Unit 2 Fluid and Electrolyte Review

Lab Values and Normals

100

K+

3.5-5

200

C+

8.5-10.4

300

Na+

135-145

400

Mg++

1.5-2.5

500

Cl-

95-105

Signs and Symptoms

100

1. Muscle weakness, especially in the legs and arms
2. Fatigue and lethargy
3. Constipation or intestinal distention
4. Cardiac irregularities (arrhythmias)
5. Hypotension (low blood pressure)
6. Nausea and vomiting
7. Paralytic ileus (paralysis of intestinal muscles)
8. Paresthesia (numbness or tingling sensations)
9. Shallow respirations
10. Mental confusion
11. Glucose intolerance and hyperglycemia
12. ECG changes:
    • Flattened T waves
    • Depressed ST segments
    • Presence of U waves
    • Prolonged QRS complex

What is Hypokalemia?

200

1. Neurological:

   • Fatigue
   • Lethargy
   • Weakness
   • Confusion
   • Hallucinations (in severe cases)
   • Seizures (in severe cases)

2. Gastrointestinal:

   • Anorexia (loss of appetite)
   • Nausea
   • Vomiting
   • Constipation

3. Cardiovascular:

   • Dysrhythmias (irregular heartbeats)
   • Bradycardia (slow heart rate)
   • Heart block
   • Ventricular tachycardia (in severe cases)
   • Hypertension

4. Renal:

   • Polyuria (increased urine output)
   • Kidney stones
   • Impaired renal function

5. Musculoskeletal:

   • Bone pain
   • Muscle weakness

6. Other:

   • Thirst
   • Dehydration
   • Depression
   • Shortened QT segment and depressed, widened T waves on ECG

What is Hypercalcemia? 

300

1. Neuromuscular:

   • Muscle weakness and cramps
   • Tremors
   • Hyperactive deep tendon reflexes
   • Positive Chvostek and Trousseau signs
   • Tetany
   • Seizures

2. Neurological:

   • Confusion
   • Vertigo
   • Ataxia
   • Nystagmus

3. Cardiovascular:

   • Tachydysrhythmias
   • Torsades de pointes
   • Ventricular fibrillation

4. Other:

   • Fatigue
   • Nausea
   • Vomiting
   • Anorexia
   • Weakness

What is Hypomagnesemia? 

400

• Thirst
• Dry, sticky mucous membranes
• Red, flushed skin
• Fatigue and lack of energy
• Confusion
• Muscle twitching or spasms
• Temperature elevation
• Water retention (edema)
• Hypertension
• Decreased or absent urination

What is hypernatremia? 

500

1. Neuromuscular:

   • Tingling and numbness, especially around the mouth and in fingers/toes
   • Muscle cramps
   • Carpopedal spasm (Trousseau sign)
   • Hyperreflexia
   • Tetany (severe muscular twitching and spasms)
   • Laryngospasm

2. Neurological:

   • Irritability
   • Mental changes
   • Anxiety
   • Seizures (in severe cases)

3. Cardiovascular:

   • Prolonged QT interval on ECG
   • Cardiac dysrhythmias
   • Decreased cardiac contractility

4. Other:

   • Chvostek sign (facial muscle twitching when tapping the facial nerve)
   • Intestinal cramping
   • Hyperactive bowel sounds

What is hypocalcemia? 

Causes and Risk Factors

100

• Cell hypoxia
• Certain types of acidosis
• Insulin deficiency
• Acute or chronic kidney disease
• Use of potassium-sparing medications:
  • ACE inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Potassium-sparing diuretics
  • Aldosterone antagonists
  • Other factors:
    • Volume depletion
    • Acute infection
    • Severe acidosis
    • Marked hyperglycemia

What are causes of hyperkalemia? 

200

1. Impaired renal function:

   • End-stage kidney disease
   • Acute kidney injury
   • Oliguric renal disease

2. Excessive intake:

   • Overuse of magnesium-containing antacids or laxatives
   • Excessive parenteral magnesium administration
   • Magnesium-containing enemas

3. Endocrine disorders:

   • Hypothyroidism
   • Adrenal insufficiency

4. Other medical conditions:

   • Diabetic ketoacidosis
   • Tumor lysis syndrome
   • Rhabdomyolysis

What are causes of hypermagnesemia? 

300

1. Excessive vomiting
2. Severe diarrhea
3. Diuretic use, especially loop diuretics
4. Metabolic alkalosis
5. Respiratory acidosis (compensatory mechanism)
6. Addison's disease
7. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
8. Burns
9. Congestive heart failure
10. Excessive sweating
11. Cystic fibrosis 
12. Hyponatremia 

What is hypochloridemia? 

400

1. Kidney dysfunction:

   • Acute kidney injury
   • Chronic kidney disease

2. Increased phosphate intake:

   • Excessive use of phosphate-containing laxatives or enemas
   • Phosphate-rich diet

3. Cellular shifts:

   • Tumor lysis syndrome
   • Rhabdomyolysis
   • Rapid cell destruction (e.g., during chemotherapy for metastatic tumors)

4. Hormonal imbalances:

   • Hypoparathyroidism
   • Vitamin D intoxication

5. Decreased phosphate excretion:

   • Renal tubular defects

6. Other factors:

   • Severe tissue damage
   • Respiratory alkalosis

What are causes of hyperphosphatemia? 

500

• Prolonged vomiting
• Severe diarrhea
• Excessive sweating
• Diuretic use
• Adrenal insufficiency (inadequate aldosterone secretion)
• Low-sodium diets, especially when combined with diuretic use

1. Dilutional hyponatremia (excess water):

   • Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
   • Excessive water intake (water intoxication)
   • IV administration of hypotonic fluids

2. Medical conditions:

   • Congestive heart failure
   • Liver cirrhosis with ascites
   • Chronic kidney disease
   • Hypothyroidism

3. Medications:

   • Some antidepressants
   • Certain pain medications
   • Some antipsychotic drugs

4. Other factors:

   • Intense physical exertion (e.g., marathon runners)
   • Certain cancers
   • Severe burns

What are causes of hyponatremia? 

Nursing Interventions

100

Frequent monitoring of these allow for early detection of imbalances and evaluation of treatment effectiveness, enabling timely adjustments to the care plan.

What are electrolytes?

200

Precise tracking helps assess fluid balance, which directly impacts electrolyte levels and guides fluid replacement or restriction strategies.

What is an I&O? 

300

Proper administration helps correct imbalances while minimizing risks of over-correction or adverse effects.

What are prescribed electrolyte replacements? 

400

Patient education helps manage electrolyte levels long-term, particularly for sodium and potassium balance.

What are dietary modifications? 

500

Allows for early detection of subtle changes indicative of electrolyte disturbances, facilitating prompt intervention.

What are mental status, muscle strength, and vital signs assessments? 

IV fluids

100

This type of solution has the same osmolality as cell fluid, causing no net movement of water.

What is isotonic? 

200

When surrounded by this type of fluid, cells may swell and possibly burst.

What is hypotonic? 

300

3% saline solution is an example of this type of fluid that causes cells to shrink.

What is hypertonic? 

400

This fluid is isotonic when outside of the body, but hypotonic while inside. 

What is D5W? 

500

 These types of solutions are ideal for replacing fluid in patients with acute blood loss or hemorrhage.

What are isotonic solutions?