Fluids and Electrolytes - MODULE

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Fluids & Electrolytes This self-directed learning module contains information you are expected to know to protect yourself, our patients, and our guests. Target Audience: All CHS licensed nurses providing patient care and/or involved in the delivery of patient care. Contents Instructions ........................................................2 Learning Objectives...........................................2 Module Content .................................................3-7 Appendixes ………………………………………. 8-14 Job Aid ..............................................................15 Posttest .............................................................16-18

Fluids and Electrolytes

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The material in this module is an introduction to important general information. After completing this module, contact your supervisor to obtain additional information specific to your department.

• Read this module.

• If you have any questions about the material, ask your supervisor.

• Complete the online post test for this module.

• The Job Aid on page 15 may be customized to fit your department and then used as a quick reference guide.

• Completion of this module will be recorded under My Learning in PeopleLink

Learning Objectives: When you finish this module, you will be able to:

• Discuss the basic principles of fluid and electroly tes

• Describe the imbalances related to sodium, potassiu m, magnesium, calcium, phosphorus, and chloride

• Identify the treatment for fluid and electrolyte im balances

Reference: Fluid & Electrolytes Made Incredibly Easy, 5th Ed. (2011), Lippincott, Williams & Wilkins


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Balancing Basics: A Look at Fluids

All major organs work together to maintain the prop er balance of fluid �� to maintain that balance, the amount of fluid gained t hroughout the day must equal the amount lost

Body fluids have many functions:

� Lubricants / solvents for metabolic processes

� Carriers for nutrients (i.e. Oxygen, glucose)

� Transport wastes

� Regulate body temperature

� Internal medium for cell metabolism

� Participate in chemical & metabolic processes

Fluids are used to rehydrate cells, add fluid to th e intravascular space, improve electrolyte balance, and maintain hemodynamic balan ce.


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Fluid Classification and Tonicity:

Classified as a Crystalloid or Colloid and Blood Pr oducts

o Crystalloids: solutions with small molecules that flow easily from the bloodstream into cells and tissues. May be isotonic, hypotonic, or hypertonic. They are the least expensive and generally used for volume resuscitation.

o Colloids : act as plasma expanders (help to maintain protein balance and colloid osmotic pressure) – examples: albumin, plasma protein fraction, dextran, and hetastarch

o Blood products: used for fluid volume resuscitation, maintenance of

RBC and HGB levels, and coagulation factor replacement

Tonicity

o Isotonic - has the same solute (matter dissolved in solution) concentration as another solution (i.e. 0.9% NaCl)

o Hypotonic – has a lower solute concentration than another solution (i.e. 0.45% NaCl)

� When giving a hypotonic IV solution you may cause too much fluid to move into the cells. As a result the cells can swell and burst.

o Hypertonic – has a higher solute concentration than another solution

(i.e. D5W initially before the dextrose is metabolized by the cells, 3% NaCl)

� Water is drawn out of the cells and into the ECF compartment. � Therapeutic in some instances: to decrease cerebral edema. � When giving a hypertonic solution to a patient, it may cause too

much fluid to be pulled from cells into the bloodstream, and the cells can shrink

** See AppendixA : A Look at IV Solutions for types of IV fluids, uses and special considerations **


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A Look at Electrolytes:

Electrolytes functions include: helping to maintain homeostasis, metabolic functions, cardiac and nerve conduction, acid-base balance and water distribution.

Potassium (K+)

• Major Intracellular fluid (ICF) cation • Regulates cell excitability & nerve impulse conduction • Permeates cell membranes, thereby affecting the cell’s electrical status (resting

membrane potential) • Helps to control ICF osmolality and, consequently, ICF osmotic pressure • Regulates muscle contraction and myocardial membrane responsiveness

Magnesium (Mg+)

• A leading ICF cation • Contributes to many enzymatic and metabolic processes, particularly protein

synthesis • Modifies nerve impulse transmission and skeletal muscle response (unbalanced

Mg+ concentrations dramatically affect neuromuscular processes) • Influences normal function of the cardiovascular system and Na+ and K+ ion

transportation Phosphorus/Phosphate (P-)

