inverse relationship between the diet, or from loop diuretics that excrete phosphorus and calcium. magnesium. Example: if you are taking alcohol, Treatment for hyperphosphatemia includes they often develop hypomagnesemia, because decreasing intake of phosphorus, administration of there is poor diet and impaired nutrient phosphate-binder medications to help with absorption. Loop diuretic- increases renal excretion, and hemodialysis. excretion of magnesium and may conduced to Example of phosphate binder medication- magnesium deficit sevelamer(most recommended because it does not Chronic proton pump inhibitor use can also cause contain calcium) (renvela), calcium carbonate (may hypomagnesemia calcium not recommended usually by doctors) - Signs and symptoms of hypomagnesemia include phosphate binder that contain calcium - problem is nausea, vomiting, lethargy, weakness, leg increase risk of mineral deposits in our wall vessels cramps, tremor, dysrhythmias, and tetany. causing vascular calcification- there is risk of blood Treatment for hypomagnesemia consists of clot or stroke. increasing dietary intake of magnesium HYPOPHOSPHATEMIA containing foods and oral or IV magnesium Decreased phosphorus level in the blood supplementation. Acute hypophosphatemia can be caused by acute Vegetable citrus, chocolate (dark chocolate) alcohol abuse, burns, diuretic use, respiratory alkalosis, resolving diabetic ketoacidosis, and starvation. Chronic hypophosphatemia is caused by hyperparathyroidism, vitamin D deficiency, prolonged use of phosphate binders, and hypomagnesemia or hypokalemia. Hypophosphatemia is usually asymptomatic, but in severe cases, it can cause muscle weakness, anorexia, encephalopathy, seizures, and death- phosphorus has something to do with nerve function, membrane building and retain, energy metabolism Treatment for hypophosphatemia includes treating what is causing the imbalance, oral or IV phosphorus replacement, and increased phosphate-containing foods in the diet. Eat fruits, vegetables, cereals, meat and diary product. MAGNESIUM Magnesium levels typically range from 1.5-2.4 mEq/L Magnesium is essential for normal cardiac, nerve, muscle, and immune system functioning. Dietary sources of magnesium include green leafy vegetables, citrus, peanut butter, almonds, legumes, and chocolate CHLORIDE  The normal range for chloride in adults is roughly Test to know how well our lung are able to move between 98 and 107 milliequivalents of chloride oxygen into the blood and remove our CO2 from our per liter of blood (mEq/L) blood Maintains proper ph level, stimulates stomach acid From collecting blood on your radial artery rather that needed for digestion, stimulate muscle function than brain , facilitate flow of oxygen 10 cc syringe pero 10 ml ang kukunin pero sa ospital Chloride carries an electric charge and therefore is 3cc syringe lang ang ginagamit. Heparinine syringe classified as an electrolyte, along with sodium and to prevent blood clot sometimes 2 cc or 3 cc of blood potassium. 90 degree into your radial artery. Collected by We can find in: table salt (sodium chloride), respiratory therapist yung blood iddrop lang sa It helps to regulate the amount of fluid and types of microchip then iinsert sa abg machine. nutrients going in and out of the cells. ABGs measure the pH level of the blood, the partial Chloride is absorbed in the small intestine and pressure of arterial oxygen (PaO2), the partial remains in the body’s fluids and blood. Any excess pressure of arterial carbon dioxide (PaCO2), the amount is excreted in urine. bicarbonate level (HCO3), and the oxygen saturation Chloride is usually bound to sodium, and therefore level (SaO2) the amount in blood tends to coincide with sodium Prior to collecting blood gases, it is important to levels. ensure the patient has appropriate arterial blood flow Chloride is involved in many of our bodily functions. to the hand. Similar to sodium and potassium, chloride creates This is done by performing the Allen test. specific channels in the membranes of our cells When performing the Allen test, pressure is held on which help to carry different vital tasks. both the radial and ulnar artery below the wrist. This mineral is needed to help red blood cells Pressure is released from the ulnar artery to check if exchange oxygen and carbon dioxide in both the blood flow is adequate. If arterial blood flow is lungs (taking up oxygen and releasing carbon adequate, warmth and color should return to the dioxide) and other parts of the body (delivering hand. oxygen and taking up carbon dioxide). Interpreting Arterial Blood Gases: Chloride also plays a role in the digestion of foods, by supporting the production and release of hydrochloric acid (HCl) in the stomach. Key in controlling water and the type of cell that goes in and out. It has something to with balance of the body including maintaining a proper pH level. Help us carry messages in our nerves, digestion, release of hydrochloric acid for proper digestion and absorption food. HYPERCHLOREMIA Excess chloride levels in the blood. It can be caused by severe dehydration, diarrhea, or metabolic problems in which the blood becomes too acidic, such as with kidney disease. A high salt diet can lead to an excessive intake of sodium chloride, which is associated with elevated blood pressure - if you have high bp you need to MODIFIED ALLEN’S TEST maintain a low salt low fat diet The symptoms that may indicate hyperchloremia Put pressure on both the radial and ulnar artery are usually those linked to the underlying cause of below your wrist. Pressure being release to check if the high chloride level. Often this is acidosis, in blood flow is adequate. If it arterial pressure is which the blood is overly acidic. These symptoms adequate, warms and color should adequate may include: When performing the Allen test, pressure is held on o fatigue