IV fluids/ICF/ECF
Isotonic Fluids
Normal Saline
5% dextrose in water
5% dextrose in 1/4 NS
Lactated Ringers
No fluid shift
Potassium normal values
3.5-5
Hyperkalemia
S&S: muscle weakness, decreased urine, respiratory distress, hyperreflexia
Causes: Renal Failure, adrenal insufficiency, trauma
Interventions: IV calcium gluconate, diuretics, monitor vitals, monitor labs
Hypoacalcemia
S&S: hypotension, bradycardia, arrythmias, tetany, muscle spasms, positive trousseaus and chvostek signs
Causes: hypoparathyroidism, radial neck resection, lack of vitamin D, insulin, loop diuretics
Interventions: stop diuretics, monitor I&O, IV calcium gluconate
Hyperphosphatemia
S&S: asymptomatic, hyperreflexia, parasthesias, tetany, N/V, anorexia
Causes: CKD, excessive vitamin D, DKA, hypoparathyroidism, renal failure
Interventions: phosphate binding gels, monitor Ca, dialysis, monitor I&O
Hypotonic Fluids
1/2 NS
1/4 NS
1.3 NS
Fluids swells the cells
Sodium Normal Values
135-145
Hypokalemia
S&S: Alkalsosis, shallow respirations, constipation, irritability, dig toxicity
Causes: too much insulin, gastric suctioning, diuretics, burns
Interventions: HR monitor, monitor I&O, assess bowel sounds, labs
Hypermagnesemia
S&S: decreased DTR, lethargy, N/V, hypotension
Causes: DKA, Bowel Disorder, overconsumption of anti-acids, renal function
Interventions: IV Ca gluconate, Dialysis, monitor vitals and labs
Hypophosphatemia
S&S: Altered mental status, numbness neurologic instability, weakness, seizure, increased Respiratory Rate, pain, chest pain
Causes: Vitamin D deficiency, DKA, respiratory alkalosis, hyperparathyroidism, alcoholism
Interventions: monitor I&O, monitor mental status, vitals, phosphate PO or IV
Hypertonic Fluids
3% NS
5% NS
10% dextrose in water
5% dextrose in NS
5% dextrose in 1/2 NS
5% dextrose in LR
cells shrink
Magnesium Normal Values
1.6-2.6
Hypernatremia
critical greater than 160
S&S: headache, excessive thirst, dry sticky membranes, seizures, disorientation, HTN
Causes: impaired thirst mechanism, cushing syndrome
interventions: Fluid replacement, diuretics, Na restriction, monitor labs
Hypomagnesemia
S&S: agitation, mood changes, confusion, weakness, hyperactive reflexes, tremor, positive chvostek and trousseau signs
Causes: malabsorption, renal wasting, poor intake, TPN, DKA, ETOH
Interventions: Monitor vitals, I&O, labs, IV mg sulfate, assess alcohol use
What happens to the heart during hyperkalemia
prolonged P-R
Wide QRS
tall tented T wave
ECF electrolytes
Na
Cl
K
Ca
Phosphate normal Values
2.5-4.5
Hyponatremia
Critical below 115
S&S: edema, weakness, abd cramps, N/V, anorexia, depression, neuro changes, tremors, coma, death
Causes: Adrenal insufficiency, HF, Renal disease, burns
Interventions: adm fluids, increase salt rich foods, daily wt, monitor I&O, labs, vitals
Hyperchloremia
S&S: kussmaul respirations, weakness, increased thirst
Causes: Renal failure, dehydration, overactive parathyroid gland, metabolic acidosis, respiratory alkalosis
interventions: Diuretics, IV fluids, Dialysis
What happens to the heart with hypokalemia
flattened T-wave
S-T segment depression
ICF electrolytes
mg
Phosphate
Chloride and Calcium normal values
Ca: 8.5-10
Cl: 95-105
Hypercalcemia
S&S: bradycardia, pallor, cardiac arrest, dig toxicity, HTN, constipation, N/V
causes: hyperparathyroidism, immobilization, lithium use, thiazide diuretics
interventions: restrict dietary intake, mobilize patient, dietary fiber, isotonic fluids, lasix
Hypochloremia
S&S paresthesia to face and extremities, behavior changes, muscle spasms, tetany
Causes: addisons disease, burns, cystic fibrosis, metabolic alkalosis, loss of body fluids
Interventions: Increase salt intake, add chloride to fluids
Which two electrolytes work inverse of each other and which two electrolytes work closely together?
Calcium and Phosphate
and
Calcium and Chloride