• Main ICF anion • Promotes energy storage and carbohydrate, protein and fat metabolism • Acts as a hydrogen buffer

Sodium (Na+) • Main extracellular fluid (ECF) cation • Helps govern normal ECF osmolality (a shift in Na+ concentration triggers a fluid

volume change to restore normal solute and water ratios) • Component of the sodium-potassium pump • Helps maintain acid base balance • Activates nerve and muscle cells • Influences water distribution (with chloride)

Chloride (Cl-)

• Main ECF anion • Helps maintain normal ECF osmolality • Affects body pH • Plays a vital role in maintaining acid-base balance � combines with hydrogen ions to

produce hydrochloric acid Calcium (Ca+) • A major cation in teeth and bones

• Found in fairly equal concentrations in ECF and ICF • Found in cell membranes � it helps cells adhere to one another and maintain their

shape • Acts as an enzyme activator within cells (muscles must have Ca+ to contract) • Aids in coagulation • Affects cell membrane permeability and firing level

Bicarbonate (HCO3-)

• Present in ECF • Regulates acid-base balance

Major Intracellular Electrolytes

Major Extracellular Electrolytes


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Multiple organs in the body play a role in electrol yte balance:

Kidneys (regulate Na+ and K+ balance) Recommended daily Na+ intake: 2 Grams

Lungs and Liver – regulate Na+ and water balance and blood pressure

Heart – secretes ANP, causing Na+ excretion

Sweat glands – excrete Na+, K+, Cl-, and water in sweat

GI Tract – absorbs and secretes fluids and electrolytes

Parathyroid Glands – secretes parathyroid hormone, which draws calcium into the blood and helps move phosphorus to the kidneys for excretion

Thyroid Gland - secrets calcitonin, which prevents calcium release from the bone

Hypothalamus and Posterior Pituitary Gland – produce and secret ADH causing water

retention, which affects solute concentration

Adrenal Glands – secret Aldosterone, which influences NA+ and K+ balance in the kidneys

** See Appendix B: Electrolyte Imbalances – Causes of Elevation (Hyper-) and Decline (Hypo-) ** See Appendix C: Electrolyte Imbalances – Signs/Symptoms & Treatment


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Dehydration:

Lack of water in extracellular spaces that causes f luid to shift out of the cells, which then shrink

May be caused by any situation that accelerates flu id loss including o Diabetes Insipidus (DI) o Prolonged fever o Watery diarrhea o Renal failure o Hyperglycemia o Heat injury

Patients prone to dehydration:

o Comatose, confused or bedridden patients o Infants o Elderly o Patients receiving highly concentrated tube feedings without enough

supplemental water

Assessment findings : o Irritability, confusion, dizziness o Weakness, extreme thirst o Fever, dry skin, dry mucous membranes, sunken eyeballs o Poor skin turgor o Decreased urine output (with DI urine is pale and plentiful) o Increased heart rate with falling blood pressure

Hypovolemia, Hypervolemia, Water Intoxication:

Fluid volume status is assessed using some of the following methods: o Urine output o Weights o Vital signs (i.e. HR and BP changes) o Level of consciousness (changes in mental status) o Intake and output o Hemodynamic monitoring (i.e. CVP, PCWP, CO etc.) o Head-to-Toe assessment (patient signs & symptoms) o Laboratory values

Treatment based on etiology and presenting symptoms ** See Appendix D: Hypovolemia, Hypervolemia and Water Int oxication **


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Appendix A: A Look at IV Solutions

Solution Uses Special Considerations

Dextrose 5% in water (D5W) (Isotonic then becomes hypotonic)

o Fluid loss and dehydration

o Solution is isotonic initially; becomes

hypotonic when dextrose is metabolized o Don’t use for resuscitation or head injured

patients; can cause hyperglycemia o Use cautiously in renal or cardiac disease;

can cause fluid overload o Doesn’t provide enough daily calories for

prolonged use; may cause eventual breakdown of protein

0.9% Sodium Chloride (NaCl or NS) (Isotonic)

o Shock o Hyponatremia o Used with Blood transfusions o Fluid Volume Resuscitation o Fluid challenges o Metabolic acidosis o Hypercalcemia o Fluid replacement in patients with diabetic

ketoacidosis (DKA)

o Because this replaces extracellular fluid, use with caution in patients with heart failure, edema, or Hypernatremia; can lead to fluid volume overload and pulmonary edema

