Fluid And Electrolytes Distributed 02 sample PDF

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Fluid and Electrolytes: Balance and Distribution

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CONTENTS

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A. Normal physiology of electrolytes  Body Water  Body Water Distribution  Functions of Body Water  Electrolytes  Electrolytes – Location  Electrolytes – Relationships  General Functions of Electrolytes  Specific Functions of Electrolytes  Normal Values  Factors that Contribute Alteration in Electrolytes

D. Electrolytes  Chemical compounds that are charged: (+) = cation (-) = anion  They have the ability to conduct electrical current.  Constantly breaking and combining in water.  Cations Na+ K+ Ca2+ Mg2+  Anions ClHCO3PO4-3 SO4-2 Proteinate Carbonic Acid Lactic Acid

B. Electrolyte Imbalances  Natremia  Kalemia  Calcemia  Magnesemia

NORMAL PHYSIOLOGY OF ELECTROLYTES A. Body Water  Male  Female

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Infant

60% 50% 80%

Has more fats than male, fats has no water Under the influence of maternal hormone estrogen which has water retention property

B. Body Water Distribution  Intracellular Fluid (ICF)  Extracellular Fluid (ECF) Interstitial Intravascular Transcellular   

70% 30% 11-12 L 3 L 1 L

Interstitial – between cells, example: lymph Intravascular – plasma Transcellular – secreted by cells and stored in different parts of the body, examples: CSF, digestive juices, humor

C. Functions of Body Water  Maintains ECF  Maintains ICF  Maintains body temperature

Elimination of waste

E. Electrolytes - Location  Intracellular K (Most abundant cation) Mg (Second most abundant cation) PO4 

Extracellular Na (Most abundant cation) Cl (Most abundant anion)

F. Electrolytes - Relationship  Na & Cl (proportional & lovers)  K & PO4 (proportional & lovers)  Ca & PO4 (not proportional)  Mg & HCO4 (not proportional)

G. General Functions of Electrolytes  Water distribution by determining osmotic pressure  Transmission of impulses  Acid-base balance H. Specific Functions of Electrolytes  Sodium (Na) Controls ECF osmotic pressure Controls the water distribution throughout the body

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Establish electrochemical state necessary for transmission of nerve and for muscle contraction Must be present to facilitate transport of glucose into the cells 

Potassium (K) Controls ICF osmotic pressure. Neuromuscular and smooth and cardiac muscle impulse transmission Maintains acid-base balance  

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Small bowel is the major absorption site.

I. Normal Values  Electrolytes are constantly breaking down and combining in water.  Combining power is expressed in terms of mEq/L or milliequivalent per liter.  1 mEq = 1 mg of H Na K Ca Mg

98% ICS, 2% ECS (needed in neuromuscular functioning) 80% is excreted in the kidney (primary regulator) 20% is excreted through sweat and bowel

: : : :

135.0 – 145.0 3.5 - 5.5 4.5 - 5.5 1.5 - 2.5

Serum Serum Total Ca Serum

J. Factors that Contribute Alteration in Electrolytes 

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FHM-DD  Fluid loss – diarrhea, vomiting, urine, diaphoresis, fistulas, active bleeding, suctioning, gavage, lavage  Hormones  Medications  Diets – over and under  Diseases

Calcium (Ca) Transmission of nerve impulse transmission and helps in muscle contraction and relaxation including cardiac muscles Maintains intracellular connection Activation of enzymes that stimulates many chemical reactions in the body Needed for the release of ACh Formation of bone and teeth Blood coagulation 99% of calcium is in the bones, 1% is in the blood. This is the one needed in nerve impulse transmission 50% is ionized, 45% is bound to protein and 5% form complexes with other chemicals Calcium is absorbed from foods in the presence of gastric acid and vitamin D Excreted primarily in the feces Serum calcium is controlled by parthyroid hormone (increase absorption of calcium and release of calcium to the blood) and calcitonin (decreased calcium in the blood)

Magnesium (Mg) Metabolism of proteins and carbohydrates Activator of many intracellular enzyme system (precipitates cellular metabolic activities) Plays an important role in neuromuscular function, has sedative effect by inhibiting the release of neurotransmitter acetylcholine (controls the release of acetylcholine)

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ELECTROLYTES IMBALANCES 1. SODIUM (Na) Hyponatremia

Hypernatremia

Etiology  FHM-DD Fluid loss – all mentioned Hormone – increased aldosterone or ADH Medications – diuretics Diet – sodium restrictions Disease - SIADH

Etiology  FHM-D Fluid loss – diarrhea Hormone – decreased ADH Medications – none Diet – high Na intake, salt tablets, water deprivation Disease – diabetes Insipidus

Types  Excessive water elimination – sodium goes with water when being eliminated  Dilutional Natremia – related to water retention thus sodium is diluted in the water (increased ADH)

Pathophysiology  Fluids from the ICS is pulled towards the ECS causing the cell to shrink. There is cell dehydration and it becomes thirsty.

Pathophysiology  Fluids from the ECS is pulled towards the ICS causing the cell to swell. There is trapping of fluids inside the cell.