both the radial and ulnar artery below the wrist. o muscle weakness Pressure is released from the ulnar artery to check if o excessive thirst blood flow is adequate. If arterial blood flow is o dry mucous membranes adequate, warmth and color should return to the o high blood pressure hand. HYPOCHLOREMIA pH Low level of chloride in the blood A loss of chloride in the body usually accompanies conditions that cause sodium losses. Diuretic medications that remove fluid through the kidneys can also cause decreased chloride levels. In cases of sudden, very high levels of blood glucose such as seen in people with diabetes, the kidneys will flush more sodium and water out of the body, leading to lower chloride levels. A neutral pH is 7, which is the same pH as water.. Normally, the blood has a pH between 7.35 and 7.45. A blood pH of less than 7.35 is considered acidic, and ACID-BASE BALANCE a blood pH of more than 7.45 is considered alkaline. ARTERIAL BLOOD GASES The body has several mechanisms for maintaining blood pH. The lungs are essential for maintaining pH An arterial blood gases (ABG) test measures the and the kidneys also play a role.The lungs are acidity (pH) and the levels of oxygen and carbon dioxide in the blood from an artery.  essential for maintaining pH and the kidneys also play a role. Example if your pH is too low (acidosis), the respiratory rate quickly increases to eliminate acid in the form of carbon dioxide, and the kidney excrete additional hydrogen ions or acid in the urine and retain bicarbonate. If pH is to high (alkalosis) , respiratory rate decrease to retain acid in the form of carbon dioxide and kidney excrete bicarbonate in the urine and retain hydrogen ions pH of our blood is Measure of hydrogen ion concentration.- byproduct of our metabolism substance such as protein fats and carbohydrates. This create extra hydrogen ions in our blood that need for balance PaCO2 PaCO2 is the partial pressure of arterial carbon RESPIRATORY ACIDOSIS dioxide in the blood. The normal PaCO2 level is 35- Respiratory acidosis develops when carbon dioxide 45 mmHg. (CO2) builds up in the body causing the blood to For example: high respiratory rate or deeper- become increasingly acidic. additional carbon dioxide is removed causing You will see this see this on patient who are having decreased acid levels in the blood and increase ph asthma exacerbation and COPD, and heart failure, CO2 forms an acid in the blood that is regulated by pulmonary edema the lungs by changing the rate or depth of Respiratory acidosis is identified when reviewing respirations. ABGs and the pH level is below 7.35 and the PaCO2 Generally, the lungs work quickly to regulate the level is above 45, indicating the cause of the acidosis PaCO2 levels and cause a quick change in the pH. is respiratory. Therefore, an acid-base problem caused by Note that in respiratory acidosis, as the PaCO2 hypoventilation can be quickly corrected by level increases, the pH level decreases. increasing ventilation, and a problem caused by RESPIRATORY ALKALOSIS hyperventilation can be quickly corrected by Respiratory alkalosis develops when the body decreasing ventilation. removes too much carbon dioxide through HYPERVENTILATION: Due to anxiety nag respiration, resulting in increased pH and an alkalotic hhyperventilate, we are asking them to breathe sa state. brown bag because to rebreathe some carbon When reviewing ABGs, respiratory alkalosis is dioxide that they are blowing off. identified when pH levels are above 7.45 and the HYPOVENTILATION: sedative effects like PaCO2 level is below 35. medications or anesthesia if patient hyperventilate With respiratory alkalosis, notice that as the we are asking to cough and to take a deep breath to PaCO2 level decreases, the pH level increases. blow off more carbon dioxide METABOLIC ACIDOSIS HCO3 Metabolic acidosis occurs when there is an HCO3 is the bicarbonate level of the blood, and the accumulation of acids (hydrogen ions) and not normal range is 22-26. enough bases (HCO3) in the body. HCO3 is a base managed by the kidneys and helps Under normal conditions, the kidneys work to excrete to make the blood more alkaline. acids through urine and neutralize excess acids by The kidneys take longer than the lungs to adjust the increasing bicarbonate (HCO3) reabsorption from acidity or alkalinity of the blood, and the response is the urine to maintain a normal pH. not visible upon assessment. Metabolic acidosis is characterized by a pH level As the kidneys sense an alteration in pH, they begin below 7.35 and an HCO3 level below 22 when to retain or excrete HCO3, depending on what is reviewing ABGs. needed. It is important to notice that both the pH and If ph becomes acidic, the kidneys retain bicarbonate HCO3 decrease with metabolic acidosis. to increase the amount of bases present in our blood METABOLIC ALKALOSIS to increase your pH, if the pH becomes alkalosis, the Metabolic alkalosis occurs when there is too much kidney excrete more bicarbonate causing ph to bicarbonate (HCO3) in the body or an excessive loss decrease. of acid (H+ ions). PaO2 Metabolic alkalosis is defined by a pH above 7.45 PaO2 is the partial pressure of arterial oxygen in the and an HCO3 level above 26 on ABG results. blood. Note that both pH and HCO3 are elevated in It more accurately measures a patient’s oxygenation metabolic alkalosis. status than SaO2 (the measurement of hemoglobin saturation with oxygen). Therefore, ABG results are also used to manage ANALYZING ABG RESULTS patients in respiratory distress. Pulse oxymeter is not accurate. It is included in ABG para mas accurate INTERPRETING ARTERIAL BLOOD GASES ROME (PCo2)Respiratory Opposite- resp component moves in opposite direction of the ph if resp ph causing imbalance ph and pco2 is opposite (HCO3) Metabolic Equal - ph and bicarbonate moves in the same direction. If high - metabolic alkalosis