0.45% Sodium Chloride (1/2 NS) (Hypotonic)

o Water replacement o DKA after initial normal saline solution

and before dextrose infusion o Hypertonic dehydration o Sodium and chloride depletion o Gastric fluid loss from nasogastric

suctioning or vomiting

o Use cautiously; may cause cardiovascular collapse or increased intracranial pressure (ICP)

o Don’t use on patients with liver disease, trauma or burns

Dextrose 5% in .45% Normal Saline (D5 ½ NS) (Hypertonic)

o DKA after initial treatment with NS and ½ NS solution – prevents hypoglycemia and cerebral edema (occurs when serum osmolality is reduced too rapidly)

o In patients with DKA, use only when glucose falls <250 mg/dL

Dextrose 5% in normal saline (D5NS) (Hypertonic)

o Hypotonic dehydration o Temporary treatment of circulatory

insufficiency and shock if plasma expanders are not available

o Syndrome of Inappropriate Antidiuretic Hormone (SIADH) or use 3% NaCl

o Addison’s crisis

o Use with caution in patients with cardiac or renal disease because of danger of heart failure and pulmonary edema

3% Sodium Chloride (Hypertonic)

o Severe dilutional Hypernatremia o Severe sodium depletion o Volume resuscitation o Electrolyte imbalance (i.e. salt wasting)

o Administer cautiously to prevent pulmonary edema

o Observe infusion site closely for signs or infiltration and tissue damage


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Appendix B: Electrolyte Imbalances – Causes of Elev ation and Decline

Normal Range Causes of elevation (hyper) Causes of Decline (hypo)

Sodium (Na): 135-145 mEq/L

Water loss, inadequate water intake, excessive sodium intake, Diabetes Insipidus (DI), certain diuretics, tube feedings, hypothalamic lesions, hyperaldosteronism, corticosteroid use, Cushing’s Syndrome, in elderly (diarrhea, low body weight, tube feeds without adequate water replacement)

Inadequate sodium intake, excessive water loss, or water gain, heart failure, cirrhosis, nephrosis, syndrome of inappropriate ADH (SIADH), sodium depletion, loss of body fluids without replacement, laxatives, nasogastric suctioning, hypoaldosteronism, Medications such as anticoagulants, anticonvulsants, antidiabetics, antineoplastics, antipsychotics, diuretics, sedatives

Potassium (K): 3.5-5.0 mEq/L

Aldosterone deficiency, sodium depletion, acidosis, trauma, burns, crush injuries, hemolysis of red blood cells, severe infection, potassium-sparing diuretics (spironolactone), ACE inhibitors, beta-blockers, chemotherapy agents, digoxin, heparin, NSAIDS, excessive amounts of potassium, metabolic acidosis and insulin deficiency decrease movement of K+ into cells, Addison’s Disease Hemolyzed blood sample

Lack of dietary intake of potassium, vomiting, diarrhea, nasogastric suctioning, potassium-depleting diuretics, certain antibiotics, insulin, laxatives – when used excessively, adrenergics such as albuterol and epinephrine, hyperaldosteronism, hepatic disease, acute alcoholism, heart failure, acute leukemia’s, salt wasting kidney disease, major GI surgery, diuretic therapy with inadequate potassium replacement

Calcium (Ca): 8.9-10.1 mg/dL (serum) 4.4-5.3 mg/dL (ionized)

Excessive vitamin D, immobility, hyperparathyroidism, hyperthyroidism, fractures, Hypophosphatemia, acidosis, potassium-sparing diuretics, ACE inhibitors, malignancy of bone or blood, Vitamin D overdose