Assessment  Cell swelling Headache (changes in the brain tissue) Nausea and vomiting (medulla – the most sensitive to cranial changes) Anorexia (hypothalamus in the limbic system) Seizure/coma  Aberration in transmission of impulse Muscle weakness Fatigue  Low level of glucose Weight loss  Others Abdominal cramps Collaborative management  IVF 0.9 NaCl/IV  Replace other electrolytes needed  Salty foods in diet  Safety precaution – CNS effect

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Assessment  Initial manifestation - dehydration Extreme thirst (primary characteristics) Dry sticky buccal mucosa Firm, rubbery tissue turgor Red dry swollen tongue Oliguria  Tachycardia – compensatory mechanism  Fatigue – related to tachycardia  Restlessness (moderate hypernatremia)  Dallucination (severe hypernatremia) – water deprivation of the CNS cells Collaborative Management  Increase oral fluids or D5W/IV  Diuretic  Restrict Na in diet  Monitor I & O and behavioral changes

2. POTASSIUM (K) Hypokalemia

Hyperkalemia

Etiology  FHM-DD Fluid loss – all mentioned Hormone – decreased ADH Medications – diuretics, steroids, antibiotics Diet – decreased intake Disease – burn, kidney disorders, HTN

Etiology  FHM-DD Fluid retention Hormone – increased ADH Medications – KCl, heparin, Diet – excessive intake Disease – burn (extracellular shift), renal failure

Assessment (all related to decreased impulse or no transmission of impulses)  CNS: Lethargy Confusion Mental depression 

Cardiovascular Arrhythmias Cardiac arrest ECG Changes T-wave flattening (depression) U-wave appearance

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GIT

Assessment  CNS Tingling sensation (few impulse, erratic) Numbness (no impulse)

Slowed peristalsis Abdominal distention Paralytic ileus Nausea and vomiting Anorexia 

Cardiovascular- most important consequence Conduction disturbance Ventricular fibrillation Cardiac arrest ECG Changes P-wave widening and flat (absent in extreme hyperkalemia) QRS complex widening T-wave peak (elevation)

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GIT Diarrhea Colic Nausea and vomiting

Kidneys

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Inability to concentrate urine Water loss Thirst Kidney damage 

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Kidney Oliguria Anuria

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Muscle Flaccid paralysis Weakness of the respiratory muscles Respiratory arrest

Collaborative Management  Potassium supplement: K durule tab 1-3 tabs daily  IV incorporation/slow drip Potassium rich foods Fruits Vegetable Apple Asparagus Banana (latundan, green) Broccoli (highest) Cantalope (melon) Carrots Orange (highest)

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Muscles Weakness (due to continued transmission of impulse) Flaccid paralysis

Collaborative Management  10% glucose with regular insulin/IV  Avoid K-rich foods  Promote bed rest  Dialysis

3. CALCIUM (Ca) Hypocalcemia

Hypercalcemia

Etiology  FHM-DD Fluid loss – mostly through diarrhea Hormones –hyporathyroidism Medications – alcohol abuse, aluminum cantaining antacids, caffeine, aminoglycosides Diet – adequate intake of calcium and Vit D Diseases – thyroid and parathyroid surgery, inflammation of the pancrease, renal failure (related to high level of phosphatemia)

Etiology  FHM-DD Fluid loss – none Hormones - hyperparathyroidism Medications - steroids Diet – excess intake Disease – malignancies, immobility (loss of Ca from the bone)

Assessment (increases neuromuscular activity)  CNS Seizure (increased irritability of CNS) Depression Impaired mental functioning Hallucination

Assessment (reduces neuromuscular activity)  CNS Dec DTR Lethargy Coma 

Cardiovascular Depressed act  Dysrhythmias  Cardiac arrest

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Cardiovascular Vetricular tachycardia ECG changes QT interval prolongation due to ST segment prolongation (Torsades de pointes)

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GIT/GUT Decreased GIT movement (constipation) Nausea and vomiting Anorexia Stone formation  Kidney damage

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GIT

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Musculoskeletal Pain  Osteoporosis  Fracture Fatigue, Hypotonia Weakness

Increase peristalsis Diarrhea Nausea and vomiting 

Musculoskeletal Osteoporosis  Fracture Tingling sensation (tip of fingers, mouth, feet is the most common) Spasm (pain may develop as result of spasm) Tetany (entire symptoms complex induced by increased neural excitability. These symptoms are due to spontaneous discharges of both sensory and motor fibers in peripheral nerve) Trosseau’s (carpopedal spasm) Chovstek’s (facial twitching)

Collaborative Management Ca gluconate, oral Ca salts High Ca diet Monitor breathing (laryngeal stridor) Seizure precaution

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Collaborative Management NSS/IV and diuretic Increase fluid intake (3-4 L/day), prevent urolithiasis Acid-ash fruit juices (prune, cranberry), ascorbic acid Mithramycin – reduces serum Ca level Protect from injury to avoid fracture

4. MAGNESIUM (Mg) Hypermagnesemia Hypomagnesemia

Etiology  FHM-DD Fluid loss – tube feeding or parenteral nutrition Hormones - none Medications – magnesium-containing antacids, cathartics Diet – decreased intake Disease – renal failure, diabetic ketoacidos

Etiology  FHM-DD Fluid loss – tube feeding or parenteral nutrition Hormones - none Medications – withdrawal from alcohol Diet – decreased intake Disease - impaired GI absorption – hypocalcemia

Assessment (Magnesium toxicity) BP down Urinary output decreased Respiration less than 12 Patellar reflex absent

Assessment (largely confined to neuromuscular sustem)  CNS Convulsion Mental Changes Agitation Depression Confusion 

Cardiovascular Same with hypocalcemia ECG changes QRS prolonged ST segment depression

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Musculoskeletal Muscle weakness Tremors Tetany Chovstek’s Trossue Laryngeal stridor

Collaborative Management Ca gluconate/IV Dialysis if with renal failure

Collaborative Management Mg salts oral/parenteral Diet supplements: fruits, green leafy vegetable, whole grain cereals, meats, nuts, seafoods Promote safety, prevention of injury Monitor for laryngeal stridor

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