Hypoparathyroidism, malabsorption, insufficient or inactivated vitamin D, inadequate intake of calcium, hypoalbuminemia, Hyperphosphatemia, diuretic therapy, diarrhea, acute pancreatitis, bone cancer, gastric surgery, alkalosis

Magnesium (Mg): 1.5-2.5 mg/dL

Excessive use of magnesium containing antacids and laxatives, untreated diabetic ketoacidosis (DKA), excessive magnesium infusions, renal failure, Addison’s Disease, adreno-cortical insufficiency, hemodialysis using magnesium-rich dialysate, TPN with excessive Mg, continuous Mg sulfate infusion to treat certain conditions

Malabsorption related to GI disease, excessive loss of GI fluids, acute alcoholism/cirrhosis, diuretic therapy, hyper- or hypothyroidism, pancreatitis, preeclampsia, nasogastric suctioning, fistula drainage, poor dietary intake of magnesium, poor GI absorption of Mg, increased loss from GI or urinary tract, pregnancy, chronic diarrhea, hemodialysis, Hypercalcemia, hypothermia, sepsis, burns, wound debridement

Chloride (Cl): 98-108 mEq/L

Hypernatremia may cause Hyperchloremia, increased water and decreased chloride intake, hyperparathyroidism, resp. alkalosis, neurogenic hyperventilation, dehydration, excessive NaCl intake, decreased absorption of chloride from the intestines, metabolic acidosis

Poor chloride intake because of a salt restricted diet, IV fluid replacement without electrolyte supplementation, loss of gastric secretions, diuretic therapy, diaphoresis, sodium or potassium deficiency or metabolic acidosis, DKA, Addison’s Disease, rapid removal of ascetic fluid, heart failure


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Normal Range Causes of elevation (hyper) Causes of Decline (hypo)

Phosphate (P): 2.5-4.5 mg/dL

Renal failure, Hypoparathyroidism, respiratory acidosis, DKA, necrosis, rhabdomyolysis, trauma, heat stroke, infection, over administration of phosphorus supplements, laxatives or enemas, excessive intake of Vitamin D, insecticide / fertilizer poisoning, catabolic states, neoplastic diseases

Respiratory alkalosis, hyperglycemia, refeeding syndrome, malabsorption syndrome, excessive use of phosphorus-binding antacids, diarrhea, laxative abuse, diuretics, DKA, hyperparathyroidism, hypocalcemia, malnutrition, starvation, severe burns, alcoholism, Increased renal excretion


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Appendix C: Electrolyte Imbalances – Signs/Symptoms & Treatment

Imbalance Signs/Symptoms Treatment

Hypernatremia Na > 145 mEq/L

o Restless, agitation o Lethargy, seizures, coma o Weakness o Muscle twitching o Dry tongue – “fuzzy” o Thirst o Dry skin & mucus membranes o Soft, sunken eyeballs o Flushed skin o Low grade fever o Confusion

o Varies with cause – treat underlying cause o Replace vascular fluid loss with isotonic

solution o Replace gradually – over 48 hrs o Avoid shifting H2O into brain cells o .45% NaCl o Restrict sodium intake

Hyponatremia Na < 135 mEq/L

o Serum osmolality <280 mOsm/kg (dilute blood)

o Urine specific gravity <1.010 o Abdominal cramps o Nausea & vomiting o Headache o Altered LOC-lethargy and confusion o Anorexia o Muscle twitching, tremors o Seizures o Depletional � dry mucous membranes,

orthostatic hypotension, poor skin turgor, tachycardia Dilutional � hypertension, rapid bounding pulse, weight gain

o d/t Hypervolemia �Fluid restriction, Oral sodium supplements

o d/t Hypovolemia � isotonic IV fluids, high sodium foods

o If Severe (Na <120 mEq/L) then Hypertonic saline (3% or 5%) if symptomatic (causes water to shift out of cells to the ECF compartment) - administer slowly and in small volumes o Furosemide may also be administered

Hyperkalemia K> 5 mEq/L Moderate: K = 6.1 – 7.0 mEq/L Severe: K > 7.0 mEq/L

o Paresthesia (early sign) and irritability o Skeletal muscle weakness which may lead to

flaccid paralysis o Decreased deep tendon reflexes o nausea o abdominal cramping o diarrhea (early sign) o bradycardia, irregular pulse, hypotension,

decreased cardiac output and possibly cardiac arrest

o ECG Changes - tall, peaked T wave, flat P wave, bundle branch block causing widened QRS, prolonged PR interval, depressed ST segment

o Decreased arterial pH, indicating acidosis

o Reduce intake of potassium o Administer loop diuretics (mild to moderate) For severe cases : o Calcium Chloride or Gluconate:

� Administer 10% Calcium Gluconate (10 ml) or 10% Calcium Chloride (5 ml) IV over 2 minutes as ordered (connect pt to monitor)

� Caution : 1 ampule of calcium chloride has 3 x more calcium than calcium gluconate!!!

o Bicarbonate: IV sodium bicarbonate (50 mEq) – lasts 1-3 hrs

o Insulin : 10 units regular insulin IV) o Glucose : D10% or D50% o Kayexalate/Sorbitol – increase excretion o Dialysis o CBIGKD – “see big kid” is the acronym


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Imbalance Signs/Symptoms Treatment Hypokalemia K < 3.5 mEq/L

o Skeletal muscle weakness (especially in legs)

o Leg cramps o Flattened or inverted T-wave, depressed ST-

segment, U-wave o Constipation, ileus o Toxicity of digitalis glycoside o Irregular, weak pulse, palpitations o Orthostatic hypotension o Numbness (parasthesia), paralysis o Decreased or absent deep tendon reflexes o Tachycardia and tachypnea if respiratory

muscles become weak o Severe – rhabdomyolysis o Anorexia, nausea, vomiting o Difficulty concentrating urine (polyuria)

o Removing or preventing underlying cause o IV replacement – 10-20 mEq/hr o Dietary – high K+ and low Na+ diet o Oral replacement o Potassium-sparing diuretic, if needed

Hypercalcemia Serum Ca > 10.1 mg/dL Ionized Ca > 5.3 mg/dL

o Nausea, vomiting, anorexia, weight loss o Abdominal pain and constipation o Hypertension o Bone pain and bone loss o Kidney stones o Muscle hypotonicity and hyporeflexia o Confusion, lethargy, depression, altered

mental status o A-V block, short QT interval o Polyuria and extreme thirst

o Manage underlying cause o Hydration – encourages diuresis o Loop diuretics o Corticosteroids o Bisphosphonates (if caused by malignancy) o Plicamycin (antineoplastic) o Decreased calcium intake o HCO3 – binds excess ionized calcium Emergent – dialysis

Hypocalcemia Serum Ca < 8.9 mg/dL Ionized Ca < 4.4 mg/dL

o Muscle cramps o Hyperreflexia, tetany o Parathesia of face, fingers and toes o Chvostek’s sign o Trousseau’s sign o Anxiety, confusion, irritability o Laryngeal stridor o Prolonged QT interval, arrhythmias o Decreased cardiac output o Fractures o Tremors, twitching

o Correct underlying imbalance o IV Calcium Gluconate – more freq given o IV Calcium Chloride o Vitamin D supplement o O o ral calcium o Correct low magnesium/reduce phosphate

Hypomagnesemia Mg < 1.5 mEq/L

o Skeletal muscle weakness o Altered LOC, CNS agitation, confusion,

depression o Seizures, vertigo o tetany, ataxia o Chvostek’s and Trousseau’s signs o tachycardia o increased BP o ventricular dysrhythmias o Vomiting o Increased/hyperactive DTR’s o EKG changes: depressed ST, prolonged QT

Ventricular dysrhythmias include: PVC’s, VF, torsades de pointes

o Emergency Situations: 1-2 g diluted in D5W and given over 1-2 minutes

o Nonemergency: 1-2 g diluted in 100-250 ml of D5W over 2 hours.

o Increase dietary intake of Mg


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Imbalance Signs/Symptoms Treatment Hypermagnesemia Mg > 2.5 mEq/L

o Decreased muscle and nerve activity o Hypoactive DTR’s (hyporeflexia) o Generalized weakness, drowsiness and

lethargy o Facial parasthesia o Flushed appearance and diaphoresis o Slow, shallow, depressed respirations o Respiratory arrest o Nausea and vomiting o Hypotension, vasodilation o Arrhythmias and bradycardia o Coma

o Oral or IV fluids (to increase urine output of excess Mg)

o In an emergency� calcium Gluconate (a Mg antagonist) – 10-20 ml of a 10% solution

o Dialysis with Mg-free dialysate (for dialysis patients)

o Mechanical ventilation for severe cases where respiratory depression present

o Avoidance of Mg containing products

Hypochloremia Cl < 98 mEq/dL

o Hyperactive DTR’s o Muscle hypertonicity and cramps o Neuromuscular irritability, tetany o Weakness o Resp. depression o Metabolic alkalosis o Hyponatremia and hypokalemia

o Increase dietary intake o Treatment of underlying cause of metabolic

alkalosis o IV saline solution with either NaCl or KCL

Hyperchloremia Cl > 108 mEq/dL

o CNS depression, lethargy, changes in cognition

o Metabolic acidosis o Decreased bicarbonate (Cl and HCO3

inversely related) o Tachypnea o Weakness o Arrhythmias, Kussmaul’s respirations,

decreased cardiac output, decreased LOC that may progress to coma (with severe metabolic acidosis)

o IV fluids to speed renal excretion of Cl o Restricted sodium and chloride intake o IV sodium bicarbonate for severe

Hyperchloremia

Hypophosphatemia Phosphorus < 1 mg/dL

o Skeletal muscle weakness o Slurred speech o Dysphagia o Cardiomyopathy o Hypotension o Decreased cardiac output o Rhabdomyolysis o Cyanosis o Anemia, ⇓ 2,3 DPG o ⇓ ATP o Respiratory muscle weakness, cyanosis

o Oral supplements o Increased dietary intake o IV phosphorus (Potassium phosphate or

sodium phosphate)

Hyperphosphatemia Phosphorus > 6 mg/dL

o Numbness, tingling, parasthesia o Hyperreflexia, tetany o Trousseau’s/Chvostek’s sign o Prolonged QT interval o Decreased mental status o Anorexia, nausea, vomiting o Arrhythmias, irregular heart rate, decreased

UOP, conjunctivitis, cataracts, impaired vision

o Muscle cramps & weakness

o Correct underlying problem o Low-phosphorus diet and drugs to decrease

absorption of phosphorus (aluminum, calcium salts, Mg, phosphate binding antacids

o IV saline solution o Proximal diuretics to promote excretion o Dialysis if necessary


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Imbalance Etiology/Cause Signs/Symptoms Hypovolemia

o Hypotonic fluid loss from extracellular

space o Bleeding (trauma, GI, etc.) o Vomiting, diarrhea o Neurogenic shock o May progress to hypovolemic shock if not

detected early and treated properly o Is caused by excessive fluid loss or third

space fluid shift

Mild Fluid Loss: -Orthostatic hypotension -Restlessness, anxiety -Weight loss -Increased heart rate

Moderate Fluid Loss: -Confusion, dizziness, irritability -Extreme thirst -Nausea -Cool, clammy skin -Rapid Pulse -Decreased urine output (10-30 ml/hr)

Severe Fluid Loss -Decreased cardiac output -Unconsciousness -Marked tachycardia -Hypotension -Weak or absent peripheral pulses -Cool, mottled skin -Decreased urine output (<10 ml/hr)

Hypervolemia

o Excess isotonic fluid in extracellular spaces o Can lead to heart failure and pulmonary

edema, especially in prolonged or severe Hypervolemia or in patients with poor heart function

o Mild to moderate/severe fluid gain equaling a 5% to 10% or >10% weight gain

o Excessive sodium or fluid intake o Fluid or sodium retention o Shift in fluid from interstitial space to

intravascular space o Acute or chronic renal failure

o Tachypnea o Dyspnea, crackles o Rapid or bounding pulse o Hypertension (unless in heart failure) o Increased CVP, PAP, and PAWP o Distended neck and hand veins o Acute weight gain o Edema o S3 gallop

Water Intoxication

o Excess fluid in the intracellular space from

the extracellular space o Causes increased intracranial pressure

(ICP) o May lead to seizures and coma o Syndrome of Inappropriate ADH (SIADH) o Rapid infusion of a hypotonic solution o Excessive use of tap water as an NG tube

irrigant or enema o Psychogenic polydipsia

o Headache and personality changes o Confusion, irritability o Lethargy, Dulled sensorium o Nausea, vomiting, cramping o Muscle weakness o Twitching o Thirst o Dyspnea on exertion o Seizures & coma o Serum Na+ < 125 mEq/L o Serum osmolality < 280 mOsm/kg


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JOB AID

1. Body fluids serve as lubricants, carriers for nutrients, transport wastes, regulate body temperature, medium for cell metabolism, and participate in chemical and metabolic processes.

2. Fluids types include hypotonic, isotonic and hypertonic

3. Thirst is the simplest mechanism for maintaining fluid balance

4. The major extracellular electrolytes: Na+, Cl-, Ca+ and HCO3-

5. The major intracellular electrolytes: K+, Mg+, Phosphate (P-)

6. Older adults are at risk for electrolyte imbalances because with age the kidneys

have fewer functioning nephrons

7. Phosphorus and calcium have an inverse relationship.

8. Bicarbonate and chloride are inversely related


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Posttest Name: _____________________________________________

Date: ______________________________________________

Acknowledgement of Module Content review (Check appropriate response): I have read the module contents: Fluids and Electrolytes

Yes □ No □ 1. The only IV fluid that can be infused with blood is NaCl: a.) True b.) False 2. The main extracellular cation is:

a.) Calcium

b.) Potassium c.) Bicarbonate

d.) Sodium

3. The recommended daily requirement of sodium for an average adult is:

a.) 2 grams

b.) 4 grams

c.) 5 grams

d.) 8 grams


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4. You have sent a blood sample to the lab for a ch emistry panel. The potassium level comes back at a critical value of 12. As you are cr itically thinking, what may be a possible cause of this elevated value? a.) The lab technician does not know how to work the machine b.) Your patient drank an extra glass of orange juice at breakfast c.) The sample you sent to the lab was hemolyzed d.) You withdrew the blood from the running IV fluid line 5. Signs and symptoms of Hyponatremia include:

a.) Change in LOC, abdominal cramps, and muscle twitching

b.) Headache, rapid breathing, and high energy level

c.) Chest pain, fever, and pericardial rub

d.) Weight loss, slow pulse, and vision changes

6. A sign of Hypervolemia is:

a.) Increased urine output

b.) Clear, watery sputum

c.) Severe hypertension

d.) A rapid, bounding pulse 7. Populations at risk for dehydration include:

a.) Infants and the elderly

b.) Adolescents

b.) Patients with SIADH d.) Young adults


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8. You are interpreting the 6-second ECG strip for your patient and notice that the T-wave appears elevated/peaked. What electrolyte imba lance should you suspect?

a.) Hyponatremia

b.) Hyperkalemia

c.) Hypocalcemia

d.) Hypermagnesemia

9. A patient with a head injury has just been admit ted to your unit for observation. The IV fluid ordered is D5W at 100 ml/hr. What is your response to this order?

a.) Administer the IV fluid as ordered

b.) Use a filter when giving this IV fluid

c.) Check the patients blood sugar before administering

d.) Question this order since this patient has been admitted with a head injury

10. Medications to help treat severe Hyperkalemia i nclude:

a.) Methylprednisolone and mannitol

b.) Mannitol and regular insulin

c.) Digoxin and diuretics

d.) 10% calcium gluconate and regular insulin

Fluids and Electrolytes - MODULE

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